- Prescription opioid dispensing in Australian children and adolescents: a national population-based study. [Journal Article]Lancet Child Adolesc Health 2019LC
- CONCLUSIONS: In 2017, one in 74 Australian children, including one in 25 adolescents, were dispensed an opioid. Dispensing of weak opioids decreased between 2013 and 2017, but codeine is still commonly dispensed in younger children and education to reduce this practice is required. Dispensing of strong opioids increased in all age groups. Children and adolescents must receive appropriate pain management, but further evidence on the risks and benefits of opioid use in this young population is needed.
- Self-Extubation in Patients with Traumatic Head Injury: Determinants, Complications, and Outcomes. [Journal Article]Anesth Essays Res 2019 Jul-Sep; 13(3):589-595AE
- CONCLUSIONS: More than one-tenth of patients with traumatic head injury develop self-extubation; this group of patients is more likely to have prescribed tramadol, develop agitation, and have longer hospital length of stay and less sedation use. Further prospective studies are needed to assess the predictors of self-extubation in TICU.
- Comparative Study of Effectiveness of Tramadol and Butorphanol as Adjuvants to Levobupivacaine for Supraclavicular Brachial Plexus Block. [Journal Article]Anesth Essays Res 2019 Jul-Sep; 13(3):446-451AE
- CONCLUSIONS: Butorphanol (2 mg) as an adjuvant to levobupivacaine in supraclavicular block hastens the onset and prolongs the duration of the block as well as postoperative analgesia to a greater extent as compared to the addition of 100 mg tramadol.
- Opioids as substrates and inhibitors of the genetically highly variable organic cation transporter OCT1. [Journal Article]J Med Chem 2019JM
- Genetic variants in the hepatic uptake transporter OCT1, observed in 9% of Europeans and White Americans, are known to affect pharmacokinetics and efficacy of tramadol, morphine, and codeine. Here, we report further opioids to be substrates and inhibitors of OCT1. Methylnaltrexone, hydromorphone, oxymorphone, and meptazinol were identified as OCT1 substrates. Methylnaltrexone is the strongest OCT…
Genetic variants in the hepatic uptake transporter OCT1, observed in 9% of Europeans and White Americans, are known to affect pharmacokinetics and efficacy of tramadol, morphine, and codeine. Here, we report further opioids to be substrates and inhibitors of OCT1. Methylnaltrexone, hydromorphone, oxymorphone, and meptazinol were identified as OCT1 substrates. Methylnaltrexone is the strongest OCT1 substrate currently reported. It showed 86-fold higher accumulation in OCT1-overexpressing cells compared to control cells. We observed substantial differences in the inhibitory potency among structurally highly similar morphinan opioids (IC50 ranged from 6.4 µM for dextrorphan to 2 mM for oxycodone). The ether linkage of C4-C5 in the morphinan ring leads to strong reduction of inhibitory potency. In conclusion, although polyspecific, OCT1 possesses a strong selectivity for its ligands. In contrast to methylnaltrexone and hydromorphone, oxycodone and hydrocodone do not interact with OCT1 and may be safer for use in individuals with genetic OCT1 deficiency.
- Preventing Excess Narcotic Prescriptions in New Robotic Surgery Discharges: The PENN Prospective Cohort Quality Improvement Initiative. [Journal Article]J Endourol 2019JE
- CONCLUSIONS: The majority of robotic surgery patients do not require opioids upon discharge. Implementation of a simple, standardized, non-opioid protocol resulted in a dramatic reduction in the amount of opioids prescribed in our patient population. An escalation protocol allows for a patient centered approach to reduce narcotic prescribing while still addressing surgical pain.
- Antinociceptive effects of Salvia divinorum and bioactive salvinorins in experimental pain models in mice. [Journal Article]J Ethnopharmacol 2019; :112276JE
- CONCLUSIONS: Data provide evidence of the potential of this species, where salvinorin A is in part responsible bioactive constituent involving participation of the opioids and/or 5-HT1A serotonin receptors depending on the kind of pain model explored.
- Social, demographic, and economic correlates of food and chemical consumption measured by wastewater-based epidemiology. [Journal Article]Proc Natl Acad Sci U S A 2019PN
- Wastewater is a potential treasure trove of chemicals that reflects population behavior and health status. Wastewater-based epidemiology has been employed to determine population-scale consumption of chemicals, particularly illicit drugs, across different communities and over time. However, the sociodemographic or socioeconomic correlates of chemical consumption and exposure are unclear. This stu…
Wastewater is a potential treasure trove of chemicals that reflects population behavior and health status. Wastewater-based epidemiology has been employed to determine population-scale consumption of chemicals, particularly illicit drugs, across different communities and over time. However, the sociodemographic or socioeconomic correlates of chemical consumption and exposure are unclear. This study explores the relationships between catchment specific sociodemographic parameters and biomarkers in wastewater generated by the respective catchments. Domestic wastewater influent samples taken during the 2016 Australian census week were analyzed for a range of diet, drug, pharmaceutical, and lifestyle biomarkers. We present both linear and rank-order (i.e., Pearson and Spearman) correlations between loads of 42 biomarkers and census-derived metrics, index of relative socioeconomic advantage and disadvantage (IRSAD), median age, and 40 socioeconomic index for area (SEIFA) descriptors. Biomarkers of caffeine, citrus, and dietary fiber consumption had strong positive correlations with IRSAD, while tramadol, atenolol, and pregabalin had strong negative correlation with IRSAD. As expected, atenolol and hydrochlorothiazide correlated positively with median age. We also found specific SEIFA descriptors such as occupation and educational attainment correlating with each biomarker. Our study demonstrates that wastewater-based epidemiology can be used to study sociodemographic influences and disparities in chemical consumption.
- Tramadol use is associated with enhanced postoperative outcomes in breast cancer patients: a retrospective clinical study with in vitro confirmation. [Journal Article]Br J Anaesth 2019BJ
- CONCLUSIONS: After breast cancer surgery, patients who received tramadol had a decreased risk of postoperative recurrence and mortality. The anti-tumour effect of tramadol appears to involve inhibition of proliferation, induction of apoptosis, and effects on 5-HT2B receptor and TRPV-1.
- A rare complication of knee hematoma after genicular nerve radiofrequency ablation. [Case Reports]Pain Rep 2019 May-Jun; 4(3):e736PR
- CONCLUSIONS: This is the first report describing iatrogenic vascular injury in the knee after a genicular RFA procedure. Pain medicine physicians should be aware of the vascular anatomy of the knee, particularly paying close attention to variations after previous surgeries. Future trials should investigate modalities that minimize vascular complications including concomitant use of ultrasonography with fluoroscopy and other forms of RFA including pulsed or cooled RFA.
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- Associations Between Opioid Prescribing Patterns and Overdose Among Privately Insured Adolescents. [Journal Article]Pediatrics 2019Ped
- CONCLUSIONS: One of 1600 (0.06%) previously opioid-naive adolescents who received a prescription for opioids experienced an opioid overdose a median of 1.75 years later that resulted in medical care. Preexisting mental health conditions, use of tramadol, and higher number of dispensed tablets (>30 vs <18) were associated with an increased risk of opioid overdose.