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At least 1,549 records · Page 86Linked to original sources
PubMed1998

Postoperative analgesia and vomiting, with special reference to day-case surgery: a systematic review.

BACKGROUND: Day-case surgery is of great value to patients and the health service. It enables many more patients to be treated properly, and faster than before. Newer, less invasive, operative techniques will allow many more procedures to be carried out. There are many elements to successful day-case surgery. Two key components are the effectiveness of the control of pain after the operation, and the effectiveness of measures to minimise postoperative nausea and vomiting. OBJECTIVES: To enable those caring for patients undergoing day-case surgery to make the best choices for their patients and the health service, this review sought the highest quality evidence on: (1) the effectiveness of the control of pain after an operation; (2) the effectiveness of measures to minimise postoperative nausea and vomiting. METHODS: Full details of the search strategy are presented in the report. RESULTS - ANALGESIA: The systematic reviews of the literature explored whether different interventions work and, if they do work, how well they work. A number of conclusions can be drawn. RESULTS-ANALGESIA, INEFFECTIVE INTERVENTIONS: There is good evidence that some interventions are ineffective. They include: (1) transcutaneous electrical nerve stimulation in acute postoperative pain; (2) the use of local injections of opioids at sites other than the knee joint; (3) the use of dihydrocodeine, 30 mg, in acute postoperative pain (it is no better than placebo). RESULTS-ANALGESIA, INTERVENTIONS OF DOUBTFUL VALUE: Some interventions may be effective but the size of the effect or the complication of undertaking them confers no measurable benefit over conventional methods. Such interventions include: (1) injecting morphine into the knee joint after surgery: there is a small analgesic benefit which may last for up to 24 hours but there is no clear evidence that the size of the benefit is of any clinical value; (2) manoeuvres to try and anticipate pain by using pre-emptive analgesia; these are no more effective than standard methods; (3) administering non-steroidal anti-inflammatory drugs (NSAIDs) by injection or per rectum in patients who can swallow; this appears to be no more effective than giving NSAIDs by mouth and, indeed, may do more harm than good; (4) administering codeine in single doses; this has poor analgesic efficacy. RESULTS-ANALGESIA, INTERVENTIONS OF PROVEN VALUE: These include a number of oral analgesics including (at standard doses): (1) dextropropoxyphene; (2) tramadol; (3) paracetamol; (4) ibuprofen; (5) diclofenac. Diclofenac and ibuprofen at standard doses give analgesia equivalent to that obtained with 10 mg of intramuscular morphine. Each will provide at least 50% pain relief from a single oral dose in patients with moderate or severe postoperative pain. Paracetamol and codeine combinations also appear to be highly effective, although there is little information on the standard doses used in the UK. The relative effectiveness of these analgesics is compared in an effectiveness 'ladder' which can inform prescribers making choices for individual patients, or planning day-case surgery. Dose-response relationships show that higher doses of ibuprofen may be particularly effective. Topical NSAIDs (applied to the skin) are effective in minor injuries and chronic pain but there is no obvious role for them in day-case surgery. RESULTS-POSTOPERATIVE NAUSEA AND VOMITING: The proportion of patients who may feel nauseated or vomit after surgery is very variable, despite similar operations and anaesthetic techniques. Systematic review can still lead to clear estimations of effectiveness of interventions. Whichever anti-emetic is used, the choice is often between prophylactic use (trying to prevent anyone vomiting) and treating those people who do feel nauseated or who may vomit. Systematic reviews of a number of different anti-emetics show clearly that none of the anti-emetics is sufficiently effective to be used for prophylaxis. (ABSTRACT TRUNCATE

Acetaminophen↗
PubMed2000

The antitussive activity of delta-opioid receptor stimulation in guinea pigs.

In this study, the activity of the delta-opioid receptor subtype-selective agonist, SB 227122, was investigated in a guinea pig model of citric acid-induced cough. Parenteral administration of selective agonists of the delta-opioid receptor (SB 227122), mu-opioid receptor (codeine and hydrocodone), and kappa-opioid receptor (BRL 52974) produced dose-related inhibition of citric acid-induced cough with ED(50) values of 7.3, 5.2, 5.1, and 5.3 mg/kg, respectively. The nonselective opioid receptor antagonist, naloxone (3 mg/kg, i.m.), attenuated the antitussive effects of codeine or SB 227122, indicating that the antitussive activity of both compounds is opioid receptor-mediated. The delta-receptor antagonist, SB 244525 (10 mg/kg, i.p.), inhibited the antitussive effect of SB 227122 (20 mg/kg, i.p.). In contrast, combined pretreatment with beta-funaltrexamine (mu-receptor antagonist; 20 mg/kg, s.c.) and norbinaltorphimine (kappa-receptor antagonist; 20 mg/kg, s.c.), at doses that inhibited the antitussive activity of mu- and kappa-receptor agonists, respectively, was without effect on the antitussive response of SB 227122 (20 mg/kg, i.p.). The sigma-receptor antagonist rimcazole (3 mg/kg, i.p.) inhibited the antitussive effect of dextromethorphan (30 mg/kg, i.p.), a sigma-receptor agonist, but not that of SB 227122. These studies provide compelling evidence that the antitussive effects of SB 227122 in this guinea pig cough model are mediated by agonist activity at the delta-opioid receptor.

Animals↗
PubMed2001

Determination of opiates in serum, saliva and hair addicted persons.

In the last ten years advances in analytical methods have enabled the determination of xenobiotics in alternative material such as sweat, saliva, and hair. The aim of this study was to develop an analytical method and measure the concentration of the main opiates in serum saliva and hair of subjects from a detoxification and methadone treatment programme. The analytical strategy in the presented study, based on enzymoimmunoassay screening of opiates in urine and GC/MS confirmation, meets the needs of forensic and clinical toxicology. Blood and saliva samples from thirty seven patients and hair from twenty three with a history of intravenous opiate use were collected for analysis. The ranges of morphine in serum and saliva were 0-2081 and 0-208 ng/ml respectively; corresponding concentrations of codeine were 0-580 and 0-428 ng/ml respectively. The concentration of morphine, codeine and 6-MAM in hair of addicts ranged respectively from 0-32.4, 0-12.5 and 0-2.8 ng/mg. From the clinical toxicology point of view, hair analysis is supplementary to urine, serum or saliva determination, but in drug testing at the workplace it can play a crucial role.

Adult↗
PubMed2001

[Guillain-Barre syndrome as a result of poisoning with a mixture of "kompot"(Polish heroin) and drugs].

Guillain-Barré Syndrome is the most common form of polineuropathy. It is suggested that some infectious, immune and allergic factors are involved in developing the syndrome. "Kompot" or "Polish heroine", a domestic product, is produced from poppy straw or juice of poppy head (Papaver somniferum) and it is administered intravenously. "Kompot" shows variable contents of heroine, 6-MAM, 3-MAM, morphine, acetylo-codeine and codeine as well as papaverine, thebaine and narcotine. The case history of a young man dependent on "Polish heroine" who developed the Guillain-Barré Syndrome due to severe intoxication induced by home made heroine, barbiturates and benzodiazepines is described.

Adult↗
PubMed1979

Reinforcing properties of nicocodine in the rhesus monkey.

The present study demonstrates that nicocodine is self-administered by the rhesus monkey in cross self-administration experiments. The minimum reinforcing dose is 10 times higher than that of codeine and 100 times higher than that of heroin. At reinforcing doses the rate of self-administered infusions of nicocodine is comparable with those of codeine. Further experiments are necessary to rank order nicocodine as to its positive reinforcing properties among the opiate-like compounds. On the other hand the present experiments demonstrate that nicocodine is an opium-like reinforcing compound.

Animals↗
PubMed2001

Blind trials of an onsite saliva drug test for marijuana and opiates.

The objective of these clinical trials was to calculate the performance, limit of detection, specificity and sensitivity of a novel, semi-quantitative immunoassay for drugs of abuse in saliva and to determine operator bias when measured blind by four different operators. The test is based on lateral flow gold particle technology coupled with digital photography to provide a semi-quantitative end point. The performance of the test was compared with that of enzyme immunoassays and GC/MS methods. Volunteers consumed marijuana or codeine and their saliva was collected 0.25 to 24 h later with the Cozart RapiScan collection device. The sensitivity and specificity of the opiate test were both 100%+/-10.4% for codeine for 9 h after dosing. The cutoff of the marijuana test at 10 ng/mL THCA was too high to detect marijuana use for more than a few hours after smoking. There was no operator bias because the results were presented in written form either as "positive" or "negative" for each of the five drug classes on the screen of the hand-held reader.

Cannabinoids↗
PubMed1975

Studies on the localization of central cough mechanism; site of action of antitussive drugs.

The localization of the central cough mechanism was studied by electrically stimulating the lower brainstem in cats lightly anesthetized with pentobarbital sodium or in unanesthetized midcollicular decerebrate preparations. Cough responses were recorded with the aid of a microphone. The cough responsive region was concentrated in an area dorsomedial to the trigeminal tract and nucleus. The sites of action of antitussive agents (dextromethorphan, codeine, clonazepam, diazepam and caramiphen) were studied on the centrally induced cough responses. Each of these drugs was administered intravenously to determine the dorsal levels for cough suppression. In other series, the threshold dose via the intravertebral route was determined first. Because the agent necessary to prevent cough via this route was so small in amount, recovery usually occurred in 20 to 90 minutes. Then the same agent was given intravenously in an attempt to obtain an effective dose which was close to the minimum dose for blocking the cough. The mean effective doses of these agents to abolish the cough via the vertebral artery were only about 1/20 of those required via intravenous injection. The findings suggest that these agents act centrally to suppress the cough responses. Clonazepam was found to be the most potent antitussive among these agents, the mean effective dose being about 1/35 of that of codeine. The antitussive potency of benzodiazepines is not well correlated with their muscle relaxant activity. For instance, clonazepam and diazepam have the same potency in depressing polysynaptic spinal reflexes, whereas the former is 6 times more potent than diazepam as an antitussive. This finding indicates that clonazepam has a high specificity as an antitussive.

Animals↗
PubMedDate not supplied

[Optimal conditions for extraction of "caffetin" and "saridon" tablet components from aqueous solutions].

Using a mathematical method of experiment planning (Latin square), the authors suggest the optimal conditions for extraction of propifenasone and paracetamol, the basic components of caffeine and saridon tablets, from water solutions: extraction with ethylacetate (pH 2) for 5 min in the presence of an electrolyte (sodium chloride or ammonium sulfate) quantum satis. The possibility of extraction of caffeine and codeine under these conditions was tested. When extracting the components of caffeine and saridon tablets, paracetamol, propifenasone, and caffeine should be extracted with ethylacetate at pH 2 and codeine by chloroform at pH 10.

Acetaminophen↗
PubMed1998

[Studies on analytical method for 10 drugs of abuse in urine using HPLC].

A systematic determination method for 10 drugs of abuse, morphine, codeine, 6-monoacetylmorphine, heroin, levorphanol, pethidine, ethylmorphine, anadol, pentazocine and ethamivan, using high performance liquid chromatography is described. Separation of the 10 drugs was achieved on a 25 cm x 4.6 mm ID, 10 microns Zorbax C8 column, using methanol--0.05 mol.L-1 KH2PO4--diethyl amine (27:73:0.5, pH 4) as mobile phase. Codeine was used as the interal standard. Calibration graphs were linear over the concentration range of 10-200 micrograms.ml-1 and regression equations showed correlation coefficients of greater than 0.999. Precision (RSD) were found to be better than 3% for each compound. Precision and linearity of the method are satisfactory for clinical toxicological applications. The extraction procedure yielded cleaner extracts. The recovery rates from urine were all above 87% without interference. This method is rapid, sensitive and specific.

Chromatography, High Pressure Liquid↗
PubMed2002

[Analysis of psychotropic drug mixtures using high-pressure liquid chromatography in acute poisoning cases].

The qualitative and quantitative method of determination of amitryptilin, codeine and fluoxetine in the mixture using high-pressure liquid chromatography is described in this paper. Chromatogram is presented which shows, that preparations are fully separated and do not interfere each others analysis. Tables with chromatographical separation characteristics are also presented. Proposed calibration curves of quantitative analysis and calculated medium relative error of quantitative ascertainment for every preparation of the mixture are shown. Final conclusion: method is applicable for qualitative and quantitative analysis of amitryptiline, fluoxetine and codeine in the mixture in hasty poisoning cases.

Acute Disease↗
PubMed1999

[Determination of alkaloids in pericarpium papaveris by gas chromatography with wide bore capillary column].

A method for the simultaneous determination of codeine, morphine, thebaine, papaverine and narcotine in pericarpium papaveris by gas chromatography with wide bore capillary column is described. The major components in pericarpium papaveris were extracted with methanol and chloroform by supersonic extraction and evaporation. The residue was dissolved in methanol. The resulting solution was used for analysis. The conditions for determination were: FID detector, HP-1 capillary column, 5 m x 0.53 mm x 2.65 microns film, column temperature 260 degrees C, The method requires 10 minutes for the whole analysis. The average recoveries of codeine, morphine, thebaine, papaverine and narcotine in the sample were 94.0%, 96.5%, 93.8%, 91.0% and 91.4% respectively. The relative standard deviations were from 0.92% to 2.75%. The advantages of this method are simple, rapid, accurate and sensitive.

Alkaloids↗
PubMedDate not supplied

Induction of early apoptosis marker by morphine in human lung and breast carcinoma cell lines.

We have investigated whether morphine and codeine, potent analgesic compounds most commonly used as cancer pain relievers, show tumor-specific cytotoxic activity and whether they can induce apoptosis or necrosis by monitoring the stainability with Annexin V and propidium iodide with fluorescence-activated cell sorter. Both opioids showed higher cytotoxic activity against three human tumor cell lines (lung carcinoma A549, mammary gland carcinoma MCF7, promyelocytic leukemia HL-60) than against three normal human cells (periodontal ligament fibroblast HPLF, gingival fibroblast HGF, pulp cell HPC). Morphine produced the major part of the apoptotic cell populations and the minor part of the necrotic cell populations in A549 and MCF7 cells, more effectively than codeine. In addition, morphine increased the activity of mitochondrial Mn-containing superoxide dismutase (MnSOD) in HL-60 cells, but decreased the MnSOD activity in A549 and MCF7 cells. The apoptosis-inducing activity of opioids may provide new strategies for the treatment and prevention of cancer.

Analgesics, Opioid↗
PubMed1992

[Drug therapy in severe tumor pain. Comparative study of a new combination preparation versus diclofenac-Na].

In a multicentric, interindividual, double-blind study, the analgesic action, duration of effect, tolerability and side effects of the new combination preparation, Combaren (diclofenac-Na 50 mg+codeine phosphate 50 mg), were compared with those of diclofenac-Na 50 mg (Voltaren 50) in 184 patients with severe tumor-related pain. The results show that Combaren is a highly effective preparation for the treatment of severe tumor pain. The combination of diclofenac-Na with codeine phosphate leads to a clear, statistically significant, augmentation of the effectiveness of additionally used analgesics on pain severity, and the general effectiveness of the combination is more positively assessed that that of monotherapy with diclofenac (also effective). In the staged approach to the treatment of malignancy-related pain in which the aim is to provide continuous, preventive analgesia rather than ad hoc treatment of newly developing or worsening pain, this combination preparation will presumably find a permanent place in stage I/II of the generally accepted staged pain-treatment scheme.

Adult↗
PubMed2004

Weak opiate analgesics: modest practical merits.

(1) The first-line drugs for mild to moderate pain are non opiate analgesics, namely paracetamol and nonsteroidal antiinflammatory drugs (NSAIDs). (2) Codeine, dextropropoxyphene and tramadol are weak opiates; they are often used with paracetamol in fixed-dose combinations, in order to reinforce the analgesic effect of paracetamol. (3) These analgesic combinations have only been evaluated in a few situations associated with chronic and acute pain. And the endpoints used in clinical trials are designed more to show statistically significant differences than clear clinical differences. (4) In acute pain, available meta-analyses confirm that the first-line drug is paracetamol, or, if necessary, ibuprofen, a NSAID. (5) The paracetamol + codeine combination slightly increases the analgesic effect of paracetamol, but causes more adverse effects. Combinations of paracetamol + dextropropoxyphene and paracetamol + tramadol are even less useful. (6) The few available clinical trials fail to demonstrate that combining paracetamol with a NSAID is any more effective than either drug given alone, while adverse effects are increased. (7) Paracetamol is also the first-line treatment for chronic non cancer pain, such as low back pain or pain due to osteoarthritis of the hip. NSAIDs have no advantages over paracetamol in these settings. We found no trials of paracetamol + NSAID combinations. Combinations of paracetamol and weak opiates have been inadequately studied in this situation, and are only second-line options.

Acetaminophen↗
PubMed2004

Reliability and validity of opiate use self-report in a population at high risk for esophageal cancer in Golestan, Iran.

OBJECTIVE: To assess the reliability and validity of self-reported opium use in a rural Iranian population at high risk for esophageal cancer in preparation for a large cohort study. METHOD: 1,057 subjects ages 33 to 84 years were recruited from Gonbad city and three surrounding villages in Golestan province of Iran and completed a questionnaire and provided biological samples. The history and duration of using opium, smoking tobacco, chewing nass, and drinking alcohol were measured by questionnaire in the entire cohort. A subgroup of 130 people was reinterviewed after 2 months to assess reliability. Validity of the opium question was assessed by comparing the questionnaire responses with the presence of codeine and morphine in the urine of 150 selected subjects. RESULTS: Self-reported opiate use is reliable and valid in this population. The reliability of ever opium use and duration of opium use had kappa's of 0.96 and 0.74, respectively. The validity of self-reported opium use was also high. Using urine codeine or morphine as the gold standard for use of opium, self-report had a sensitivity of 0.93 and a specificity of 0.89. CONCLUSIONS: The self-reported use of opium can provide a reliable and valid measurement in this population and will be useful for studying associations between opium use and occurrence of esophageal cancer and other diseases.

Adult↗
PubMed1991

Autonomic and verbal responses to the experimental nociceptive stimulation.

Human pain studies require a multidimensional evaluation for the complex understanding of the stated problem. For this reason, not only the subjective verbal evaluations but also objective indices are considered. To estimate the latter ones, autonomic, vasomotor and electrodermal responses to electric stimulation were selected in the presented study together with the verbal assessment. In comparison with the chronic non-malignant pain patients, different findings were obtained in healthy subjects, both in the objective and subjective indices. In the second part of the study, the analgesic effects of acetylsalicylic acid or codeine or placebo were compared under indentical experimental conditions. The differences were less impressive than those found in the first part of the study. The antinociceptive effect was registered only after codeine administration.

Adult↗
PubMedDate not supplied

Central action of narcotic analgesics. Part III. The role of endogenous noradrenaline in hyperactivity induced by morphine or fentanyl in mice.

Hyperactivity produced in mice with morphine or fentanyl, and methylamphetamine was antagonized by naloxone. The depression of locomotor activity induced by codeine was practically unchanged by the opiate antagonist. L-DOPA did not restore the stimulatory action of morphine and fentanyl in reserpinized mice. The hyperactivity produced by morphine and fentanyl was abolished in mice treated with alpha-methyl-p-tyrosine, but this was restored by L-DOPA administration. Agents inhibiting the central noradrenaline receptors, phentolamine, phenoxybenzamine, and aceperone, prevented or even reversed the locomotor stimulatory action of morphine and fentanyl. Pimozide did not affect the increase of locomotor activity produced by morphine, but depressed that induced by fentanyl. Haloperidol, used in a dose which did not affect the locomotor activity of mice, completely blocked or even reversed the stimulatory action of morphine and fentanyl, and potentiated the depression of locomotor activity produced by pentazocine and codeine. Diethyldithiocarbamate significantly depressed, but did not inhibit completely the stimulatory action of morphine and fetanyl. The stimulatory action of methylamphetamine was also significantly depressed. It seems that the stimulatory effect of morphine and fentanyl depends on the release of endogenous noradrenaline.

Animals↗
PubMed1990

Mast cell heterogeneity in chronic idiopathic urticaria.

Patients with chronic urticaria are more sensitive to codeine skin testing than other allergic individuals. Nonlesional skin in most patients with chronic urticaria was found to contain increased numbers of both total and atypical mast cells. The presence of increased mast cell density was found to correlate with the degree of clinical (dermatographism) and functional (codeine skin test) skin sensitivity.

Adolescent↗