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PubMed1978

Blood chemistry abnormalities in bacterial endocarditis of narcotic addicts.

We recently treated two narcotic addicts with bacterial endocarditis who developed the syndrome of inappropriate antidiuretic hormone secretion (SIADH). This prompted a retrospective review of blood chemistry studies in all narcotic addicts admitted to our hospital over a 30-month period because of a clinical suspicion of bacterial endocarditis. Patients with culture-positive endocarditis (group 1) had significantly lower plasma osmolality, sodium, calcium and albumin values (P less than .02, .001, .005, and .005 respectively) than addicts without endocarditis (group 2). More than 90% of those in group 1 had hyponatremia, and 48% had plasma hypoosmolality. These findings may be of value in the initial evaluation of ill narcotic addicts for hospitalization.

Adult↗
PubMed1989

Intravenous narcotics for premedication in outpatient anaesthesia.

One hundred adult female patients scheduled for outpatient laparoscopic procedures were studied. Each patient received intravenous premedication about 30 min before induction of anaesthesia. The premedications were given in a double-blind random order and were either a placebo, morphine (0.04 mg/kg), meperidine (0.35 mg/kg), fentanyl (0.75 microgram/kg) or sufentanil (0.15 microgram/kg). All patients received a standard anaesthetic regimen. Transient light-headedness was common following narcotic injections. Overall, sufentanil was superior to the placebo and to other narcotics in its ability to reduce preoperative anxiety and to provide more satisfactory induction, maintenance and recovery from anaesthesia. The incidence of postoperative nausea, vomiting and other side effects was not higher and discharge times were not longer after sufentanil compared to the placebo group. Complete recovery as assessed by telephone interview 24-48 h after the operation revealed no difference between the sufentanil and the other groups. The results of this study indicate that intravenous short-acting narcotics like fentanyl or sufentanil should be considered as an alternative premedicant for anxious patients who are scheduled for outpatient surgery.

Adolescent↗
PubMed2004

Dosage regimes in the prescription of heroin and other narcotics to chronic opioid addicts in Switzerland--Swiss national cohort study.

AIMS: Within the guidelines of the research programme on medical prescription of narcotics for opioid addicts (PROVE), heroin, morphine, and methadone were prescribed to heavily opioid addicted individuals in Switzerland since 1994. This contribution analyses the course of dose levels during the treatment period. DESIGN: Naturalistic description of consumed dosages per day and month. SETTING AND PARTICIPANTS: The study describes the dosages prescribed to all individuals who began outpatient treatment in the PROVE programme in Switzerland between 1994 and 1996. MEASUREMENTS: Consumed amount of narcotics per day and the course of dosage of injectable heroin in different treatment regimes. FINDINGS: Heroin was the most frequently prescribed narcotic. Of all consumption days, heroin had been applied in 77% as injection and in 9% in a smokeable form. The mean daily dosage was 474 mg for intravenous application and 993 mg for the smokeable form. Second most frequent was the prescription of oral methadone, in most cases in combination with heroin. The mean amount of daily consumption of oral methadone was 53 mg. There were dosage differences between treatment regimes. During the course of treatment the mean dosage for injectable heroin per day decreased significantly and, depending on the treatment regime, almost linearly. CONCLUSIONS: The significance of heroin dosages in heroin-assisted therapy for treatment outcome should be further explored, especially in the light of the markedly higher dosages in Switzerland compared to the UK. During the treatment period, dosages did not increase but generally decreased, indicating no further increase in tolerance.

Administration, Oral↗
PubMed1992

Administration of narcotics in cancer pain.

Cancer pain can be successfully managed with oral or parenteral narcotics in 80% of patients, if those factors that magnify pain perception are also controlled. Pain from any source can be made worse and pain tolerance impaired by depression, regression, intolerance to stress, and/or recurrent withdrawal, all of which require attention and management. Those patients whose cancer pain is still intractable may benefit from a procedure to interrupt pain pathways. Such procedures have become far less common since the introduction of chronic administration of intraspinal narcotics. The subarachnoid route is preferable to the epidural route because it is less likely to result in catheter failure and because much smaller doses can be used, with less systemic effect. In addition, tolerance can be managed more readily by readjustment of dose with the subarachnoid route, and there is no greater incidence of complications. Intraventricular narcotics can be considered in patients whose spinal canal does not allow catheter placement, at approximately 1/10th the spinal dose requirement.

Administration, Oral↗
PubMed1985

The neonatal narcotic abstinence syndrome: a brief review.

Because substance abuse experts are not available in many institutions, the consulting psychiatrist is required to diagnose and manage conditions such as the neonatal narcotic abstinence syndrome, which is readily recognized and treated. The authors discuss morbidity due to this syndrome in neonates born to narcotic addicted mothers. The clinical usefulness of neonatal narcotic abstinence scales is reviewed, with special reference to their application in treatment. The dosing of various drugs currently in use is also discussed.

Chlorpromazine↗
PubMed1975

Blockade by narcotic drugs of naloxone-precipitated jumping in morphine-dependent mice.

A dose regimen for administration of morphine, test drugs with potential to cause physical dependence and naloxone was determined to allow within one experimental day acquisition of morphine-dependent mice and evaluation of the narcotic drugs for their ability to prevent naloxone-precipitated jumping. This test procedure can be used to assess capacity of unknown drugs to suppress morphine withdrawal symptoms; the mechanism of suppression can be subsequently determined in secondary tests. However, for known morphine-like analgesics, the test procedure appears to reliably assess physical dependence properties. The results obtained on subcutaneous administration of five selected narcotic drugs and apomorphine show that their order of potency was methadone greater than meperidine equal apomorphine greater than d-propoxyphene greater than pentazocine. Codeine, also tested subcutaneously, did not substitute at sublethal doses. Except for apomorphine, which might have masked naloxone-precipitated jumping by inducing behavioral aggression, the order of potency compares favorably with the degree of physical dependence reported in humans. Thus, the described procedure might be employed to evaluate morphine substitution and hence potential physical dependence liability of unknown narcotic-like analgesics.

Administration, Oral↗
PubMed2003

Administering caudal anesthesia at completion of clubfoot surgery does not affect postoperative use of narcotics.

In the pediatric population, control of postoperative pain is a challenging and important issue. We conducted this retrospective study to determine whether single-dose caudal anesthesia administered after club-foot surgery helps to decrease postoperative use of narcotics. Fifty-one patients given an injection of caudal anesthesia (bupivacaine) at completion of clubfoot surgery were compared with 41 patients who did not receive a caudal block. Postoperative pain control was assessed by recording how much narcotic was used by each patient during time in the recovery room and during the first 8 hours after surgery. Results show that a single dose of caudal anesthesia administered at completion of clubfoot surgery is not associated with a statistically significant change in use of narcotics during either postoperative period.

Anesthesia, Caudal↗
PubMed1976

An evaluation of the hot plate technique to study narcotic antagonists.

The mouse hot plate model, with slight differences from the way it is used to study narcotic analgesics, was evaluated as a method for determining the oral effectiveness, relative potency and duration of action of two standard narcotic antagonists, naloxone and naltrexone, and a new agent, 6-desoxy-6-methylene-naltrexone (ORF 11676). Naltrexone and ORF 11676 were found to be more effective orally than naloxone. Naltrexone and ORF 11676 were equipotent by 3 routes of administration and both were more potent than naloxone. Naloxone produced a significantly shorter duration of action than the other two drugs. It was concluded that the mouse hot plate method, used to detect and characterize the activity of narcotic antagonists, provides information compatible with that obtained in other species, including man.

Animals↗
PubMedDate not supplied

[Role of the forensic medical expertise in the campaign of Russia Defense Ministry against trafficking of narcotics and strong drug substances].

The forensic medical measures undertaken by Russia's Defense Ministry (RDM) in its campaign against trafficking of narcotics and drastic medicines in Russia's territory are addressed in the paper. The dynamic mortality rate due to poisoning by narcotic and psychotropic agents (among Russian citizens) is shown for 1996-2001; the following issues are also discussed: specificity of drug-trafficking and drug-addiction in the contemporary Russian society and, primarily, in the Armed Forces of the Russian Federation and the conditions, on which the RDM expert forensic-and-medical institutions are involved in state measures against trafficking of narcotics and drastic medicines in Russia's territory.

Crime↗
PubMedDate not supplied

Narcotic infusions--a changing scene.

Controlling patients' pain is no longer a luxury in health care. Studies have shown that pain can cause physical harm. A better understanding of the pain pathway has enabled health care professionals to control pain more effectively. Development of pain control techniques that include patient-controlled analgesia (PCA) and intraspinal infusions of narcotics and local anesthetic agents has enhanced the level of pain control. Fewer side effects and decreased narcotic use are among the advantages demonstrated with PCA and intraspinal infusions. Side effects can be minimized and complications reduced when nursing can intervene during narcotic infusions. The role of the intravenous nurse is expanding into the area of pain management as educator and clinical practitioner.

Analgesia, Epidural↗
PubMedDate not supplied

Home pain management. Continuous infusion of narcotics.

Home pain management is a complex and challenging therapy for the home infusion nurse. A thorough knowledge of pain assessment, therapeutic approaches, and pharmacology of narcotics; management of side effects; and a recognition of individual variations in response are necessary for successful pain control. Continuous infusions of narcotics can be safely administered in the home setting, thus leading to an improved quality of life for patients with intractable pain. A retrospective chart review of 20 patients cared for by Deaconess Home Health Care Corporation in Boston, Massachusetts, illustrates the wide variation in individual narcotic requirements necessary to achieve pain control. Three case studies are also included to provide further comparison.

Adult↗
PubMedDate not supplied

Continuous subcutaneous infusion of narcotics.

Many cancer patients will experience pain. However, this pain can be controlled through the appropriate administration of narcotics. While narcotics can be taken orally and titrated to achieve a level of patient comfort, complications or the progression of disease may prohibit the use of oral analgesics. Continuous subcutaneous infusion of narcotics represents an alternate approach to pain management which can be effective in the management of cancer pain.

Catheterization, Peripheral↗
PubMed1989

Practical aspects of epidural and intrathecal narcotic analgesia in the intensive care setting.

The administration of epidural and intrathecal narcotics is a technique of providing postoperative analgesia that is gaining popularity in many operating rooms, labor suites, and intensive care units. The epidural and intrathecal methods, first introduced a century ago, have been implemented as additional techniques for the administration of narcotic analgesics. Patients who have received epidural or intrathecal narcotics are frequently admitted to the intensive care unit for postoperative care. Because of their continuous proximity to the patient and their monitoring skills, critical care nurses are able to evaluate the analgesic effect and intervene in the event of a complication.

Analgesia↗
PubMed1986

Evaluation, narcotics and behavioral treatment influences on pain ratings in chronic pain patients.

Changes in self-reported pain ratings were assessed in 95 chronic pain patients from data collected at three times: pretreatment evaluation, initial days of treatment and final days of treatment. These data were collected separately for regular, sporadic and nonusers of narcotic medication. Each patient completed a four-week interdisciplinary behaviorally based noninvasive treatment program. There was an average decrease of 7% in self-reported pain ratings between evaluation and the onset of treatment for the three groups. An additional decrease of 21%, 16% and 10% for the sporadic, nonusers and regular users of narcotics respectively was noted during treatment. Statistical analysis revealed a significant decrease in pain ratings across assessment phases but not between groups. Sporadic users of narcotics showed a pattern more similar to nonusers than to the regular users.

Behavior Therapy↗
PubMed1987

Methylphenidate associated with narcotics for the treatment of cancer pain.

Thirty-two patients with chronic pain due to advanced cancer were treated with methylphenidate (10 mg with breakfast and 5 mg with lunch) for 3 days, versus placebo, in a randomized, double-blind, cross-over study designed to evaluate the capacity of methylphenidate to potentiate the analgesic effect of narcotics and/or to decrease sedation induced by narcotics. In 28 evaluable patients, the intensity of pain (visual analogue 0-100) and intake of extra doses of analgesics (number of doses/day) were 43 +/- 27 and 2.2 +/- 2.4 during methylphenidate, versus 55 +/- 24 (P less than 0.02) and 2.9 +/- 2.9 (P less than 0.002) during placebo, respectively. Activity and drowsiness (visual analogue 0-100) were 57 +/- 25 and 58 +/- 24 after methylphenidate, respectively, versus 41 +/- 26 (P less than 0.05) and 45 +/- 27 (P less than 0.02) after placebo. Upon completion of the study, the investigator and the patient chose methylphenidate blindly as a more useful drug in 23 cases (83%) and 20 cases (70%), respectively (P less than 0.02). No cases of severe toxicity were observed. We conclude that methylphenidate can increase the analgesic effect and decrease sedation of narcotics in this population.

Adult↗
PubMed1987

Investigation into the use of narcotic antagonists in the treatment of a stereotypic behavior pattern (crib-biting) in the horse.

Crib-biting in horses is a repetitive behavior pattern which may involve the activation of both narcotic receptors and dopamine receptors in the CNS. Crib-biting frequency, determined in 7 nontreated horses under controlled conditions, was usually linear for many hours and ranged from 0.3 to 14.9 bites/min. Intravenous or IM injections of narcotic antagonists decreased these rates to almost zero by about 20 minutes after the injection was given. The duration of the response to a single injection ranged from 20 minutes for naloxone to 4 hours or more for nalmefene and diprenorphine. Effective doses were 0.02 to 0.04 mg of naloxone/kg, 0.04 mg of naltrexone/kg, 0.08 mg of nalmefene/kg, and 0.02 to 0.03 mg of diprenorphine/kg. Crib-biting could be prevented completely for up to a week by continuous infusion of 5 to 10 mg of nalmefene/hr. Crib-biting resumed when the infusion was discontinued, and plasma nalmefene concentrations decreased to below 5 ng/ml. Doses of nalmefene as large as 0.4 mg/kg, IV, produced only minor side effects. These side effects included some passage of semifluid fecal material, intermittent penile relaxation, and mild sedation. Treated horses responded normally to external stimuli, retained their appetites, and performed appropriately when ridden. Sedation wore off during the course of prolonged infusions. Narcotic antagonists may provide a novel and effective treatment of stereotypic behavior disorders.

Animals↗
PubMed1983

Transcutaneous electrical nerve stimulation and postoperative use of narcotic analgesics.

Transcutaneous electrical nerve stimulation (TENS) has been reported to reduce the use of narcotic analgesic medication for pain relief in the postoperative period. This study compares the use of narcotic analgesics and the occurrence of postoperative complications in 205 patients who underwent gastric bypass surgery for control of obesity. Seventy-four patients used TENS for postoperative pain relief. The control group comprised 131 patients who did not use TENS. There were no statistically significant differences in the use of narcotic analgesic medication and the occurrence of postoperative complications between the experimental group and the control group.

Adult↗
PubMed1980

Reduction of postoperative pain and narcotic use by transcutaneous electrical nerve stimulation.

Transcutaneous electrical nerve stimulation (TENS) was evaluated as a postoperative analgesic. Patients undergoing lumbar spine operations, hip surgery, and gynecological laparotomies were studied. Sterile electrodes, placed near the incision immediately after operation, were connected to a continuously operating stimulator for 48 hours after operation. Results from 46 experimental patients demonstrated that TENS could reduce the demand for postoperative narcotics in a group of patients who had not used narcotic analgesics before operation. No significant benefit was observed for patients who had used narcotics prior to operation.

Analgesia↗