scholarly journals Use of parecoxib by continuous subcutaneous infusion for cancer pain in a hospice population

2017 ◽  
Vol 8 (1) ◽  
pp. 25-29 ◽  
Author(s):  
Peter Armstrong ◽  
Pauline Wilkinson ◽  
Noleen K McCorry
Keyword(s):  
Cancer Pain ◽  
Cancer Diagnosis ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Subcutaneous Infusion ◽  
Opioid Dose ◽  
Local Site ◽  
Pain Scores ◽  
Continuous Subcutaneous Infusion ◽  
Sparing Effect

ObjectivesTo characterise the use of the parenteral non-steroidal anti-inflammatory drug parecoxib when given by continuous subcutaneous infusion (CSCI) in a hospice population. Clinical experience suggests parecoxib CSCI may be of benefit in this population, but empirical evidence in relation to its safety and efficacy is lacking.MethodsRetrospective chart review of patients with a cancer diagnosis receiving parecoxib CSCI from 2008 to 2013 at the Marie Curie Hospice, Belfast. Data were collected on treatment regime, tolerability and, in patients receiving at least 7 days treatment, baseline opioid dose and changes in pain scores or opioid rescue medication requirements.ResultsParecoxib CSCI was initiated in 80 patients with a mean administration of 17.9 days (median 11, range 1–94). When used for a period of 7 days, there was a statistically significant reduction in pain scores (p=0.002) and in the number of rescue opioid doses required (p=0.001), but no statistically significant opioid-sparing effect (p=0.222). It was generally well tolerated, although gastrointestinal, renal adverse effects and local site irritation were reported.ConclusionsParecoxib may have a valuable place in the management of cancer pain, especially towards the end of life when oral administration is no longer possible and CSCI administration is relied on. Further studies into the efficacy and tolerability of parecoxib CSCI are merited.

Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series

2021 ◽  
Author(s):  
Jonathan P Scoville ◽  
Evan Joyce ◽  
Joshua Hunsaker ◽  
Jared Reese ◽  
Herschel Wilde ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Chart Review ◽  
Statistical Tests ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Opioid Use ◽  
Pain Scores ◽  
Surgical Methods ◽  
Significant Difference

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.

Comparison of hydromorphone continuous subcutaneous infusion and basal rate subcutaneous infusion plus PCA in cancer pain: a pilot study

Pain ◽  
1993 ◽  
Vol 53 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Marie-Claude Vanier ◽  
Gaston Labrecque ◽  
Dolorès Lepage-Savary ◽  
Éric Poulin ◽  
Louise Provencher ◽  
...  
Keyword(s):  
Pilot Study ◽  
Cancer Pain ◽  
Subcutaneous Infusion ◽  
Basal Rate ◽  
Continuous Subcutaneous Infusion

Continuous Subcutaneous Infusion of Ketorolac in Cancer Neuropathic Pain Unresponsive to Opioid and Adjuvant Drugs. A Case Report

1996 ◽  
Vol 82 (4) ◽  
pp. 413-415 ◽  
Author(s):  
Carla Ripamonti ◽  
Chiara Ticozzi ◽  
Ernesto Zecca ◽  
Carlos H. Rodriguez ◽  
Franco De Conno
Keyword(s):  
Neuropathic Pain ◽  
Case Report ◽  
Side Effects ◽  
Cancer Patient ◽  
Cancer Pain ◽  
Antidepressant Drugs ◽  
Analgesic Efficacy ◽  
Subcutaneous Infusion ◽  
Continuous Subcutaneous Infusion ◽  
Nonopioid Analgesic

Ketorolac is a new non-steroidal anti-inflammatory drug (NSAID) having a potent nonopioid analgesic activity. Administered by continuous subcutaneous infusion (CSI), its analgesic efficacy has been documented in the treatment of somatic and visceral cancer pain whilst it has been shown to be ineffective in the treatment of neuropathic pain. Here is a description of a cancer patient with neuropathic pain unresponsive to anticonvulsant or antidepressant drugs administered in association or not with oral opioids but who was successfully treated with ketorolac alone via CSI. Furthermore, the analgesia lasted over 75 days of treatment without any significant renal and gastric side effects.

scholarly journals Perioperative Intravenous Acetaminophen in Pediatric Tonsillectomies

2018 ◽  
Vol 53 (5) ◽  
pp. 316-320 ◽  
Author(s):  
Brandi Bowman ◽  
Leslie Sanchez ◽  
Preeyaporn Sarangarm
Keyword(s):  
Chart Review ◽  
Primary Outcome ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Descriptive Statistics ◽  
Pain Medications ◽  
Frequent Administration ◽  
Intravenous Acetaminophen ◽  
Sparing Effect ◽  
Opiate Administration

Purpose: This study investigated the effect of perioperative intravenous (IV) acetaminophen on opioid requirements in pediatric patients undergoing tonsillectomy at a single center. Methods: This retrospective chart review included patients who were less than 18 years old and underwent an outpatient tonsillectomy procedure. Patients who received non–Food and Drug Administration (FDA)-approved dosing of IV acetaminophen, without documented weights, and on chronic pain medications at the time of the procedure were excluded. The primary outcome was opioid requirements postoperatively prior to discharge measured as morphine equivalents per kilogram. Descriptive statistics were used to compare differences between groups. A multivariate analysis was performed, accounting for differences between groups in baseline and procedural characteristics. Results: In total, 157 patients were included in this study, of whom 55 had received IV acetaminophen and 102 had not. The average IV acetaminophen dose for was 14.5 mg/kg for patients weighing less than 50 kg (n = 22); the remaining patients received the maximum 1 g dose. Patients who received IV acetaminophen were less likely to be administered postoperative opiates as compared with those did not (45.5% vs 63.7%, odds ratio = 0.48, P = .036). There was a trend toward a decrease in total amount of opiates administered with IV acetaminophen (0 vs 0.033 µg/kg, P = .61). After adjusting for age and documented pain assessment, IV acetaminophen administration remained a significant factor for postoperative opiate administration. Conclusions: Perioperative administration of IV acetaminophen was associated with less frequent administration of symptom-directed opiates in pediatric tonsillectomies. This finding indicates that the agent may have an opioid-sparing effect in this patient population.

Continuous Subcutaneous Infusion of Buprenorphine for Cancer Pain Control

1989 ◽  
Vol 5 (2) ◽  
pp. 147-152 ◽  
Author(s):  
Junko Noda ◽  
Shinichiro Umeda ◽  
Toshiyuki Arai ◽  
Akihiro Harima ◽  
Kenjiro Mori
Keyword(s):  
Cancer Pain ◽  
Pain Control ◽  
Subcutaneous Infusion ◽  
Continuous Subcutaneous Infusion

Use of medical cannabis to reduce pain and improve quality of life in cancer patients.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 198-198
Author(s):  
Jessica Cudmore ◽  
Paul Joseph Daeninck
Keyword(s):  
Quality Of Life ◽  
Cancer Pain ◽  
Cancer Patients ◽  
Retrospective Chart Review ◽  
Clinic Visit ◽  
Average Dose ◽  
Improve Quality ◽  
Medical Cannabis ◽  
Opioid Dose

198 Background: Early attention to pain and symptoms in those with cancer improves both quality of life and survival. Opioid medications are the mainstay treatment of cancer-related pain. Cannabinoids are increasingly used as adjunctive treatments for cancer pain, but clinical evidence supporting their use as an “opioid sparing agent” or to improve quality of life is as yet unknown. Our study sought to determine if the addition of cannabinoids (medical cannabis) resulted in the reduction of the average opioid dose required for pain control, and improve self-reported quality of life indices. Methods: A retrospective chart review of cancer patients followed in our CCMB Pain and Symptom Clinic was conducted. Inclusion criteria: age over 18 years and formal enrollment in Health Canada’s Marihuana for Medical Purposes (MMPR) program (n = 24). Average dose of opioids were calculated in milligrams of morphine equivalent (ME) per day at the last documented visit prior to enrolment in the MMPR and then at the subsequent clinic visit. Averages of self-reported ESAS scores (pain, tiredness, drowsiness, nausea, appetite, depression, anxiety, sense of wellbeing) were calculated for the same visits. Statistical analysis using the paired student’s t-test compared means and determined the significance of any changes. Results: Following enrolment in the MMPR, the average opioid dose decreased by 70.375mg of MEs (p = 0.29). Self-reported ratings (10-point Likert scale) in pain (0.75, p = 0.23), tiredness (0.58, p = 0.21), drowsiness (1.125, p = 0.04), nausea (1.125, p = 0.04), appetite (1.42, p = 0.04), depression (1.29, p = 0.02) and anxiety (1.58, p = 0.004) improved after enrolment. Sense of wellbeing ratings did not change. Conclusions: Patients with cancer pain benefited from the addition of cannabinoids. The average opioid dose decreased following access to medical cannabis. Self-reported ratings of several quality of life indicators showed statistically significant improvement. Our study shows a signal that cannabinoids may reduce cancer patients’ reliance on opioids to control pain. Further prospective controlled studies are needed to further elucidate the role of cannabinoids in the treatment of cancer pain.

A retrospective chart review of opioid-induced nausea and somnolence on commencement for cancer pain treatment

2010 ◽  
Vol 6 (6) ◽  
pp. 431-434 ◽  
Author(s):  
Yoshiaki Okamoto, BP ◽  
Satoru Tsuneto, MD, PhD ◽  
Mamiko Tsugane, PhD ◽  
Tatsuya Takagi, PhD ◽  
Etsuko Uejima, PhD
Keyword(s):  
Cancer Pain ◽  
Chart Review ◽  
Pain Treatment ◽  
Retrospective Chart Review
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