Articles: opioid.
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Randomized Controlled Trial
Effects of morphine on respiratory load detection, load magnitude perception, and tactile sensation in obstructive sleep apnea.
Pharyngeal and respiratory sensation is impaired in obstructive sleep apnea (OSA). Opioids may further diminish respiratory sensation. Thus protective pharyngeal neuromuscular and arousal responses to airway occlusion that rely on respiratory sensation could be impaired with opioids to worsen OSA severity. ⋯ This suggests that altered respiratory sensation to acute mechanical stimuli is not likely to be a mechanism that contributes to worsening of OSA with a moderate dose of morphine. NEW & NOTEWORTHY Forty milligrams of MS-Contin does not alter upper airway tactile sensation, respiratory load detection thresholds, or respiratory load magnitude perception in people with obstructive sleep apnea but does decrease breathing compared with placebo during wakefulness. Despite increasing concerns of harm with opioids, the current findings suggest that impaired respiratory sensation to acute mechanical stimuli with this dose of MS-Contin is unlikely to be a direct mechanism contributing to worsening sleep apnea severity in people with mild-to-moderate disease.
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Randomized Controlled Trial
Does fentanyl or remifentanil provide better postoperative recovery after laparoscopic surgery? a randomized controlled trial.
Fentanyl and remifentanil are widely used opioids in surgery, but it has not been evaluated whether the choice of opioids during surgery affects the patients' postoperative quality of recovery. Accordingly, we aim to compare postoperative recovery of fentanyl-based anesthesia with remifentanil-based anesthesia after laparoscopic surgery using the QoR 40 questionnaire (QoR-40). ⋯ Although the global QoR is higher in the fentanyl group by 20 points compared with remifentanil group, no significant differences revealed between the groups. Further studies with large numbers of subjects of the same gender are needed.
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Randomized Controlled Trial Multicenter Study
Nonresponsiveness and Susceptibility of Opioid Side Effects Related to Cancer Patients' Clinical Characteristics: A Post-Hoc Analysis.
The response to opioids is not always positive in cancer patients. A considerable proportion of patients do not respond (nonresponders [NRs]) or experience severe toxicity. The aim of this analysis was to assess the role of demographic characteristics, pain features, comorbidities, and ongoing therapy on the lack of efficacy and on the occurrence of severe adverse drug reactions (ADRs). ⋯ Several clinical variables are correlated with opioid response in cancer patients. In particular, the presence of BTP is associated with nonresponse. Additionally, patients who receive polypharmacological therapy are more likely to experience opioid adverse events.
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Drug Alcohol Depend · Jun 2018
Randomized Controlled Trial Multicenter StudyOutpatient transition to extended-release injectable naltrexone for patients with opioid use disorder: A phase 3 randomized trial.
Injectable extended-release naltrexone (XR-NTX), approved to prevent relapse to opioid dependence, requires initial abstinence. This multisite outpatient clinical trial examined the efficacy and safety of low-dose oral naltrexone (NTX), combined with a brief buprenorphine (BUP) taper and standing ancillary medications, for detoxification and induction onto XR-NTX. ⋯ A 7-day detoxification protocol with NTX alone or NTX + BUP provided similar rates of induction to XR-NTX as placebo. For those inducted onto XR-NTX, management of opioid withdrawal symptoms prior to induction was achieved in a structured outpatient setting using a well-tolerated, fixed-dose ancillary medication regimen common to all three groups.
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J Pain Palliat Care Pharmacother · Jun 2018
Randomized Controlled TrialA Prospective, Randomized, Double-Blind, Placebo-Controlled Trial to Evaluate Intravenous Acetaminophen Versus Placebo in Patients Undergoing Robotic-Assisted Laparoscopic Prostatectomy.
Radical prostatectomy for prostate cancer is one of the most commonly performed operations in men. The objective of this study was to determine the impact of intravenous (IV) acetaminophen when added to the perioperative analgesic regimen for robotic-assisted laparoscopic prostatectomy (RALP) on hospital length of stay (LOS), postoperative pain scores, and opioid consumption. In this prospective, randomized, double-blind, placebo-controlled trial, a total of 86 patients undergoing RALP were prospectively enrolled and randomly assigned to receive either 1 g IV acetaminophen (study group; n = 43) or IV placebo (n = 43) within 15 minutes following the induction of anesthesia and prior to surgical incision. ⋯ Hospital LOS was shorter in the IV acetaminophen group compared with placebo by 32% (P = .006). Median intraoperative opioid use in the IV acetaminophen group was 42 mg morphine equivalents compared with 50 mg in placebo (P = .64) and 8 mg in both groups postoperatively (P = .16). Overall, use of perioperative IV acetaminophen decreased hospital LOS without a significant difference in PACU LOS, pain scores, or opioid use.