Effectiveness of Huffing Manoeuvre on Fentanyl Induced Cough

Aim: To determine the effect of huffing manoeuvre to preventing cough caused by intravenous administration of fentanyl during induction of anaesthesia. Study Design: Cross-sectional study Place and duration of study: General Anaesthesia Department, SICU and Pain Management, Civil Hospital Karachi from 1st June 2019 to 30th November 2019. Methodology: One hundred and sixty four patients meeting were enrolled. Every patient was taught to perform huffing manoeuvre by primary investigator visiting patient in ward at night before surgery. The act of huffing manoeuvre was lasts within 5 seconds. Any episode of cough within 60 seconds of fentanyl administration was classified as fentanyl induced cough. All patients were received Propofol (2mg/kg) for induction of anaesthesia. Results: The mean age was 46.42±8.92 years. Incidence of fentanyl induced cough was observed in 4.3% cases and huffing manoeuvre was effective in 95.7% cases. Conclusion: Huffing manoeuvre is an effecting method of reducing fentanyl induced cough in patients undergoing surgery, especially the manoeuvre prevents developing of severe fentanyl induced cough. Keywords: Fentanyl, Cough, Huffing manoeuvre, Analgesic opioids

Community consumption of analgesic opioids and opiate substitution treatments in a self-employed workers health plan: trend, substitution effects and demographic factors

Objective: Our aim was to evaluate community consumption of strong prescription opioid treatments in France in 2015 and 2017.Methods: A nation-wide French health care insurance claims database was analyzed for opioids average annual cost, annual prevalence of dispensations and users by mean of two repeated retrospective cross sectional study in 2015 and 2017.Results: In 2015–2017 prevalence of users per 100 000 beneficiaries per year rose from 878 to 932 (+6%) for strong opioid analgesics and lowered from 160 to 150 (-6%) for opiate substitution treatments. Prevalence of users of oxycodone, fentanyl, morphine, hydromorphone, buprenorphine, and methadone shifted by +17%, -5%, +4%, -8%, -13%, and +10%, respectively (+20% for methadone capsules). Oxycodone moved from third place to first place in terms of number of dispensation. Highest prevalence were in the western half of France, age over 60 and female for strong analgesic opioids and the north-east quarter and the south-west quarter of France, age 30 to 49 and male for opiate substitution treatments. The factor most strongly associated with prevalencewas age in strong analgesic opioids and gender in opiate substitution treatments.Conclusions: In 2 years the use of analgesics progresses, especially for oxycodone, while that of the substitution drugs decreases. Despite its greater danger, methadone tends to replace buprenorphine and capsule form tends to replace the syrup. Regulatory changes or enhanced controls may have played a role. The age of strong analgesic opioids consumers highlights the issue of severe pain in the elderly.

Evaluating the activity of dispensing opioid analgesic medication

Objectives. The purpose of this paper was to evaluate the drug dispensing activity of analgesic opioids in pharmacies. Materials and methods. The study was conducted in an observational and retrospective manner, based on a questionnaire distributed in different pharmacies across Romania. Results. The dispensing activity of opioid analgesics is conducted in 71 out of the 100 pharmacies that have received the questionnaire. These pharmacies are located in 12 out of the 41 counties, mostly in the urban area and 96% of them are community pharmacies. The most prescribed and dispensed pharmaceutical forms are solid forms, the injectable products and transdermic systems being dispensed in a high percentage, up to 40% respectively, only in 25% of the questioned pharmacies. The average time spent by a pharmacist for the entire activity of dispensing an opioid analgesic prescribed by a doctor was estimated at 17.82± 0.58 minutes. Conclusions. The activity regarding opioid analgesics in the community pharmacy is limited by the low rentability, high costs and time consumption. The results of the study impose a further analysis on the impact that this service has upon public health, in order to this activity be sustained by the national health insurance system. Measures must be implemented to ensure that patients from rural or unprivileged areas are able to get their analgesics from the nearest community pharmacy constantly.

Evaluation of spin in the abstracts of systematic reviews focused on analgesic opioids for non-cancer chronic pain management: A cross sectional analysis (Preprint)

BACKGROUND Patients with chronic, non-cancer pain are frequently prescribed opioids, often due to favourable results from systematic reviews. However, even studies with high-quality evidence can suffer from spin, which includes misleading reporting, interpretation, and extrapolation of study results. OBJECTIVE This study evaluated spin in systematic review abstracts concerning analgesic opioids for non-cancer, chronic pain management and the relationship between its presence and study characteristics. METHODS We searched MEDLINE and Embase for systematic reviews pertaining to analgesic opioids for non-cancer, chronic pain management. Screening and data extraction were done in a masked, duplicate fashion. Abstracts were evaluated for the presence of the nine most-severe types of spin. RESULTS Our search returned 1,109 articles; of which, 53 systematic reviews met our eligibility criteria. We found at least one type of spin in 30.2% of the included systematic review abstracts. Spin type 5 was the most common type of spin in our sample and occurred in 17% of abstracts. Spin types 1, 2, 4, 6, and 8 were not detected. Abstracts of systematic reviews published in journals that recommend PRISMA adherence were 9.33 times more likely to contain spin compared to those published in journals without specific PRISMA guidelines. The remaining study characteristics were not significantly associated with spin. CONCLUSIONS Our results showed that nearly one-third of the 53 included systematic reviews contained at least one type of spin in their abstract. Based on our results, systematic reviews about managing chronic, non-cancer pain with opioids require improvements in their abstract reporting.

Heat Therapy to Reduce Chest-Pain Among Patients with Acute Coronary Syndromes (ACS): A Literature Review

The main clinical manifestations of patients with Acute Coronary Syndrome (ACS) during the acute period is chest pain. Handling complaints of pain patients with ACS definitively done with medication; however, it is possible to do additional nonpharmacological therapies to optimize the results. Nonpharmacological treatment can be performed in various ways, one of them with heat therapy. This literature review aimed to determine the use of heat therapy as an additional nonpharmacological intervention in reducing the intensity of chest pain in patients with ACS. Four electronic databases were used to carry out systematic searches on articles, namely Proquest, Science Direct, Pubmed, and CINAHL-Ebsco. The combination of keywords was "heat therapy" AND "chest pain" AND "acute coronary syndrome" NOT "Literature review" OR "Literature review" OR "Overview" OR "Systematic Review" OR "Meta-analysis." The inclusion criteria used were experimental study articles, peer-reviewed articles, and research articles written in English and performed in the period between 2014-2019. The search results obtained three articles that met the inclusion criteria and analyzed. The results of the study found that heat therapy effective in reducing the intensity of chest pain, the use of analgesic opioids, and improving the patient's hemodynamics. In conclusion, the therapy can be considered used as adjunctive therapy to reduce chest pain in patients with ACS with certain criteria. In addition, further research is also needed to see the effectiveness of this therapy if it is implemented with more frequent frequencies and compare its effectiveness in reducing chest pain if the application is given to the anterior or posterior of the chest.

Acute Pain Management for Patients Receiving Medication-Assisted Therapy

Evidence-based approaches for the treatment of opioid use disorder include the use of opioid medications (methadone, buprenorphine, or naltrexone), collectively referred to as medication-assisted therapy. Patients receiving medication-assisted therapy may present in the acute care setting with pain, often related to planned surgical procedures to treat health issues that were not addressed before entering treatment. Because these medications act on the same receptors as do analgesic opioids—and, in the cases of methadone and buprenorphine, have analgesic properties — managing acute pain in these patients can be challenging. Principles of effective pain management for these patients include continuing the usual medication-assisted therapy dose; using nonpharmacological and nonopioid pain management strategies as possible and immediate-release opioids, titrating to effect and monitoring for toxicity; anticipating tolerance and hyperalgesia; and establishing a collaborative treatment relationship with the medication-assisted therapy provider. Providing effective pain treatment supports ongoing recovery in patients with opioid use disorder.