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Qian P, Zheng X, Wei H, Ji K. Efficacy of Serratus Anterior Plane Block Versus Paravertebral and Intercostal Blocks for Pain Control After Surgery:: A Systematic Review and Meta-analysis. Clin J Pain 2024; 40:124-134. [PMID: 37982705 DOI: 10.1097/ajp.0000000000001175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/23/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Our study aimed to compare the analgesic efficacy of serratus anterior plane block (SAB) with the paravertebral block (PVB) and intercostal block (ICB) for patients undergoing surgical procedures. MATERIALS AND METHODS A literature search was performed on the databases of ScienceDirect, Google Scholar, PubMed, and Embase from inception to October 24, 2021. Only randomized controlled trials comparing SAB with either PVB or ICB and reporting pain outcomes were included. RESULTS A total of 16 randomized controlled trials were included. Thirteen compared SAB with PVB and 3 with ICB. Comparing SAB with PVB, we noted no difference in 24-hour morphine consumption between the groups (mean difference: 1.37; 95% CI: -0.33, 3.08; I2 = 96%; P = 0.11). However, the exclusion of 1 study indicated significantly increased analgesic consumption with the SAB. No difference was found in pain scores between SAB and PVB at 2, 4, 6, 8, 12, and 24 hours. Meta-analysis failed to demonstrate any statistically significant difference in time to the first analgesic request between the two groups (mean difference: -0.79; 95% CI: -0.17, 1.75; I2 = 94%; P = 0.11). We also noted no statistically significant difference in the incidence of nausea/vomiting with SAB or PVB (odds ratio: 0.79; 95% CI: 0.41, 1.51; I2 = 0%; P = 0.47). CONCLUSIONS Evidence on the analgesic efficacy of the SAB versus the PVB is conflicting. Twenty-four-hour total analgesic consumption may be higher with the SAB as compared with PVB but with no difference in pain scores and time to the first analgesic request. Data on the comparison of the SAB with the ICB is insufficient to draw strong conclusions.
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Affiliation(s)
- Ping Qian
- Department of Anesthesiology, Shengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Zhejiang, China
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Daoust R, Paquet J, Marquis M, Williamson D, Fontaine G, Chauny JM, Frégeau A, Orkin AM, Upadhye S, Lessard J, Cournoyer A. Efficacy of prescribed opioids for acute pain after being discharged from the emergency department: A systematic review and meta-analysis. Acad Emerg Med 2023; 30:1253-1263. [PMID: 37607265 DOI: 10.1111/acem.14790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/21/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Opioids are often prescribed for acute pain to patients discharged from the emergency department (ED), but there is a paucity of data on their short-term use. The purpose of this study was to synthesize the evidence regarding the efficacy of prescribed opioids compared to nonopioid analgesics for acute pain relief in ED-discharged patients. METHODS MEDLINE, EMBASE, CINAHL, PsycINFO, CENTRAL, and gray literature databases were searched from inception to January 2023. Two independent reviewers selected randomized controlled trials investigating the efficacy of prescribed opioids for ED-discharged patients, extracted data, and assessed risk of bias. Authors were contacted for missing data and to identify additional studies. The primary outcome was the difference in pain intensity scores or pain relief. All meta-analyses used a random-effect model and a sensitivity analysis compared patients treated with codeine versus those treated with other opioids. RESULTS From 5419 initially screened citations, 46 full texts were evaluated and six studies enrolling 1161 patients were included. Risk of bias was low for five studies. There was no statistically significant difference in pain intensity scores or pain relief between opioids versus nonopioid analgesics (standardized mean difference [SMD] 0.12; 95% confidence interval [CI] -0.10 to 0.34). Contrary to children, adult patients treated with opioid had better pain relief (SMD 0.28, 95% CI 0.13-0.42) compared to nonopioids. In another sensitivity analysis excluding studies using codeine, opioids were more effective than nonopioids (SMD 0.30, 95% CI 0.15-0.45). However, there were more adverse events associated with opioids (odds ratio 2.64, 95% CI 2.04-3.42). CONCLUSIONS For ED-discharged patients with acute musculoskeletal pain, opioids do not seem to be more effective than nonopioid analgesics. However, this absence of efficacy seems to be driven by codeine, as opioids other than codeine are more effective than nonopioids (mostly NSAIDs). Further prospective studies on the efficacy of short-term opioid use after ED discharge (excluding codeine), measuring patient-centered outcomes, adverse events, and potential misuse, are needed.
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Affiliation(s)
- Raoul Daoust
- Study Center in Emergency Medicine, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), Montréal, Québec, Canada
- Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherce, Hôpital du Sacré-Cœur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, Québec, Canada
| | - Jean Paquet
- Study Center in Emergency Medicine, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), Montréal, Québec, Canada
| | - Martin Marquis
- Study Center in Emergency Medicine, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), Montréal, Québec, Canada
| | - David Williamson
- Centre de Recherce, Hôpital du Sacré-Cœur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, Québec, Canada
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec, Canada
| | - Guillaume Fontaine
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jean-Marc Chauny
- Study Center in Emergency Medicine, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), Montréal, Québec, Canada
- Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherce, Hôpital du Sacré-Cœur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, Québec, Canada
| | - Amélie Frégeau
- Study Center in Emergency Medicine, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), Montréal, Québec, Canada
- Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Aaron M Orkin
- Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, St. Joseph's Health Centre, Unity Health, Toronto, Ontario, Canada
| | - Suneel Upadhye
- McMaster University, Division of Emergency Medicine, Hamilton, Ontario, Canada
| | - Justine Lessard
- Study Center in Emergency Medicine, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), Montréal, Québec, Canada
- Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherce, Hôpital du Sacré-Cœur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, Québec, Canada
| | - Alexis Cournoyer
- Study Center in Emergency Medicine, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), Montréal, Québec, Canada
- Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherce, Hôpital du Sacré-Cœur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, Québec, Canada
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Horn ME, Simon CB, Lee HJ, Eucker SA. Associations Between Management Pathway and Opioid Prescriptions for Patients Entering the Emergency Department With Neck and Back Pain. Mayo Clin Proc Innov Qual Outcomes 2023; 7:490-498. [PMID: 37842687 PMCID: PMC10568062 DOI: 10.1016/j.mayocpiqo.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Objective To determine associations between post-emergency department (ED) management pathways and downstream opioid prescriptions in patients seeking care for incident neck and/or back pain. Patients and Methods We identified patients seeking first-time ED care for neck and/or back pain from January 1, 2013, through November 6, 2017. We reported demographic characteristics and opioid prescriptions across management pathways using descriptive statistics and assessed the relative risk of any opioid prescription 12 months post-ED visit among 5 different post-ED management pathways using Poisson regression adjusted for patient demographic characteristics. Results Within 12 months after the index ED visit, 58.0% (n=10,949) were prescribed an opioid, with most patients prescribed an opioid within the first week (average daily morphine milligram equivalents of 6.8 mg (SD 9.6 mg). The morphine milligram equivalents decreased to 0.7 mg (SD 8.2 mg) by week 4 and remained consistently less than 1 mg between week 4 and 12 months. Compared with the ED to primary care provider pathway, the relative risk of opioid prescription between 7 days and 12 months after the index ED visit was similar for the ED to physical therapy pathway, higher for both the ED to hospital admission or repeat ED visit pathway (30% increase; relative risk (RR), 1.3; 95% CI, 1.17-1.44) and the ED to specialist pathway (19% increase; RR, 1.19; 95% CI, 1.07-1.33), and lower in the ED with no follow-up visits pathway (41% decrease; RR, 0.59; 95% CI, 0.54-0.65). Conclusion In general, more conservative care was associated with lower opioid prescription rates, and escalated care was associated with higher opioid prescription rates.
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Affiliation(s)
- Maggie E. Horn
- Department of Orthopaedic Surgery, Division of Physical Therapy, Duke University, Durham, NC
- Department of Population Health Sciences, Duke University, Durham, NC
| | - Corey B. Simon
- Department of Orthopaedic Surgery, Division of Physical Therapy, Duke University, Durham, NC
| | - Hui-Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
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Use of Benzodiazepines and Z-Drugs in Inflammatory Bowel Disease. Am J Gastroenterol 2022; 117:2046-2054. [PMID: 36288107 DOI: 10.14309/ajg.0000000000001955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/29/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION We estimated the incidence and prevalence of benzodiazepine and Z-drug (separately and jointly as BZD) use in the inflammatory bowel disease (IBD) population compared with matched controls without IBD and examined the association of mood/anxiety disorders (M/ADs) with the use of BZD from 1997 to 2017. METHODS Using administrative data from Manitoba, Canada, we identified 5,741 persons with incident IBD who were matched in a 1:5 ratio to controls on sex, birth year, and region. Validated case definitions were used to identify M/AD. Dispensations of BZD were identified. Multivariable generalized linear models were used to assess the association between IBD, M/AD, and BZD use. RESULTS In 2016, the incident age/sex-standardized benzodiazepine use rates per 1,000 were 28.06 (95% confidence interval [CI] 26.41-29.81) in the IBD cohort and 16.83 (95% CI 16.28-17.39) in controls (adjusted rate ratio = 1.69 [95% CI 1.56-1.79]). Benzodiazepine incidence rates were higher for women with IBD than men, but the RR between cases and controls were similar for men and women. The incident age/sex-standardized Z-drug use rate per 1,000 was 21.07 (95% CI 19.69-22.41) in the IBD cohort. This was 1.87-fold higher than in controls (95% CI 1.73-2.01). In 2017, approximately 20% of persons with IBD used benzodiazepines and 20% used Z-drugs. There was a subadditive effect of both benzodiazepine and Z-drug uses between IBD and M/AD after adjusting for covariates. DISCUSSION The use of BZD is more common in people with IBD than in population controls. Strategies to reduce the use of BZDs in persons with IBD and to offer alternative management strategies for M/ADs, sleep disorders, and other symptomatic concerns are needed.
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Wentz A, Wang R, Marshall B, Shireman T, Liu T, Merchant R. Opioid Analgesic Use After an Acute Pain Visit: Evidence from a Urolithiasis Patient Cohort. West J Emerg Med 2022; 23:864-871. [DOI: 10.5811/westjem.2022.8.56679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/13/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: Urolithiasis causes severe acute pain and is commonly treated with opioid analgesics in the emergency department (ED). We examined opioid analgesic use after episodes of acute pain.
Methods: Using data from a longitudinal trial of ED patients with urolithiasis, we constructed multivariable models to estimate the adjusted probability of opioid analgesic use 3, 7, 30, and 90 days after ED discharge. We used multiple imputation to account for missing data and weighting to account for the propensity to be prescribed an opioid analgesic at ED discharge. We used weighted multivariable regression to compare longitudinal opioid analgesic use for those prescribed vs not prescribed an opioid analgesic at discharge, stratified by reported pain at ED discharge.
Results: Among 892 adult ED patients with urolithiasis, 79% were prescribed an opioid analgesic at ED discharge. Regardless of reporting pain at ED discharge, those who were prescribed an opioid analgesic were significantly more likely to report using it one, three, and seven days after the visit in weighted multivariable analysis. Among those who were not prescribed an opioid analgesic, an estimated 21% (not reporting pain at ED discharge) and 30% (reporting pain at discharge) reported opioid analgesic use at day three. Among those prescribed an opioid analgesic, 49% (no pain at discharge) and 52% (with pain at discharge) reported using an opioid analgesic at day three.
Conclusion: Urolithiasis patients who received an opioid analgesic at ED discharge were more likely to continue using an opioid analgesic than those who did not receive a prescription at the initial visit, despite the time-limited nature of urolithiasis.
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Affiliation(s)
- Anna Wentz
- Brown University School of Public Health, Department of Epidemiology, Providence, Rhode Island
| | - Ralph Wang
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Brandon Marshall
- Brown University School of Public Health, Department of Epidemiology, Providence, Rhode Island
| | - Theresa Shireman
- Brown University School of Public Health, Health Services Policy & Practice, Providence, Rhode Island
| | - Tao Liu
- Brown University School of Public Health, Data & Statistics Core of Brown Alcohol Research Center on HIV (ARCH), Providence, Rhode Island
| | - Roland Merchant
- Harvard Medical School, Brigham and Women’s Hospital Department of Emergency Medicine, Boston, Massachusetts
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Dyson MP, Dong K, Sevcik W, Graham SZ, Saba S, Hartling L, Ali S. Quantifying unused opioids following emergency and ambulatory care: A systematic review and meta‐analysis. J Am Coll Emerg Physicians Open 2022; 3:e12822. [PMID: 36203538 PMCID: PMC9523453 DOI: 10.1002/emp2.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/24/2022] [Accepted: 08/31/2022] [Indexed: 11/08/2022] Open
Abstract
Objective To quantify unused opioids among adult and pediatric patients discharged from the emergency department (ED) or ambulatory care settings with a prescription for acute pain. Methods We searched MEDLINE, Embase, CINHAL, PsycINFO, the Cochrane Library, and the gray literature from inception to April 29, 2021. We included observational studies in which any patient with an acutely painful condition received a prescription for an opioid on discharge from an outpatient care setting, and unused opioids were quantified. Two reviewers screened records for eligibility, extracted data, and conducted the quality assessment. Where possible, we pooled data and otherwise described the results of studies narratively. Total unused prescriptions were synthesized using a weighted average. Random effects models were used, and heterogeneity was measured by the I2 statistic. Our primary outcome was the quantity of unused opioid medication available after receiving a prescription for acute pain. Secondary outcomes were the proportion of patients with unused opioids following a prescription, the proportion of patients using no opioids, morphine equivalents of unused opioids, and factors associated with leftover opioids. Results In this systematic review and meta‐analysis of 9 studies in emergency and ambulatory care settings, 59.6% of prescribed opioids remained unused; pediatric patients had 69.3% of their prescriptions remaining, compared to 54.6% among adult patients. The highest proportion of unused opioids was found following dental extractions (82.6%). Conclusions and Relevance More than 50% of opioids remain unused following prescriptions for acute pain. Responsible prescribing must be accompanied by education on safer use, storage, and disposal.
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Affiliation(s)
- Michele P. Dyson
- Department of Pediatrics University of Alberta Edmonton Alberta Canada
| | - Kathryn Dong
- Department of Emergency Medicine University of Alberta Edmonton Alberta Canada
- Inner City Health and Wellness Program Royal Alexandra Hospital Edmonton Alberta Canada
| | - William Sevcik
- Department of Pediatrics University of Alberta Edmonton Alberta Canada
- Department of Emergency Medicine University of Alberta Edmonton Alberta Canada
| | - Samir Z. Graham
- Department of Pediatrics University of Alberta Edmonton Alberta Canada
| | - Sabrina Saba
- Department of Pediatrics University of Alberta Edmonton Alberta Canada
| | - Lisa Hartling
- Department of Pediatrics University of Alberta Edmonton Alberta Canada
| | - Samina Ali
- Department of Pediatrics University of Alberta Edmonton Alberta Canada
- Department of Emergency Medicine University of Alberta Edmonton Alberta Canada
- Women and Children's Health Research Institute University of Alberta Edmonton Alberta Canada
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Lurie T, Bonnin N, Rea J, Tuteja G, Dezman Z, Wilkerson RG, Buganu A, Chasm R, Haase DJ, Tran QK. Patterns of opioid prescribing in emergency departments during the early phase of the COVID-19 pandemic. Am J Emerg Med 2022; 56:63-70. [PMID: 35367681 PMCID: PMC8956353 DOI: 10.1016/j.ajem.2022.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/09/2022] [Accepted: 03/20/2022] [Indexed: 02/06/2023] Open
Abstract
Introduction The COVID-19 pandemic was superimposed upon an ongoing epidemic of opioid use disorder and overdose deaths. Although the trend of opioid prescription patterns (OPP) had decreased in response to public health efforts before the pandemic, little is known about the OPP from emergency department (ED) clinicians during the COVID-19 pandemic. Methods We conducted a pre-post study of adult patients who were discharged from 13 EDs and one urgent care within our academic medical system between 01/01/2019 and 09/30/2020 using an interrupted time series (ITS) approach. Patient characteristics and prescription data were extracted from the single unified electronic medical record across all study sites. Prescriptions of opioids were converted into morphine equivalent dose (MED). We compared the “Covid-19 Pandemic” period (C19, 03/29/2020–9/30/2020) and the “Pre-Pandemic” period (PP, 1/19/2020–03/28/2020). We used a multivariate logistic regression to assess clinical factors associated with opioid prescriptions. Results We analyzed 361,794 ED visits by adult patients, including 259,242 (72%) PP and 102,552 (28%) C19 visits. Demographic information and percentages of patients receiving opioid prescriptions were similar in both groups. The median [IQR] MED per prescription was higher for C19 patients (70 [56–90]) than for PP patients (60 [60–90], P < 0.001). ITS demonstrated a significant trend toward higher MED prescription per ED visit during the pandemic (coefficient 0.11, 95% CI 0.05–0.16, P = 0.002). A few factors, that were associated with lower likelihood of opioid prescriptions before the pandemic, became non-significant during the pandemic. Conclusion Our study demonstrated that emergency clinicians increased the prescribed amount of opioids per prescription during the COVID-19 pandemic compared to the pre-pandemic period. Etiologies for this finding could include lack of access to primary care and other specialties during the pandemic, or lower volumes allowing for emergency clinicians to identify who is safe to be prescribed opioids.
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Abstract
This paper is the forty-third consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2020 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY, 11367, United States.
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Zhong J, Hu J, Mao L, Ye G, Qiu K, Zhao Y, Hu S. Efficacy of Intravenous Lidocaine for Pain Relief in the Emergency Department: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 8:706844. [PMID: 35111766 PMCID: PMC8801430 DOI: 10.3389/fmed.2021.706844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo compare the efficacy of intravenous (IV) lidocaine with standard analgesics (NSAIDS, opioids) for pain control due to any cause in the emergency department.MethodsThe electronic databases of PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar were explored from 1st January 2000 to 30th March 2021 and randomized controlled trials (RCTs) comparing IV lidocaine with a control group of standard analgesics were included.ResultsTwelve RCTs including 1,351 patients were included. The cause of pain included abdominal pain, renal or biliary colic, traumatic pain, radicular low back pain, critical limb ischemia, migraine, tension-type headache, and pain of unknown origin. On pooled analysis, we found no statistically significant difference in pain scores between IV lidocaine and control group at 15 min (MD: −0.24 95% CI: −1.08, 0.61 I2 = 81% p = 0.59), 30 min (MD: −0.24 95% CI: −1.03, 0.55 I2 = 86% p = 0.55), 45 min (MD: 0.31 95% CI: −0.66, 1.29 I2 = 66% p = 0.53), and 60 min (MD: 0.59 95% CI: −0.26, 1.44 I2 = 75% p = 0.18). There was no statistically significant difference in the need for rescue analgesics between the two groups (OR: 1.45 95% CI: 0.82, 2.56 I2 = 41% p = 0.20), but on subgroup analysis, the need for rescue analgesics was significantly higher with IV lidocaine in studies on abdominal pain but not for musculoskeletal pain. On meta-analysis, there was no statistically significant difference in the incidence of side-effects between the two study groups (OR: 1.09 95% CI: 0.59, 2.02 I2 = 48% p = 0.78).ConclusionIV lidocaine can be considered as an alternative analgesic for pain control in the ED. However, its efficacy may not be higher than standard analgesics. Further RCTs with a large sample size are needed to corroborate the current conclusions.
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Affiliation(s)
- Junfeng Zhong
- Department of Pain Medicine, Shaoxing People's Hospital, Shaoxing, China
| | - Junfeng Hu
- Department of Pain Medicine, Shaoxing People's Hospital, Shaoxing, China
| | - Linling Mao
- Department of Pain Medicine, Shaoxing People's Hospital, Shaoxing, China
| | - Gang Ye
- Department of Pain Medicine, Shaoxing People's Hospital, Shaoxing, China
| | - Kai Qiu
- Department of Pain Medicine, Shaoxing People's Hospital, Shaoxing, China
| | - Yuhong Zhao
- Department of Pain Medicine, Shaoxing People's Hospital, Shaoxing, China
| | - Shuangyan Hu
- Department of Anesthesiology, Shaoxing Peoples's Hospital, Shaoxing, China
- *Correspondence: Shuangyan Hu
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Daoust R, Paquet J, Marquis M, Chauny JM, Williamson D, Huard V, Arbour C, Émond M, Cournoyer A. Evaluation of Interventions to Reduce Opioid Prescribing for Patients Discharged From the Emergency Department: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2143425. [PMID: 35024834 PMCID: PMC8759006 DOI: 10.1001/jamanetworkopen.2021.43425] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/09/2021] [Indexed: 12/29/2022] Open
Abstract
Importance Limiting opioid overprescribing in the emergency department (ED) may be associated with decreases in diversion and misuse. Objective To review and analyze interventions designed to reduce the rate of opioid prescriptions or the quantity prescribed for pain in adults discharged from the ED. Data Sources MEDLINE, Embase, CINAHL, PsycINFO, and Cochrane Controlled Register of Trials databases and the gray literature were searched from inception to May 15, 2020, with an updated search performed March 6, 2021. Study Selection Intervention studies aimed at reducing opioid prescribing at ED discharge were first screened using titles and abstracts. The full text of the remaining citations was then evaluated against inclusion and exclusion criteria by 2 independent reviewers. Data Extraction and Synthesis Data were extracted independently by 2 reviewers who also assessed the risk of bias. Authors were contacted for missing data. The main meta-analysis was accompanied by intervention category subgroup analyses. All meta-analyses used random-effects models, and heterogeneity was quantified using I2 values. Main Outcomes and Measures The primary outcome was the variation in opioid prescription rate and/or prescribed quantity associated with the interventions. Effect sizes were computed separately for interrupted time series (ITS) studies. Results Sixty-three unique studies were included in the review, and 45 studies had sufficient data to be included in the meta-analysis. A statistically significant reduction in the opioid prescription rate was observed for both ITS (6-month step change, -22.61%; 95% CI, -30.70% to -14.52%) and other (odds ratio, 0.56; 95% CI, 0.45-0.70) study designs. No statistically significant reduction in prescribed opioid quantities was observed for ITS studies (6-month step change, -8.64%; 95% CI, -17.48% to 0.20%), but a small, statistically significant reduction was observed for other study designs (standardized mean difference, -0.30; 95% CI, -0.51 to -0.09). For ITS studies, education, policies, and guideline interventions (6-month step change, -33.31%; 95% CI, -39.67% to -26.94%) were better at reducing the opioid prescription rate compared with prescription drug monitoring programs and laws (6-month step change, -11.18%; 95% CI, -22.34% to -0.03%). Most intervention categories did not reduce prescribed opioid quantities. Insufficient data were available on patient-centered outcomes such as pain relief or patients' satisfaction. Conclusions and Relevance This systematic review and meta-analysis found that most interventions reduced the opioid prescription rate but not the prescribed opioid quantity for ED-discharged patients. More studies on patient-centered outcomes and using novel approaches to reduce the opioid quantity per prescription are needed. Trial Registration PROSPERO Identifier: CRD42020187251.
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Affiliation(s)
- Raoul Daoust
- Study Center in Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Le Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Nord-de-l’Île de-Montréal, Montréal, Québec, Canada
- Département de Médecine Familiale et de Médecine d’Urgence, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche de l’Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord de-l’Île-de-Montréal, Montréal, Québec, Canada
| | - Jean Paquet
- Study Center in Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Le Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Nord-de-l’Île de-Montréal, Montréal, Québec, Canada
| | - Martin Marquis
- Study Center in Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Le Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Nord-de-l’Île de-Montréal, Montréal, Québec, Canada
| | - Jean-Marc Chauny
- Study Center in Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Le Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Nord-de-l’Île de-Montréal, Montréal, Québec, Canada
- Département de Médecine Familiale et de Médecine d’Urgence, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche de l’Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord de-l’Île-de-Montréal, Montréal, Québec, Canada
| | - David Williamson
- Centre de Recherche de l’Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord de-l’Île-de-Montréal, Montréal, Québec, Canada
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec, Canada
| | - Vérilibe Huard
- Study Center in Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Le Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Nord-de-l’Île de-Montréal, Montréal, Québec, Canada
- Département de Médecine Familiale et de Médecine d’Urgence, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Caroline Arbour
- Centre de Recherche de l’Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord de-l’Île-de-Montréal, Montréal, Québec, Canada
- Faculté des Sciences Infirmières, Université de Montréal, Montréal, Québec, Canada
| | - Marcel Émond
- Département de Médecine Familiale et de Médecine d’Urgence, Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - Alexis Cournoyer
- Study Center in Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Le Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Nord-de-l’Île de-Montréal, Montréal, Québec, Canada
- Département de Médecine Familiale et de Médecine d’Urgence, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche de l’Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord de-l’Île-de-Montréal, Montréal, Québec, Canada
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11
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Esechie A, Kuo YF, Goodwin JS, Westra J, Raji MA. Trends in prescribing pattern of opioid and benzodiazepine substitutes among Medicare part D beneficiaries from 2013 to 2018: a retrospective study. BMJ Open 2021; 11:e053487. [PMID: 34794996 PMCID: PMC8603279 DOI: 10.1136/bmjopen-2021-053487] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Opioid and benzodiazepine co-prescribing is associated with a substantial increase in opioid overdose deaths. In this study, we examine the prescribing trends of substitutes of opioids and benzodiazepines alone or in combination, compared with opioids and benzodiazepines. DESIGN Retrospective cohort study. SETTING Data were collected using a 20% national sample of Medicare beneficiaries from 2013 to 2018. PARTICIPANTS 4.1-4.3 million enrollees each year from 2013 to 2018. INTERVENTION None. PRIMARY OUTCOME We employ a generalised linear mixed models to calculate ORs for opioid use, benzodiazepine or Z-drug (benzos/Z-drugs) use, opioid/benzos/Z-drugs 30-day use, gabapentinoid use and (selective serotonin reuptake inhibitors (SSRI) and serotonin norepinephrine reuptake inhibitors (SNRIs)) use, adjusted for the repeated measure of patient. We then created two models to calculate the ORs for each year and comparing to 2013. RESULTS Opioid and benzos/Z-drugs use decreased by 2018 (aOR 0.626; 95% CI 0.622 to 0.630) comparing to 2013. We demonstrate a 36.3% and 9.9% increase rate of gabapentinoid and SSRI/SNRI use, respectively. Furthermore, combined gabapentinoid and SSRI/SNRI use increased in 2018 (aOR 1.422; 95% CI 1.412 to 1.431). CONCLUSION Little is known about the prescribing pattern and trend of opioid and benzodiazepine alternatives as analgesics. There is a modest shift from prescribing opioid and benzos/Z-drugs (alone or in combination) towards prescribing non-opioid analgesics-gabapentinoids with and without non-benzos/Z-drugs that are indicated for anxiety. It is unclear if this trend towards opioid/benzos/Z-drugs alternatives is associated with fewer drug overdose death, better control of pain and comorbid anxiety, and improved quality of life.
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Affiliation(s)
- Aimalohi Esechie
- Neurology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Yong-Fang Kuo
- Division of Geriatrics and Palliative Medicine & Sealy Center on Aging, Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
| | - James S Goodwin
- Division of Geriatrics and Palliative Medicine & Sealy Center on Aging, Department of Internal Medicine, Department of Preventive Medicine and Population Health, Institute for Translational Science, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Jordan Westra
- Office of Biostatistics, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Mukaila A Raji
- Department of Neurology, Division of Geriatrics and Palliative Medicine & Sealy Center on Aging, Department of Internal Medicine, Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, Texas, USA
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12
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Opioid Analgesics and Persistent Pain After an Acute Pain Emergency Department Visit: Evidence from a Cohort of Suspected Urolithiasis Patients. J Emerg Med 2021; 61:637-648. [PMID: 34690022 DOI: 10.1016/j.jemermed.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/19/2021] [Accepted: 09/11/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Severe acute pain is still commonly treated with opioid analgesics in the United States, but this practice could prolong the duration of pain. OBJECTIVES Estimate the risk of experiencing persistent pain after opioid analgesic use after emergency department (ED) discharge among patients with suspected urolithiasis. METHODS We analyzed data collected for a longitudinal, multicenter clinical trial of ED patients with suspected urolithiasis. We constructed multilevel models to estimate the odds ratios (ORs) of reporting pain at 3, 7, 30, or 90 days after ED discharge, using multiple imputation to account for missing outcome data. We controlled for clinical, demographic, and institutional factors and used weighting to account for the propensity to be prescribed an opioid analgesic at ED discharge. RESULTS Among 2413 adult ED patients with suspected urolithiasis, 62% reported persistent pain 3 days after discharge. Participants prescribed an opioid analgesic at discharge were OR 2.51 (95% confidence interval [CI] 1.82-3.46) more likely to report persistent pain than those without a prescription. Those who reported using opioid analgesics 3 days after discharge were OR 2.24 (95% CI 1.77-2.84) more likely to report pain at day 7 than those not using opioid analgesics at day 3, and those using opioid analgesics at day 30 had OR 3.25 (95% CI 1.96-5.40) greater odds of pain at day 90. CONCLUSIONS Opioid analgesic prescription doubled the odds of persistent pain among ED patients with suspected urolithiasis. Limiting opioid analgesic prescribing at ED discharge for these patients might prevent persistent pain in addition to limiting access to these medications.
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13
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Tucker J, Salas J, Zhang Z, Grucza R, Scherrer JF. Provider specialty and odds of a new codeine, hydrocodone, oxycodone and tramadol prescription before and after the CDC opioid prescribing guideline publication. Prev Med 2021; 146:106466. [PMID: 33636196 DOI: 10.1016/j.ypmed.2021.106466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/15/2021] [Accepted: 02/20/2021] [Indexed: 11/19/2022]
Abstract
The CDC Guideline for Prescribing Opioids for Chronic Pain cautioned against high dose prescribing but did not provide guidance on type of opioid for new pain episodes. We determined if new prescriptions for Schedule II opioids vs. tramadol decreased in the 18 months after vs. before the CDC guideline and if this decrease was associated with physician specialty. New opioid prescriptions, provider type and covariates were measured using a nationally distributed, Optum® de-identified Electronic Health Record (EHR) data base. Eligible patients were free of cancer and HIV and started a new prescription for Schedule II opioids (i.e. codeine, hydrocodone, oxycodone) or Schedule IV (tramadol) in the 18 months before (n = 141,219) or 18 months after (n = 138,216) guideline publication. Fully adjusted multilevel multinomial models estimated the association between provider type (anesthesiology/pain medicine, surgical specialty, emergency, hospital, primary care, other specialty and unknown) before and after adjusting for covariates. New oxycodone prescriptions were most common among surgical and anesthesia/pain management, and new tramadol prescriptions were most common in primary care. The greatest decreases in odds of a Schedule II opioid vs. tramadol were observed in emergency care (oxycodone vs. tramadol OR = 0.82; 95%CI:0.76-0.88) and primary care (hydrocodone vs. tramadol OR = 0.85; 95%CI:0.81-0.89). Surgical specialists were least likely to start opioid therapy with tramadol. In the 18 months after vs. before the CDC guideline, emergency care and primary care providers increased tramadol prescribing. Guidelines tailored to specialists that frequently begin opioid therapy with oxycodone may enhance safe opioid prescribing.
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Affiliation(s)
- Jane Tucker
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO 63104, United States of America
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO 63104, United States of America; AHEAD Institute, Saint Louis University School of Medicine, Salus Center, 4th Floor, 3545, Lafayette Ave., St. Louis, MO 63104, United States of America
| | - Zidong Zhang
- AHEAD Institute, Saint Louis University School of Medicine, Salus Center, 4th Floor, 3545, Lafayette Ave., St. Louis, MO 63104, United States of America
| | - Richard Grucza
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO 63104, United States of America; AHEAD Institute, Saint Louis University School of Medicine, Salus Center, 4th Floor, 3545, Lafayette Ave., St. Louis, MO 63104, United States of America
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO 63104, United States of America; AHEAD Institute, Saint Louis University School of Medicine, Salus Center, 4th Floor, 3545, Lafayette Ave., St. Louis, MO 63104, United States of America.
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14
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Wakaizumi K, Vigotsky AD, Jabakhanji R, Abdallah M, Barroso J, Schnitzer TJ, Apkarian AV, Baliki MN. Psychosocial, Functional, and Emotional Correlates of Long-Term Opioid Use in Patients with Chronic Back Pain: A Cross-Sectional Case-Control Study. Pain Ther 2021; 10:691-709. [PMID: 33844170 PMCID: PMC8119524 DOI: 10.1007/s40122-021-00257-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/13/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The opiate epidemic has severe medical and social consequences. Opioids are commonly prescribed in patients with chronic pain, and are a main contributor to the opiate epidemic. The adverse effects of long-term opioid usage have been studied primarily in dependence/addiction disorders, but not in chronic pain. Here, we examine the added iatrogenic effects, psychology, and brain morphology of long-term opioid use in matched patients with chronic pain with and without opioid use (case-controlled design). METHODS We compared psychosocial, functional, and psychological measures between patients with chronic back pain (CBP) who were managing their pain with or without opioids, thereby controlling for the effect of pain on these outcomes. In addition, we investigated brain morphological differences associated with long-term opioid usage. We recruited 58 patients with CBP, 29 of them on long-term opioids and 29 who did not use opioids, and who were matched in terms of age, sex, pain intensity, and pain duration. Questionnaires were used to assess pain quality, pain psychology, negative and positive emotions, physical, cognitive, sensory, and motor functions, quality of life, and personality traits. RESULTS Patients with CBP on opioids displayed more negative emotion, poorer physical function, and more pain interference (p < 0.001), whereas there were no statistical differences in cognitive and motor functions and personality traits. Voxel-based morphometry using structural brain imaging data identified decreased gray matter density of the dorsal paracingulate cortex (family-wise error-corrected p < 0.05) in patients with opioids, which was associated with negative emotion (p = 0.03). Finally, a volumetric analysis of hippocampal subfields identified lower volume of the left presubiculum in patients on opioids (p < 0.001). CONCLUSION Long-term opioid use in chronic pain is associated with adverse negative emotion and disabilities, as well as decreased gray matter volumes of specific brain regions.
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Affiliation(s)
- Kenta Wakaizumi
- Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 355 East Erie St, Chicago, IL, 60611, USA.,Center for Translational Pain Research, and Center of Excellence for Chronic Pain and Drug Abuse Research, Northwestern University Feinberg School of Medicine, Chicago, USA.,Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Andrew D Vigotsky
- Center for Translational Pain Research, and Center of Excellence for Chronic Pain and Drug Abuse Research, Northwestern University Feinberg School of Medicine, Chicago, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,Department of Statistics, Northwestern University, Evanston, IL, USA
| | - Rami Jabakhanji
- Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 355 East Erie St, Chicago, IL, 60611, USA.,Center for Translational Pain Research, and Center of Excellence for Chronic Pain and Drug Abuse Research, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Maryam Abdallah
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 355 East Erie St, Chicago, IL, 60611, USA.,Center for Translational Pain Research, and Center of Excellence for Chronic Pain and Drug Abuse Research, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Joana Barroso
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 355 East Erie St, Chicago, IL, 60611, USA.,Center for Translational Pain Research, and Center of Excellence for Chronic Pain and Drug Abuse Research, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Thomas J Schnitzer
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 355 East Erie St, Chicago, IL, 60611, USA.,Center for Translational Pain Research, and Center of Excellence for Chronic Pain and Drug Abuse Research, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Apkar Vania Apkarian
- Center for Translational Pain Research, and Center of Excellence for Chronic Pain and Drug Abuse Research, Northwestern University Feinberg School of Medicine, Chicago, USA. .,Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, USA. .,Department of Anesthesia, Feinberg School of Medicine, Northwestern University, Tarry Bldg. 7-705, Chicago, IL, 60611, USA.
| | - Marwan N Baliki
- Shirley Ryan AbilityLab, Chicago, IL, USA. .,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 355 East Erie St, Chicago, IL, 60611, USA. .,Center for Translational Pain Research, and Center of Excellence for Chronic Pain and Drug Abuse Research, Northwestern University Feinberg School of Medicine, Chicago, USA.
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15
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Liu H, Fu X, Ren YF, Tan SY, Xiang SR, Zheng C, You FM, Shi W, Li LJ. Does Inhaled Methoxyflurane Implement Fast and Efficient Pain Management in Trauma Patients? A Systematic Review and Meta-Analysis. Pain Ther 2021; 10:651-674. [PMID: 33837931 PMCID: PMC8119536 DOI: 10.1007/s40122-021-00258-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/16/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction Evidence on the use of inhaled methoxyflurane in the management of trauma pain is conflicting and obfuscated. This study aimed to determine the efficacy and safety of inhaled methoxyflurane for trauma pain on the basis of published randomized controlled trials (RCTs). Methods RCTs assessing the efficacy of methoxyflurane in adults or adolescents with acute trauma pain published in PubMed, Web of Science, Embase, Cochrane Library, and Google Scholar were searched. The control groups were those that received placebo or standard analgesic treatment (SAT). The primary outcome was the change from baseline in pain scores during the first 30 min of treatment. Secondary outcomes included time to first pain relief, the proportion of patients experiencing pain relief, rescue analgesia rate, the treatment satisfaction of patients and investigators, and the methoxyflurane-related treatment-emergent adverse events (TEAEs). Results A total of nine RCTs (1806 patients) were identified. Results revealed that methoxyflurane provided a clinically unimportant benefit by improving the mean difference of change from baseline in pain intensity (from − 0.44 to − 1.23 cm, p < 0.001) at various time points within the first 20 min compared to control treatment. Besides, methoxyflurane decreased the time of onset of pain relief (mean difference − 5.29 min; 95% CI − 6.97 to − 3.62) and the proportion of patients who needed rescue analgesic medication (risk ratio 1.41; 95% CI 1.17–1.70) despite it increasing the risk of non-severe TEAEs (risk ratio 3.09; 95% CI 1.72–5.57). Notably, the benefit of almost all secondary pain-related outcomes was rendered clinically nonsignificant between methoxyflurane and SAT strata besides the time of onset of pain relief. The quality of evidence was low or very low in all outcomes. Conclusions In emergency situations without effective therapy, this systematic review and meta-analysis provides low-quality evidence that methoxyflurane can be used as a rapid-acting and effective treatment for acute trauma pain, although its utilization is associated a risk of non-severe TEAEs. However, the current evidence does not support the notion that inhaled methoxyflurane offered superior analgesic efficacy to SAT. Clinical Trial Number PROSPERO registration number CRD42020223000. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-021-00258-9.
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Affiliation(s)
- Hong Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072, Sichuan Province, China
| | - Xi Fu
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072, Sichuan Province, China
| | - Yi-Feng Ren
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072, Sichuan Province, China.
| | - Shi-Yan Tan
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072, Sichuan Province, China
| | - Si-Rui Xiang
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072, Sichuan Province, China
| | - Chuan Zheng
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072, Sichuan Province, China
| | - Feng-Ming You
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072, Sichuan Province, China
| | - Wei Shi
- Department of Anesthesiology, West China Hospital, Sichuan University and the Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, China.
| | - Lin-Jiong Li
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072, Sichuan Province, China.
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16
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Fassassi C, Dove D, Davis A, Butt M, Masoudi A, Drapkin J, Gohel A, Silver M, Likourezos A, Motov S. Analgesic efficacy of morphine sulfate immediate release vs. oxycodone/acetaminophen for acute pain in the emergency department. Am J Emerg Med 2020; 46:579-584. [PMID: 33341323 DOI: 10.1016/j.ajem.2020.11.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/15/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Previous research demonstrated that administration of Morphine Sulfate Immediate Release (MSIR) results in similar analgesic efficacy to Oxycodone but with significantly lesser degrees of euphoria and reward. The purpose of this study sit to investigate if MSIR combined with Acetaminophen can serve as an opioid analgesic alternative to Oxycodone combined with acetaminophen (Percocet) for acute pain in the Emergency Department (ED). METHODS A prospective, randomized, double-blind trial of ED patients aged 18 to 64 years presenting with moderate to severe acute pain as defined by an 11-point numeric rating scale (NRS) with an initial score of ≥5 (0 = no pain and 10 = very severe pain). Patients were randomized to receive either 15 mg MSIR combined with 650 mg of Acetaminophen or 10 mg Oxycodone combined with 650 mg Acetaminophen. Patients were assessed at baseline, 30, 45 and 60 min. The primary outcome was reduction in pain at 60 min. Secondary outcomes include drug likeability and adverse events. RESULTS 80 patients were enrolled in the study (40 per group). Demographic characteristics were similar between the groups (P > 0.05). Mean NRS pain scores at baseline were 8.44 for the MSIR group and 8.53 for the Percocet group (P = 0.788). Mean pain scores decreased over time but remained similar between the groups: 30 min (6.03 vs. 6.43; P = 0.453), 45 min (5.31 vs. 5.48; P = 0.779), and 60 min (4.22 vs. 4.87; P = 0.346). Reduction in mean NRS pain scores were statistically significant from baseline to 30, 45 and 60 min within each group (P < 0.0001 at each time point for both groups). The largest NRS mean difference was from baseline to 60 min: 4.2 (95% CI: 3.43 to 5.01) for MSIR group and 3.61 (95% CI: 2.79 to 4.43) for Percocet group. No clinically significant changes or any serious adverse events were observed in either group. CONCLUSION MSIR provides similar analgesic efficacy as Percocet for short-term pain relief in the ED, similar rates of nausea/vomiting, and lower rates of likeability of the drug.
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Affiliation(s)
- Catsim Fassassi
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Daniel Dove
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Ashley Davis
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Mahlaqa Butt
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Aidin Masoudi
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Jefferson Drapkin
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA.
| | - Ankit Gohel
- Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY, USA
| | - Michael Silver
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Antonios Likourezos
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Sergey Motov
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
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17
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Nelson LS, Mazer-Amirshahi M, Perrone J. Opioid Deprescribing in Emergency Medicine-A Tool in an Expanding Toolkit. JAMA Netw Open 2020; 3:e201129. [PMID: 32211866 DOI: 10.1001/jamanetworkopen.2020.1129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Lewis S Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark
- Division of Medical Toxicology, Rutgers New Jersey Medical School, Newark
| | - Maryann Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC
| | - Jeanmarie Perrone
- Department of Emergency Medicine, Center for Addiction Medicine and Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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