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Dolly A, Singh S, Prakash R, Bogra J, Malik A, Singh V. Comparative evaluation of different volumes of 70% alcohol in celiac plexus block for upper abdominal malignsancies. South Asian J Cancer 2020; 5:204-209. [PMID: 28032091 PMCID: PMC5184761 DOI: 10.4103/2278-330x.195346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Context: Celiac plexus block (CPB) (is an effective way to reduce cancer-associated pain in upper abdominal malignancies. Aims: To evaluate the efficacy and safety of different volumes of 70% alcohol in CPB. Settings and Design: Prospective, randomized, controlled clinical study. Subjects and Methods: Thirty patients of carcinoma gall bladder were randomly divided into three groups (n = 10) to receive 20, 30, and 40 ml of 70% alcohol in CPB. Statistical Analysis Used: All the continuous data were assessed analysis of variance followed by post-hoc tests (Tukey's Honestly Significant Difference test). Ordinal data were compared using Kruskal–Wallis H-test followed by Mann–Whitney U-test. Categorical comparisons were performed using Chi-square test. Results: A significant difference in visual analog scale (VAS) score of Group I, Group I and Group III was observed from week 6 onward until the end of the study. At all these time intervals, VAS scores in Group I was higher than both Groups II and III during this time interval. VAS scores in Group III were significantly lower as compared to Group II from week 10 onward until the end of the study. As compared to baseline, at all the follow-up intervals, mean morphine requirement was significantly lower in Group II and Group III. A quality of life (QOL) score of Group III were higher as compared to Group I. Between Group II and Group III, significant difference was observed at week 16 only when Group III had a higher score as compared to Group II. Conclusions: VAS score, QOL, and reduction in morphine consumption were increased on increasing the volume of alcohol in CPB, 40 ml being most effective.
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Affiliation(s)
- Archana Dolly
- Department of Anesthesiology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Sarita Singh
- Department of Anesthesiology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Ravi Prakash
- Department of Anesthesiology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Jaishri Bogra
- Department of Anesthesiology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Anita Malik
- Department of Anesthesiology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Vinita Singh
- Department of Anesthesiology, King George Medical University, Lucknow, Uttar Pradesh, India
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Zhu M, Whittaker AK, Jiang X, Tang R, Li X, Xu W, Fu C, Smith MT, Han FY. Use of Microfluidics to Fabricate Bioerodable Lipid Hybrid Nanoparticles Containing Hydromorphone or Ketamine for the Relief of Intractable Pain. Pharm Res 2020; 37:211. [PMID: 33009588 DOI: 10.1007/s11095-020-02939-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE For patients with intractable cancer-related pain, administration of strong opioid analgesics and adjuvant agents by the intrathecal (i.t.) route in close proximity to the target receptors/ion channels, may restore pain relief. Hence, the aim of this study was to use bioerodable polymers to encapsulate an opioid analgesic (hydromorphone) and an adjuvant drug (ketamine) to produce prolonged-release formulations for i.t. injection. METHODS A two-stage microfluidic method was used to fabricate nanoparticles (NPs). The physical properties were characterised using dynamic light scattering and transmission electron microscopy. A pilot in vivo study was conducted in a rat model of peripheral neuropathic pain. RESULTS The in vitro release of encapsulated payload from NPs produced with a polymer mixture (CPP-SA/PLGA 50:50) was sustained for 28 days. In a pilot in vivo study, analgesia was maintained over a three day period following i.t. injection of hydromorphone-loaded NPs at 50 μg. Co-administration of ketamine-loaded NPs at 340 μg did not increase the duration of analgesia significantly. CONCLUSIONS The two-stage microfluidic method allowed efficient production of analgesic/adjuvant drug-loaded NPs. Our proof-of-principle in vivo study shows prolonged hydromorphone analgesic for 78 h after single i.t. injection. At the i.t. dose administered, ketamine released from NPs was insufficient to augment hydromorphone analgesia.
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Affiliation(s)
- Minze Zhu
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Andrew K Whittaker
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, QLD, Australia.,ARC Centre of Excellence in Convergent Bio Nano Science and Technology, The University of Queensland, Brisbane, QLD, Australia
| | - Xingyu Jiang
- National Center for Nanoscience and Technology, Beijing, China.,Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Rupei Tang
- Engineering Research Centre for Biomedical Materials, Anhui University, Hefei, Anhui Province, China
| | - Xuanyu Li
- National Center for Nanoscience and Technology, Beijing, China
| | - Weizhi Xu
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia Campus, Brisbane, QLD, 4072, Australia
| | - Changkui Fu
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, QLD, Australia.,ARC Centre of Excellence in Convergent Bio Nano Science and Technology, The University of Queensland, Brisbane, QLD, Australia
| | - Maree T Smith
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia Campus, Brisbane, QLD, 4072, Australia
| | - Felicity Y Han
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, QLD, Australia. .,School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia Campus, Brisbane, QLD, 4072, Australia.
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6
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Han FY, Whittaker AK, Howdle SM, Naylor A, Shabir-Ahmed A, Zhang C, Smith MT. Formulation of Bioerodible Ketamine Microparticles as an Analgesic Adjuvant Treatment Produced by Supercritical Fluid Polymer Encapsulation. Pharmaceutics 2018; 10:E264. [PMID: 30563294 PMCID: PMC6321204 DOI: 10.3390/pharmaceutics10040264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/28/2018] [Accepted: 12/04/2018] [Indexed: 01/10/2023] Open
Abstract
Pain is inadequately relieved by escalating doses of a strong opioid analgesic such as morphine in up to 25% of patients with cancer-related severe pain complicated by a neuropathic (nerve damage) component. Hence, there is an unmet medical need for research on novel painkiller strategies. In the present work, we used supercritical fluid polymer encapsulation to develop sustained-release poly(lactic-co-glycolic acid) (PLGA) biodegradable microparticles containing the analgesic adjuvant drug ketamine, for injection by the intrathecal route. Using this approach with a range of PLGA co-polymers, drug loading was in the range 10⁻60%, with encapsulation efficiency (EE) of 60⁻100%. Particles were mainly in the size range 20⁻45 µm and were produced in the absence of organic solvents and surfactants/emulsifiers. Investigation of the ketamine release profiles from these PLGA-based microparticles in vitro showed that release took place over varying periods in the range 0.5⁻4.0 weeks. Of the polymers assessed, the ester end-capped PLGA5050DLG-1.5E gave the best-controlled release profile with drug loading at 10%.
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Affiliation(s)
- Felicity Y Han
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane QLD 4072, Australia.
| | - Andrew K Whittaker
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane QLD 4072, Australia.
- ARC Centre of Excellence in Convergent Bio Nano Science and Technology, The University of Queensland, Brisbane QLD 4072, Australia.
| | - Steven M Howdle
- School of Chemistry, University of Nottingham, Nottingham NG7 2RD, UK.
- Critical Pharmaceuticals Ltd., BioCity Nottingham, Nottingham NG1 1GF, UK.
| | - Andrew Naylor
- Upperton Limited, Biocity Nottingham, Nottingham NG7 2TN, UK.
| | | | - Cheng Zhang
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane QLD 4072, Australia.
- ARC Centre of Excellence in Convergent Bio Nano Science and Technology, The University of Queensland, Brisbane QLD 4072, Australia.
| | - Maree T Smith
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane QLD 4072, Australia.
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane QLD 4072, Australia.
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9
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Glare PA, Davies PS, Finlay E, Gulati A, Lemanne D, Moryl N, Oeffinger KC, Paice JA, Stubblefield MD, Syrjala KL. Pain in cancer survivors. J Clin Oncol 2014; 32:1739-47. [PMID: 24799477 DOI: 10.1200/jco.2013.52.4629] [Citation(s) in RCA: 202] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pain is a common problem in cancer survivors, especially in the first few years after treatment. In the longer term, approximately 5% to 10% of survivors have chronic severe pain that interferes with functioning. The prevalence is much higher in certain subpopulations, such as breast cancer survivors. All cancer treatment modalities have the potential to cause pain. Currently, the approach to managing pain in cancer survivors is similar to that for chronic cancer-related pain, pharmacotherapy being the principal treatment modality. Although it may be appropriate to continue strong opioids in survivors with moderate to severe pain, most pain problems in cancer survivors will not require them. Moreover, because more than 40% of cancer survivors now live longer than 10 years, there is growing concern about the long-term adverse effects of opioids and the risks of misuse, abuse, and overdose in the nonpatient population. As with chronic nonmalignant pain, multimodal interventions that incorporate nonpharmacologic therapies should be part of the treatment strategy for pain in cancer survivors, prescribed with the aim of restoring functionality, not just providing comfort. For patients with complex pain issues, multidisciplinary programs should be used, if available. New or worsening pain in a cancer survivor must be evaluated to determine whether the cause is recurrent disease or a second malignancy. This article focuses on patients with a history of cancer who are beyond the acute diagnosis and treatment phase and on common treatment-related pain etiologies. The benefits and harms of the various pharmacologic and nonpharmacologic options for pain management in this setting are reviewed.
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Affiliation(s)
- Paul A Glare
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Pamela S Davies
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Esmé Finlay
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Amitabh Gulati
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Dawn Lemanne
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Natalie Moryl
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kevin C Oeffinger
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Judith A Paice
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael D Stubblefield
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Karen L Syrjala
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
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