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PubMed1987

Reversible, narcotic-associated mental status impairment in patients with metastatic cancer.

Pain and mental status were assessed in a series of 35 consecutive hospitalized patients with metastatic cancer receiving narcotics for pain that was difficult to control. Forty-five episodes of mental status impairment were detected in 27 of these patients. Fifteen patients had dose-related oversedation or organic brain syndrome. In only 4 could the narcotic dose be decreased without exacerbating the pain. Eleven patients had mental status impairment associated with factors other than the narcotic dose. These factors were: concurrent CNS-depressant drugs, presence of fever or infection, or changing from parental to average oral equianalgesic dose of narcotic. When these factors were corrected, mental function improved and remained stable despite resumption of the previous narcotic dose. Delirium occurred more frequently in patients over 65, while oversedation without delirium was more frequent in the younger group. For some patients with advanced metastatic cancer, pain relief and intact mental status cannot coexist. For others, correction of factors other than narcotics which can impair function can often lead to improved mental status without decreasing narcotic dose or decreasing the degree of pain control.

Adult↗
PubMed2002

Narcotic-induced hypogonadism during therapy for heroin addiction.

Many patients receiving sustained-action narcotics during therapy for heroin addiction have symptoms of fatigue, depression, diminished libido, and impaired sexual function. They are rarely, however, evaluated for narcotic-induced hypogonadism, or treated with sex-hormone replacement. Studies are reviewed examining the influence of narcotic administration on sex-hormone levels. These document frequent, sometimes profound, deficiencies in many men and women treated with narcotics. We have documented improved quality of life during sex-hormone replacement therapy in patients with narcotic-induced hypogonadism, most of whom were receiving their narcotics for control of chronic pain. These studies suggest that similar hormone replacement therapy may assist patients receiving narcotics for treatment of heroin addiction.

Androgens↗
PubMed1985

EEG quantitation of narcotic effect: the comparative pharmacodynamics of fentanyl and alfentanil.

Fentanyl and alfentanil produce very similar electroencephalographic (EEG) changes in humans. With increasing serum concentrations of either narcotic, progressive slowing in frequency occurs. This narcotic effect on the brain was quantitated using off-line EEG power spectrum analysis. During EEG recording, six unpremedicated patients received a fentanyl infusion (150 micrograms/min), and six received alfentanil (1,500 micrograms/min) until a specific level of EEG depression (delta waves) occurred. Timed arterial blood samples were obtained for measurement of the narcotic serum concentrations. The narcotic-induced EEG changes were found to lag behind (in time) the serum narcotic concentration changes. To accurately relate EEG changes to serum narcotic concentrations, a pharmacodynamic model (inhibitory sigmoid Emax) was combined with a pharmacokinetic model that incorporated an "effect" compartment. (The effect compartment is the separate pharmacokinetic compartment where drug effect is directly proportional to drug concentration. It is the effect site.) The magnitude of the time lag was quantitated by the half-time of equilibration between serum narcotic concentrations and concentrations in the effect compartment. With fentanyl a significantly greater time lag was present (half-time = 6.4 +/- 1.3 min; mean +/- SD) than with alfentanil (half-time = 1.1 +/- 0.3 min). This difference in time lag between blood concentration and effect may be due to the larger brain-blood partition coefficient for fentanyl. The steady-state serum concentration that caused one-half of the maximal EEG slowing was 6.9 +/- 1.5 ng/ml for fentanyl, compared with 520 +/- 163 ng/ml for alfentanil.(ABSTRACT TRUNCATED AT 250 WORDS)

Alfentanil↗
PubMed2005

Narcotic use in patients with Crohn's disease.

OBJECTIVES: Despite advances in treatment for Crohn's disease (CD), some patients suffer from chronic pain. We sought to characterize the prevalence of narcotic use and contributing factors in CD patients at a referral center. METHODS: A retrospective analysis of 291 CD patients followed over a 5-yr period was performed. Clinical status was evaluated with the Harvey-Bradshaw index (HBI) of disease activity and the short inflammatory bowel disease questionnaire (SIBDQ). RESULTS: Narcotic use was identified in 13.1% of patients. Narcotic users were more likely to be female, 72%versus 49% (p= 0.01), had higher rates of disability, 15.4%versus 3.6% (p= 0.001), and a longer duration of disease, 17.0 versus 12.9 yr (p= 0.03). In addition, they took more medications 6.97 versus 4.7 (p < 0.001) and had a higher prevalence of neuropsychiatric drug use, 37%versus 19% (p= 0.01). CD patients receiving narcotics had worse disease activity (HBI 9.1 vs 5.0, p < 0.001) and diminished quality of life (SIBDQ 44.2 vs 51.6 (p= 0.04)). However, logistic regression analysis found that active disease [HBI score of > or = 4 (OR 3.9)], polypharmacy [use of > or = 5 drugs (OR 5.5)], and smoking (OR 2.8) were associated with narcotic use. CONCLUSIONS: Narcotic use may be an indicator of more severe disease since it is associated with increased disease activity and decreased quality of life. Factors correlating with narcotic use include smoking and PP. Our data emphasize the need for further work to characterize chronic pain in CD patients.

Adult↗
PubMed1986

Trends in alcoholism and narcotics abuse from medical examiner data.

To determine trends in alcoholism and narcotics abuse, New Jersey State Medical Examiner cases from Essex County of those age 12 or older during three consecutive 12-month periods from October 1981 to September 1984 (years 1, 2 and 3) were analyzed. Cases were classified as alcoholics or narcotics abusers according to the following criteria: any case record report of drinking problems or narcotics abuse, alcoholism or narcotics abuse indicated in the manner or cause of death or autopsy findings of liver change or pancreatitis due to alcoholism, or toxicology findings of narcotics (unless medically prescribed). The age-eligible cases decreased from 710 in year 1 to 691 in year 2 and 643 in year 3. Decedents classified as alcoholics rose from 18% in year 1 to 25% in years 2 and 3. The proportions classified as narcotic abusers and those with both conditions were relatively constant, averaging 7 and 5%, respectively, over the 3 years. Substance abuse itself was the manner of death for alcoholics and most of those with both conditions; 38% of the narcotics abusers were homicide victims. There were no appreciable demographic changes among substance abusers during this period.

Accidents↗
PubMed1985

Metoprolol in acute myocardial infarction. Narcotic analgesics and other antianginal drugs. The MIAMI Trial Research Group.

The effect of metoprolol on chest pain has been assessed in terms of the duration and the use of narcotic analgesics, nitrates and calcium-channel blockers. Fewer metoprolol-treated patients in the MIAMI trial were given narcotic analgesics (49% of the placebo patients vs 44% of the metoprolol patients, p less than 0.001), nitrates (55% vs 53%, p = 0.10) and calcium-channel blockers (12% vs 9%, p less than 0.001). A total number of 6,697 dose equivalents of narcotic analgesics were given to the placebo group compared with 5,493 dose equivalents to the metoprolol group, a difference of 18% (p less than 0.001). Mean dose equivalents were 2.3 and 1.9, respectively. The analysis of the total use of the 3 types of treatment for ischemic chest pain showed a significantly less frequent use of treatment for chest pain in the metoprolol group than in the placebo group (p less than 0.004). The relative difference in the incidence of drug treatment tended to be more striking for patients with maximal therapy, i.e., receiving high doses of narcotic analgesics, nitrates and calcium-channel blockers. There were 22% fewer patients receiving 4 or more doses of narcotic analgesics in the metoprolol group than in the placebo group. A multivariate analysis disclosed that site of suspected infarction, delay time, entry systolic blood pressure and metoprolol treatment all had a significant effect on the use of narcotic analgesics. There was a nonsignificant tendency for heart rate to be of importance. In the placebo group the use of narcotic analgesics increased with decreasing delay time and increasing systolic blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Analgesics, Opioid↗
PubMed1976

Effect of narcotic analgesics on the striatal homovanillic acid content in mice; relation to antinociceptive effect.

The effects of various narcotic analgesics on striatal homovanillic acid (HVA) content, hot plate time and rectal temperature in mice were compared in relation to dose and time. The hypothermia induced by narcotic analgesics did not correlate with the striat"al HVA increase. Pentazocine, cyclazocine and thebaine had no effect on the hot plate time. The maximum prolongation of hot plate time induced by morphine, methadone or piminodine occurred before the highest HVA increase. The highest increase induced by narcotic analgesics in striatal HVA content was twice the original concentration. This occurred 2 hr after 40 mg/kg of morphine; 2 hr after 20 mg/kg of methadone; 1/2 hr after 20 mg/kg of piminodine; and 1 hr after 60 mg/kg of pentazocine. Cyclacozine (10 and 20 mg/kg) and thebaine (10 mg/kg) did not alter the HVA content. With the exception of pentazocine, those doses of narcotic analgesics that caused equal increases in striatal HVA content were also equianalgesic. These results suggest that there are similarities in the structural requirements for antinociceptive and striatal HVA-increasing effects of narcotic analgesics. The neuroleptic compound haloperidol (0.5 mg/kg) caused a fourfold increase in striatal HVA content making it twice as efficient as narcotic analgesics. This finding suggests that narcotic analgesics do not act on the same sites as neuroleptics when causing an increase in striatal HVA content.

Analgesics, Opioid↗
PubMed1990

Intraspinal narcotics for treatment of cancer pain.

Inadequate pain relief remains a problem for many patients with cancer. Narcotic administration by the epidural or subarachnoid route is a relatively recent innovation and is indicated when pain is poorly controlled with high doses of systemic narcotics, or when patients experience limiting narcotic side effects. When given by the epidural or intrathecal route, narcotics have a longer duration of action and a lower dose is effective. These techniques involve personnel trained in catheter insertion and maintenance. Epidural and intrathecal administration of narcotics is an alternative when oral narcotics are ineffective. In this report the term "intraspinal" refers to epidural and/or subarachnoid placement of catheters and drugs.

Analgesia, Epidural↗
PubMed2005

Anesthesia for a patient with morbid obesity using dexmedetomidine without narcotics.

PURPOSE: To describe the anesthetic management of a patient with extreme obesity undergoing bariatric surgery whose intraoperative narcotic management was entirely substituted with dexmedetomidine. CLINICAL FEATURES: We describe a 433-kg morbidly obese patient with obstructive sleep apnea and pulmonary hypertension who underwent Roux-en-Y gastric bypass. Because of the concern that the use of narcotics might cause postoperative respiratory depression, we substituted their intraoperative use with a continuous infusion of dexmedetomidine (0.7 microg.kg(-1).hr(-1)). The anesthesia course was uneventful, and the intraoperative use of dexmedetomidine was associated with low anesthetic requirements (0.5 minimum alveolar concentration). After completion of the operation and after tracheal extubation, the dexmedetomidine infusion was continued uninterrupted throughout the end of the first postoperative day. The analgesic effects of dexmedetomidine extended narcotic-sparing effects into the postoperative period; the patient had lower narcotic requirements during the first postoperative day [48 mg of morphine by patient-controlled analgesia (PCA)] while still receiving dexmedetomidine, compared to the second postoperative day (morphine 148 mg by PCA) with similar pain scores. CONCLUSION: Dexmedetomidine may be a useful anesthetic adjunct for patients who are susceptible to narcotic-induced respiratory depression. In this morbidly obese patient the narcotic-sparing effects of dexmedetomidine were evident both intraoperatively and postoperatively.

Adult↗
PubMed2002

The effect of intraoperative bupivacaine administration on parenteral narcotic use after laparoscopic appendectomy.

BACKGROUND: Little is known about the effect that prophylactic administration of local anesthesia into surgical incisions has on pain and analgesic use after laparoscopic appendectomy. We examined how preemptive infiltration of a local anesthetic affected the use of parenteral narcotics after laparoscopic appendectomy. METHODS: We conducted a retrospective chart review of 60 patients who underwent a laparoscopic appendectomy from January 2000 to April 2001 at our institution. We studied the association between prophylactic bupivacaine analgesia and patterns of postoperative parenteral narcotic use. RESULTS: Of 46 patients who received intraoperative bupivacaine, 24 (52%) required postoperative parenteral narcotics as compared with 12 (86%) of 14 patients who did not receive bupivacaine (risk difference, 34%; 95% confidence interval [CI], 10-51%; p = 0.02). After adjustment for other factors, the patients who received prophylactic bupivacaine were much less likely to receive parenteral narcotics during their postoperative hospital stay than the patients who did not receive prophylactic bupivacaine (odds ratio, 0.2; 95% CI, 0.1-0.9; p = 0.03). Furthermore, the patients who received prophylactic bupivacaine required fewer doses (median number of doses, 0.5; interquartile range [IQR], 0-2) of parenteral narcotics postoperatively than those who did not receive bupivacaine (median, 2; IQR, 1-4; p value for comparison, 0.03). CONCLUSION: Intraoperative bupivacaine infiltrated locally into surgical wounds is associated with both a decreased need for postoperative parenteral narcotics and a reduced number of doses in patients who have undergone a laparoscopic appendectomy.

Adult↗
PubMed1977

A preliminary report on crime and addiction within a community-wide population of narcotic addicts.

This paper discusses the criminal behavior of narcotic addicts and is based on a sample of males identified as narcotic abusers by a large urban Police Department in the United States over a twenty-year period (1952-1971). The records of 252 subjects (representing a 92% interview response rate) were analyzed to determine whether there were differences between blacks and whites with regard to criminality before first use and after first regular use of narcotics. The findings generally support previous ones in regard to the increase of criminal activity after the onset of narcotic addiction. In addition, this community-wide population of narcotic addicts revealed that black addicts tend to commit more crimes, and more serious crimes, than white addicts before first use of narcotics and after the onset of addiction. Further, weighted crime index scores of both the "before" and "after" segments appear higher for blacks who became addicted in the most recent years, while this appears to be true for the whites only after the onset of their addiction.

Black or African American↗
PubMed1997

Comparison of lumbar and thoracic epidural narcotics for postoperative analgesia in patients undergoing abdominal aortic aneurysm repair.

OBJECTIVE: To determine whether there is an advantage of thoracic over lumbar epidural narcotics for postoperative analgesia in patients undergoing abdominal aortic aneurysm repair. DESIGN: A prospective randomized study. SETTING: Subjects were inpatients at an academic medical center. PARTICIPANTS: Fifty-two patients scheduled for elective abdominal aortic aneurysm repair. INTERVENTIONS: Subjects were randomly assigned to receive lumbar or thoracic epidural narcotics. Group 1 (n = 26) had lumbar, and group 2 (n = 26) had thoracic epidural catheters placed preoperatively. All patients were monitored with pulmonary artery catheters and arterial catheters, and had general endotracheal anesthesia, in addition to epidural anesthesia with 2% lidocaine. All patients received 5 mg of epidural morphine after intubation. Pain scores were monitored hourly for 36 hours using a visual analog scale, and additional narcotics were given, depending on the level of pain. Complications caused by epidural narcotics were recorded. RESULTS: There was no difference between groups as to the daily dose of narcotics or the time between narcotic doses. Hourly pain scores showed significant differences during hours 6, 7, 8, 20, 34, and 36, with pain scores being lower in group 1. There was no difference in the rate of complications between the groups. CONCLUSION: There is no advantage of thoracic over lumbar epidural analgesia using morphine in patients undergoing abdominal aortic aneurysm repair.

Aged↗
PubMed1990

[Long-term use of narcotics in pain therapy].

From 1. 1. 1976 to 30. 6. 1987, a total of 25,611 prescriptions for narcotics were obtained from pharmacies by 4131 persons living in a town of 250,000 inhabitants in the Federal Republic of Germany. 2412 patients (58.4%) had been prescribed narcotics on only one occasion, 3178 patients (76.9%) over a limited period of six months, presumably for acute pain. Only 520 patients (12.6%) received, over a period of at least six months, five or more narcotic prescriptions per six months. Reasons for the latter prescriptions were malignant tumours in 273 (6.6%) and chronic pain due to benign diseases in 144 (3.5%). In 21 patients (0.5%) the narcotic dosage had risen over two years, presumably because of the development of tolerance. 19 patients had been on narcotics for at least eight years, without their doctor diagnosing addiction. The data suggest that, in prescribing narcotics for patients with incurable disease, the risk of addiction should play no role.

Aged↗
PubMed2001

A retrospective study of the effect of postoperative indomethacin rectal suppositories on the need for narcotic analgesia in patients who had a cesarean delivery while they were under regional anesthesia.

OBJECTIVE: This study was undertaken to assess the efficacy of rectal indomethacin as an analgesic after cesarean delivery, comparing narcotic usage in patients receiving indomethacin with patients who received only standard narcotic analgesics. STUDY DESIGN: A retrospective study of patient records consisting of 297 women who underwent cesarean delivery while they were under regional anesthesia in a medium-sized community hospital from February 1996 through December 1999. Narcotic usage was determined as morphine equivalents whereby 10 mg morphine sulfate equals 30 mg oxycodone equals 50 mg hydrocodone equals 75 mg meperidine. Indomethacin was administered as 50-mg rectal suppositories. Statistical analysis was done by Pearson correlation and independent Student t test analysis. RESULTS: Narcotic usage was reduced by an average of 16 morphine equivalents (28%) in the indomethacin group. Pearson correlation revealed correlation at the.01 level; independent Student t test analysis revealed a P value of.001. Thus the mean amount of narcotic analgesic administered was significantly less in patients treated with indomethacin rectal suppositories. CONCLUSION: In this uncontrolled trial the use of indomethacin rectal suppositories resulted in a significant reduction in narcotic use in the postcesarean hospital recovery period as measured in morphine equivalents.

Analgesia↗
PubMed1983

Narcotic maintenance for chronic pain. Medical and legal guidelines.

Narcotic maintenance may be needed to relieve chronic pain in ambulatory patients who fail to respond to other pain therapies. Oral, long-acting narcotics are preferred, and nonnarcotic pain therapies can be administered simultaneously to reduce the narcotic dosage. To legally undertake narcotic maintenance, the physician must document the presence of an incurable, painful medical condition. We recommend that the patient give informed consent, since narcotic maintenance may lead to dependence and addiction. When done properly, narcotic maintenance is an appropriate medical-legal procedure that is safe and may provide humanitarian pain relief.

Analgesics↗
PubMed2000

Dilated bile duct in patients receiving narcotic substitution: an early report.

Narcotic substitution is now widely used. Morphine can induce a spasm of the sphincter of Oddi but dilation of bile duct has been reported only in an anecdotal case. In June 1995, we observed a first case of dilation of the common bile duct without organic obstacle in a hepatitis C virus (HCV)-infected patient who was under narcotic substitution, suggesting a causal relationship. We conducted a prospective study to evaluate the precise prevalence of bile duct abnormalities related to narcotic substitution in active intravenous drug or ex-intravenous drug users referred to our liver unit for histologic evaluation of HCV infection. We conducted a prospective study in a 30-month period of 334 HCV-infected patients, including 36 receiving narcotic substitution with methadone or buprenorphine. Biliary tract was analyzed by ultrasonography and by endoscopy ultrasound in cases of bile duct abnormalities. Of the 36 patients under narcotic substitution, 3 (8.3%) had asymptomatic dilated bile duct without organic obstacle--defined as a common bile duct > or =9 mm--compared to 1 of 298 (0.03%; p < 0.001) of those who did not receive substitution. Narcotic substitution may lead to bile duct dilation that does not require invasive diagnosis procedures.

Adult↗
PubMed2001

Narcotic analgesic effects on the sphincter of Oddi: a review of the data and therapeutic implications in treating pancreatitis.

OBJECTIVE: Traditional teaching dictates that morphine induces "spasm" in the sphincter of Oddi (SO) and should not be used in acute pancreatitis and that meperidine is the analgesic of choice because it does not elevate SO pressures. A literature search and review was performed to evaluate this teaching examining the effect of narcotic analgesic's effects on SO. METHODS: A Medline search was performed using keywords and phrases. The manufacturers of meperidine were contacted and their reports and studies were obtained and reviewed. RESULTS: Initial studies measured biliary pressure after narcotic administration in animals, and postoperative and intraoperative cholecystectomy patients. All narcotics increased biliary pressure, but morphine was associated with the largest elevation. Later studies using endoscopic retrograde cholangiopancreatography with direct SO manometry demonstrated that the SO is exquisitely sensitive to all narcotics including meperidine and that a small increase in biliary sphincter pressure is seen with higher doses of morphine. All narcotics increase SO phasic wave frequency and interfere with SO peristalsis. CONCLUSIONS: Narcotic-induced increases in phasic wave frequency interfere with SO filling and are responsible for the increase in bile duct pressure seen on the initial studies. No studies directly compare the effects of meperidine or morphine on SO manometry and no comparative studies exist in patients with acute pancreatitis. No outcome-based studies comparing these drugs have been performed in patients with acute pancreatitis. Morphine may be of more benefit than meperidine by offering longer pain relief with less risk of seizures. No studies or evidence exist to indicate morphine is contraindicated for use in acute pancreatitis.

Analgesics, Opioid↗
PubMed1991

Effect of pharmacy-conducted education on prescribing of postoperative narcotics.

The effect of written guidelines and pharmacist-conducted education on the prescribing of postoperative narcotics was studied. The postoperative narcotic regimens prescribed on a general surgery ward and patients' assessment of pain control were recorded during three eight-week study phases. After the first (baseline) phase, written guidelines for the use of postoperative narcotics were mailed to all physicians. Four weeks after the baseline phase ended, data were collected again for eight weeks. A pharmacist then began reinforcing the guidelines by presenting inservice educational sessions and participating in ward rounds. The pharmacist did not attempt to change narcotic regimens for individual patients. Four weeks after the pharmacist's efforts began, the final eight-week data-collection period commenced. In general, the appropriateness of narcotic orders increased as the educational efforts intensified. There was no difference in narcotic expenses or pain control among the study phases. The appropriateness of postoperative analgesic regimens increased as education efforts became more intense, but the efforts had no effect on drug expenses or pain control.

Drug Prescriptions↗