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At least 235 records · Page 13Linked to original sources
PubMed2001

Postoperative narcotic requirement after microscopic lumbar discectomy is not affected by intraoperative ketorolac or bupivacaine.

STUDY DESIGN: Prospective, randomized, double-blind study. OBJECTIVE: To assess the efficacy of ketorolac and bupivacaine in reducing postoperative pain after microsurgical lumbar discectomy. SUMMARY OF BACKGROUND DATA: Microsurgical lumbar discectomy often is performed as an ambulatory procedure. Pain, nausea, and urinary retention may delay discharge. It was hypothesized that intraoperative ketorolac or bupivacaine would reduce postoperative pain as measured by morphine demand. METHODS: After Institutional Review Board (IRB) approval and informed consent, 30 patients undergoing single-level microsurgical lumbar discectomy under general anesthesia randomly received either intravenous ketorolac, intramuscular bupivacaine, or placebo before wound closure. After surgery, all patients received intravenous, MSO4, patient-controlled analgesia. MSO4 demand was compared between groups at 30 minutes and at 1, 4, 8, 16, 20, and 24 hours after surgery by one-way ANOVA. Pre- and postoperative pain was assessed by using a standard scale and was correlated to postoperative MSO4 demand by Pearson correlation. Significance was assumed at P < 0.05. RESULTS: There were no group differences in age, gender, weight, disc level, preoperative pain, or preoperative use of pain medication. Neither ketorolac nor bupivacaine decreased pain or nausea scores, MSO4 demand, or time to void and ambulation. Preoperative pain was significantly correlated to postoperative narcotic demand (r = 0.46, P < 0.01). Preoperative narcotic or NSAID use was not correlated to either preoperative pain scores or postoperative MSO4 requirement. CONCLUSIONS: Neither ketorolac nor bupivacaine decreased the postoperative narcotic requirement in patients undergoing microsurgical lumbar discectomy. Postoperative narcotic requirements are increased in patients who are in severe pain before surgery, regardless of preoperative narcotic use.

Adult↗
PubMed1971

Drug taking in adolescent girls: factors associated with the progression to narcotic use.

A follow-up study of girls in a London remand home during the years 1966-8 showed that 20.6% of those taking non-narcotic drugs on admission, but only 1% of non-drug-taking control admissions, had used narcotics by June 1970. Narcotic use on admission and progression to narcotic use were associated with frequent drug taking, marked involvement in a drug milieu, and a high incidence of personal morbidity. Adolescents who use illicit drugs and have a history of court appearances for any reason are particularly vulnerable to subsequent narcotic usage and other forms of serious drug abuse.

Adolescent↗
PubMed1975

Contingent naloxone (N-allylnoroxymorphone) treatment of the paroled narcotic addict.

This is a presentation of the results of pilot and controlled research on the effectiveness of the contingent (upon narcotic drug use) administration of 500-2,000 mg daily, of the narcotic antagonist, naloxone (N-allylnoroxymorphone), to paroled narcotic addicts enrolled in a urine monitoring program conducted in a metropolitan-based outpatient clinic. Criteria of effectiveness, which include clinic attendance, the extent of narcotic drug usage, and final disposition at the end of a 6-month treatment period, are viewed in relation to already established baseline results with a sample of patients processed through the same clinic over a 5-year period prior to the introduction of naloxone treatment. Although results of the pilot study are encouraging, indicating longer patient involvement and less reinstitutionalization than baseline values, the results of the controlled evaluation reveal no benefit from contingently administered naloxone beyond placebo reactivity, which appears to be substantial in the contingent approach. The results are discussed in terms of given sample characteristics, and suggestions are offered regarding the development of new narcotic antagonist treatment approaches.

Adolescent↗
PubMedDate not supplied

Naloxone antagonism after narcotic-supplemented anesthesia.

Narcotic-supplemented balanced anesthesia is increasing in popularity; however, the narcotic must frequently be antagonized postoperatively. Authorities differ in their recommendations as to dose and as to mode and duration of administration of the narcotic antagonist. In the present study of 58 patients undergoing narcotic-supplemented anesthesia, 60 percent of 42 fentanyl patients and 81 percent of 16 morphine patients required postsurgical naloxone for respiratory inadequacy. Naloxone dosage was initially 1.5 mug/kg IV, with repeat IV doses of 1.5 mug/kg, when needed, at 3-minute intervals, until a regular respiratory rate greater than 15 breaths/min was attained. None of the fentanyl patients and only 25 percent (4/16) of the morphine patients required additional naloxone in the recovery room. For the latter, the dose of naloxone previously administered was given IM and proved satisfactory. Additional analgesia was needed by 12 percent (7/58) of the patients during the recovery room stay. Judicious naloxone titration permitted respiratory adequacy to coexist with analgesia after narcotic-supplemented anesthesia.

Adolescent↗
PubMed2000

Female smokers have increased postoperative narcotic requirements.

This study investigated the influence of tobacco use on postoperative narcotic requirements of female patients following pelvic surgery. The history of tobacco use was taken by telephone survey, and the amount of postoperative narcotic used was obtained from a retrospective review of the patients' hospital charts. Postoperative narcotic use for patients who never smoked was 10.9 mg/12 hr (n = 83, S.E. = 0.5), for former smokers was 13.0 mg/12 hr (n = 33, S.E. = 0.8) and for current smokers was 13.1 mg/12 hr (n = 53, S.E. = 0.7). Patients who never smoked used significantly less narcotic than former smokers (p = .02) or current smokers (p = .007). There was no difference between current and former smokers. Patients who have smoked required more narcotic for postoperative pain control. This effect was equally strong for former as for current smokers.

Adult↗
PubMed1987

Effects of oral narcotics on sleep-disordered breathing in healthy adults.

Alcohol and benzodiazepines may increase sleep-disordered breathing by decreasing activity of pharyngeal dilating muscles, favoring the development of obstructive apneas and hypopneas. Narcotics cause greater depression of wakeful respiration than the previously mentioned drugs; however, the influence of narcotics on the upper airway and breathing during sleep has not been studied. We, therefore, examined, in 12 healthy adults, the effects of oral hydromorphone hydrochloride (2 and 4 mg) on breathing during sleep and on a variety of awake respiratory variables (minute ventilation, gas exchange, and chemoresponsiveness). In addition, awake pharyngeal inspiratory airflow resistance was determined before and after narcotic administration to assess the drug's influence on patency of the upper airway. Following both doses, minute ventilation decreased, and carbon dioxide pressure increased. The 4-mg dose of hydromorphone hydrochloride also produced a significant decrement in the hypoxic ventilatory response, whereas hypercapnic responsiveness and pharyngeal resistance did not change following either dose of the drug. Despite the respiratory depression during wakefulness described previously, no significant change was observed in any measure of sleep-disordered breathing after either dose of narcotic. We conclude that in healthy individuals without suspected sleep apnea, oral hydromorphone in standard dosages does not significantly increase sleep-disordered breathing. This result may be due to a lack of selective depression of upper-airway muscular function by the doses of narcotic used.

Adult↗
PubMed2001

[Diagnostic criteria of the severity of the pathologic drive to narcotics].

The paper presents variation of the clinical scale for determination of the severity of the pathologic drive to narcotics (drug addiction) elaborated by the authors. The "major" (obligatory) and the "minor" (additional) criteria were established. As the "major" criteria there were the presence of thoughts about narcotic drugs, affective and behavioral disorders, disturbances of sleep. The "minor" criteria included somato-autonomic disturbances, the presence of "narcotic" dreams, attitude to treatment, criticism toward the disease. A quantitative (with the scores) evaluation of the pathologic drive to narcotics was elaborated. The method proposed permits to object quite significantly the diagnosis of the pathologic drive to narcotics, to determine both its severity and dynamics during treatment.

Behavior, Addictive↗
PubMed2002

[Survey on the utilization of narcotic analgesics].

UNLABELLED: To evaluate the prescription of narcotic analgesics by the medical staff of Nanfang Hospital. METHODS: Drug utilization index (DUI) was used to analyze the prescriptions of narcotic analgesics to both in- and out-patients in the year of 2000. RESULTS: Six kinds of narcotic analgesics were prescribed mostly to relieve renal biliary colic, cancer pain and cough in the year 2000 in Nanfang Hospital. DUI shows no abuses of narcotic analgesics. CONCLUSION: The utilization of narcotic analgesics in Nanfang Hospital is basically well justified.

Adolescent↗
PubMed1991

Naloxone reverses pattern of obstruction of the distal common bile duct induced by analgesic narcotics in hepatobiliary imaging.

It is widely known that narcotics, such as morphine, cause spasm of the sphincter of Oddi, increasing pressure in the common bile duct. This pharmacologic effect has been applied to hepatobiliary scintigraphy in patients with chronic cholecystitis or cholestasis to reducing the time required for a diagnostic study. However, this feature of narcotics could result in delayed or nonvisualization of the small bowel, simulating a distal common bile duct obstruction, in patients requiring parenteral narcotic analgesics who must undergo hepatobiliary scintigraphy. We report on three patients where administration of intravenous naloxone hydrochloride (Narcan), a narcotic antagonist, was helpful in distinguishing narcotic-induced spasm of the sphincter of Oddi from true obstruction of the common bile duct.

Adult↗
PubMed1990

Randomized trial of postoperative patient-controlled analgesia vs intramuscular narcotics in frail elderly men.

Postoperative use of as-needed intramuscular narcotics is potentially hazardous in frail elderly patients. Patient-controlled analgesia (PCA) allows patients to self-administer small boluses of narcotic, allowing better dose titration, enhanced responsiveness to variability in narcotic requirements, and reduction in serum narcotic level fluctuation. Although theoretically useful, this method has not bee well studied in the elderly or medically ill. A prospective controlled trial among 83 higher-risk elderly men after major elective surgery compared PCA containing morphine sulfate with intramuscular morphine injections as needed (mean [+/- SD] age, 67.4 +/- 5.6 vs 67.0 +/- 6.3 years). Subjects had a variety of medical illnesses, including chronic lung disease (57%), coronary artery disease (43%), heart failure (13%), and liver disease (12%). Preoperative and postoperative assessments included chest roentgenograms; daily mental status and pulmonary function testing; twice-daily serum morphine levels; and oxygen saturation values, linear analogue pain and sedation scores, and vital signs every 2 hours. Care was taken to optimize narcotic administration in control subjects as well as PCA subjects. Analgesia was significantly improved by PCA (3-day mean pain score, 40.5 +/- 18.0 vs 32.5 +/- 15.0), without an increase in sedation. Significant postoperative confusion (18% vs 2.3%) and severe pulmonary complications (10% vs 0%) occurred significantly more frequently in intramuscular-treated controls. Patient-controlled analgesia was quickly mastered by most patients; no major problems referable to its use occurred. Patients who had previously received intramuscular injections reported that PCA was easier to use and provided better analgesia. Serum morphine levels showed significantly less variability on postoperative day 1 with PCA, compared with intramuscular injections. We conclude that PCA is an improved method of postoperative analgesia in high-risk elderly men with normal mental status, compared with as-needed intramuscular injections.

Aged↗
PubMed1990

Longitudinal patterns of alcohol use by narcotics addicts.

Longitudinal patterns of alcohol use by narcotics addicts sampled from a drug-free treatment program and from several methadone maintenance treatment programs were examined. Overall, a high prevalence of alcohol use was found in both samples across several stages of the addicts' careers. Many addicts were also using nonnarcotic drugs and marijuana concurrently. Generally, levels of alcohol, as well as of other substances use, decreased as the narcotics addiction career began. Unlike other drug use, however, only alcohol consumption increased whenever a decrease occurred in narcotics use. Effects of ethnicity, gender, parental alcohol problems, and opiate and alcohol use onset sequence on the alcohol- and narcotics-related behavior are examined in detail. A pattern of early onset of heavy alcohol consumption before initial narcotics addiction was more common among Chicanos and was associated with a positive parental alcohol history. Women addicts typically had a much lower alcohol consumption level than their male counterparts. Among the 160 deaths of the original 581 addicts followed during the 20 years of the study, alcohol-related deaths accounted for 17.5% of the total. Treatment implications for addicts with an alcohol problem are discussed.

Adolescent↗
PubMed1968

Detection of narcotic use. Comparison of the nalorphine (pupil) test with chemical tests.

The nalorphine (pupil) test for narcotic abuse is widely used in California. It is based on the ability of nalorphine to produce mydriasis in subjects who have recently taken morphine-like drugs and to produce miosis in others. The test will usually detect as little as 15 mg of morphine or comparable doses of other narcotics for several hours except in special circumstances. It is even more reliable for detection of chronic use of narcotics. A simple card pupillometer is adequate for measuring changes in pupil size resulting from nalorphine. Analysis for narcotics in urine by thin layer chromatography is also used, either alone or in conjunction with the pupil test, to detect drug abuse. In one study which included many urine speciments from subjects who had negative pupil tests the correlation between the pupil test and urinalysis was good (85 percent). When urinalysis was used to confirm suspicion of drug use resulting from a positive or equivocal pupil test, inter-method agreement dropped to about 50 percent for various reasons. Even so, use of the pupil test for screening and urinalysis for confirmation provides a satisfactory program for detection of narcotic abuse.

Chromatography, Thin Layer↗
PubMed1983

Zomepirac: preclinical narcotic abuse liability evaluation.

5-(4-Chlorobenzoyl)-1,4-dimethyl-1H-pyrrole-2-acetate dihydrate (Zomepirac, Zomax) was assessed in a variety of preparations in which narcotic agonists and antagonists have distinctive profiles. Zomepirac failed to displace tritiated etorphine significantly at concentrations up to 200 mumol/l. It was active (3-7 X 10(-5) mol/l) on both the electrically stimulated guinea pig ileum and mouse vas deferens but was less efficacious than morphine; these effects were not reversed by narcotic antagonists. Zomepirac was inactive in some analgesic assays in mice: tail-flick (1-30 mg/kg s.c.); hot plate (1-100 mg/kg s.c.); Nilsen (1-50 mg/kg s.c.); it was also inactive (1-10 mg/kg s.c.) as an antagonist of morphine in the tail-flick assay. It was, however, active in the paraphenylquinone writhing assay; this action was not reversed by naloxone (1-10 mg/kg) Zomepirac (2.5-10 mg/kg s.c.) failed to suppress signs of withdrawal produced by morphine deprivation in dependent rhesus monkeys. The intraperitoneal infusion of high doses of zomepirac (50 mg/kg/24 h or more) in rats produced toxicity. However, lower doses failed to induce narcotic-like dependence over a 6-7-day infusion period. The compound failed to maintain intravenous drug self-administration responding in rhesus monkeys over a range of doses (0.1-3.2 mg/kg) although codeine did so. In rhesus monkeys trained to discriminate narcotic agonists (etorphine or ethylketazocine) from saline, zomepirac (1-10 mg/kg i.m.) failed to produce drug-appropriate responding. Thus, zomepirac appears to possess few, if any, of the characteristic actions of narcotics that are associated with their abuse liability.

Analgesics, Opioid↗
PubMed2002

Naloxone for narcotic-exposed newborn infants.

BACKGROUND: Naloxone, a specific opiate antagonist, is available for the management of newborn infants with respiratory depression that may be due to transplacentally-acquired opiates. However, it is unclear which groups of newborn infants may benefit from this therapy, and whether naloxone has any harmful effects. OBJECTIVES: In newborn infants who have been exposed trans-placentally to narcotics, does naloxone reduce the need for, or duration of, ventilatory support or neonatal unit admission. SEARCH STRATEGY: The standard search strategy of the Cochrane Neonatal Review Group was used. This included electronic searches of the Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2002), MEDLINE (1966 - February 2002), EMBASE (1988 - February 2002), and previous reviews including cross references. SELECTION CRITERIA: Randomised controlled trials comparing the administration of naloxone versus placebo, or no drug, or another dose of naloxone, to newborn infants with suspected or confirmed trans-placental exposure to narcotics. DATA COLLECTION AND ANALYSIS: Data were extracted using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by each author and synthesis of data using relative risk, risk difference and weighted mean difference. MAIN RESULTS: We found nine trials that compared the effects of naloxone versus placebo or no drug in newborn infants exposed to maternal narcotic analgesia prior to delivery. The main outcomes reported were measures of respiratory function in the first six hours of life. Although we found some evidence that naloxone increases alveolar ventilation, we did not find any data on the pre-specified primary outcomes of this review: the need for assisted mechanical ventilation or admission to a neonatal unit. REVIEWER'S CONCLUSIONS: There is a need for a randomised controlled trial to determine if naloxone confers any clinically important benefits to newborn infants with respiratory depression that may be due to trans-placentally acquired narcotic.

Female↗
PubMedDate not supplied

Acute effects of ethanol on hepatic uptake and distribution of narcotics in the isolated perfused rabbit liver.

This study was performed as an initial step in systematically defining the hepatic interactions between ethanol and opioids using a controlled in vitro system. The acute effects of ethanol on the initial uptake and distribution of long- and short-acting narcotics were studied using isolated rabbit liver perfused with rabbit blood without or with ethanol. A pulse injection of 1.5 mg of 14C-labeled narcotic [methadone, 1-alpha-acetylmethadol (LAAM), morphine, or meperidine] was made into the portal vein cannula followed by perfusion for 2 min. Radioactivity was determined in liver homogenates and subcellular fractions; methadone and its metabolites were measured by thin-layer chromatography with zonal scanning in each fraction. Ethanol preperfusion and concomitant ethanol perfusion did not effect hepatic uptake of methadone, LAAM, morphine, or meperidine. Although subcellular localization of morphine and meperidine differed from that of methadone and LAAM, perfusion with ethanol did not alter the acute hepatic uptake and distribution of any of the narcotics. These findings suggest that acute exposure to ethanol does not alter the acute hepatic disposition of narcotics.

Animals↗
PubMed1994

Tobacco use as a distal predictor of mortality among long-term narcotics addicts.

BACKGROUND: This study examined patterns of tobacco and narcotics use, associated morbidity, and subsequent mortality among long-term narcotics addicts. METHODS: The analysis included 405 patients selected from admissions to the California Civil Addict Program during 1962 through 1964. Measures were obtained at admission and at two face-to-face interviews conducted in 1974-1975 and 1985-1986 and included use of narcotics, tobacco, alcohol, and other substances, as well as morbidity and mortality information. RESULTS: For the 405 addicts interviewed initially in 1974-1975, the average age was 36.7 years, the mean age at onset of smoking was 13.1 years, and first narcotics use occurred at 18.4 years. Ninety-eight percent reported experience with cigarette smoking, 84% were currently smoking, and 31% tested positive for opiates by urinalysis. In 1985-1986, at the second interview, among the 328 interviewed, 74% reported current smoking and 32% tested positive for opiates. Seventy-seven (19%) had died. Major proximal causes of death included drug overdose, violence, and alcohol-related conditions. The death rate of the smokers identified in 1974-1975 was four times that of nonsmokers. The only other distal variable that predicted mortality was disability status in 1974-1975. CONCLUSIONS: Smoking status and disability history were major distal predictors of subsequent death. However, tobacco-attributable mortality was directly substantiated as a proximal cause of death by only 16% of the death certificates.

Adult↗
PubMed1994

Simple narcotic kits for controlled-substance dispensing and accountability.

Operating rooms require a storage, dispensing and accounting system for restricted drugs which satisfies narcotics control authorities and is compatible with efficient care of patients. We describe narcotic kits containing fentanyl-morphine-midazolam, alfentanil-midazolam and sufentanil-midazolam, for general operating rooms, and two kits with larger quantities of fentanyl and sufentanil for cardiac operating rooms. The container for each kit is a video cassette holder which has a foam-rubber liner with sculpted depressions for each ampoule. Sealed kits are delivered each morning from pharmacy to the locked narcotics cupboard in the recovery room. On request, the recovery room nurse unlocks the cupboard and the anaesthetist signs out the required kit(s) for the day. A drug utilization form is enclosed with each kit, on which the anaesthetist records the amount of drug administered to each patient, and before returning the kit to the locked narcotics cupboard, the total amount of each drug used, discarded, and returned. Used kits are collected the following morning by a pharmacy technician who reconciles the contents and drug form of each kit. More than 40 staff anaesthetists and a similar number of residents have used the system for seven years, during which time 130,000 patients have passed through the operating rooms. Detection of one case of drug diversion by a staff anaesthetist was made partly by the control system, but mainly by behavioural changes. The system is simple, inexpensive, and effective and has been well received by the departments of pharmacy, anaesthesia, and nursing.

Anesthesia Department, Hospital↗
PubMed1981

Intracerebral substance P in mice: behavioral effects and narcotic agents.

Acute intracerebral injection of the undecapeptide, substance P, in mice induced a unique reciprocal hindlimb scratching response whose intensity was dose-related. Similar intracerebral dose-response curves were obtained by the structurally related undecapeptides, physalaemin and eledoisin, but not by several unrelated peptides (TRH, neurotensin, bradykinin, somatostatin), prostaglandins E2 and F2a, dibutyryl cyclic AMP or dibutyrylcyclic GMP. Analgesic narcotic agents with predominant agonist activity administered i.p. prevented the reciprocal hindlimb scratching response induced by intracerebral substance P (0.625 microgram/mouse = ED 95). In this in vivo assay their action was stereospecific and exhibited a rank order of potency similar to that reported for analgesic activity and binding to opiate receptors in vitro. Narcotic agents with mixed agonist-antagonist activity were inactive while the narcotic antagonist, naloxone, completely reversed the action of morphine. Higher doses of naloxone alone potentiated substance P-induced reciprocal hindlimb scratching which may explain why partial narcotic agonists failed to abolish the response. There is now considerable evidence in support of a sensory neurotransmitter/modulator role for substance P within the central nervous system, and one of its actions may be associated with nociception. This concept is supported by observations in the present study which indicate that the substance P-induced reciprocal hindlimb scratching response involves nociceptive pathways within the central nervous system.

Animals↗