Lack of Influence by CYP3A4 and CYP3A5 Genotypes on Pain Relief by Hydrocodone in Postoperative Cesarean Section Pain Management

Abstract Background Genetic polymorphisms of cytochrome P450 are contributors to variability in individual response to drugs. Within the P450 family, CYP2D6 is responsible for metabolizing hydrocodone, a widely prescribed opioid for pain management. Alternatively, CYP3A4 and CYP3A5 can form norhydrocodone and dihydrocodeine. We have previously found that in a postcesarean section cohort, the rate of hydromorphone formation was dependent on the genotype of CYP2D6 and that plasma hydromorphone, not hydrocodone, was predictive of pain relief. Method Blood was obtained from a postcesarean cohort that were surveyed for pain response and common side effects. Plasma samples were genotyped for CYP3A4/5, and their hydrocodone concentrations were measured by LC-MS. R statistical software was used to check for differences in the outcomes due to CYP3A4/5 and CYP2D6, and a multivariate regression model was fit to determine factors associated with pain score. Results Two-way ANOVA between CYP3A4/A5 and CYP2D6 phenotypes revealed that the former variants did not have a statistical significance on the outcomes, and only CYP2D6 phenotypes had a significant effect on total dosage (P = 0.041). Furthermore, a 3-way ANOVA analysis showed that CYP2D6 (P = 0.036) had a predictive effect on plasma hydromorphone concentrations, and CYP3A4/A5 did not have any effect on the measured outcomes. Conclusions With respect to total dosages in a cesarean section population, these results confirm that CYP2D6 phenotypes are predictors for plasma hydromorphone concentration and pain relief, but CYP3A4/A5 phenotypes have no influence on pain relief or on side effects.

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Intrathecal Opioid Dosing During Spinal Anesthesia for Cesarean Section: An Integrative Review

Journal of Doctoral Nursing Practice ◽

10.1891/jdnp-d-19-00025 ◽

2020 ◽

Vol 13 (2) ◽

pp. 108-119

Author(s):

Nicole A. Gonzaga Gomez ◽

Nicole Warren ◽

Yuliya Labko ◽

David R. Sinclair

Keyword(s):

United States ◽

Patient Safety ◽

Pain Management ◽

Side Effects ◽

Pain Relief ◽

Cesarean Section ◽

Best Practice ◽

Postoperative Pain Management ◽

The United States ◽

Integrative Review

Approximately one in three women in the United States deliver via Cesarean section (CS), making it one of the most common surgical procedures in the country. Neuraxial (spinal or epidural) anesthesia is the most effective and common anesthetic approach for pain relief during a CS in the United States and often associated with adverse effects such as nausea, vomiting, and pruritus. While recommended dose ranges exist to protect patient safety, there are a lack of guidelines for opioid doses that both optimize postoperative pain management and minimize side effects. This integrative review synthesizes the evidence regarding best practice of opioid dosing in neuraxial anesthesia for planned CS. Evidence supports the use of lower doses of intrathecal (IT) opioids, specifically 0.1 morphine, to achieve optimal pain management with minimal nausea, vomiting, and pruritus. Lower IT doses have potential to achieve pain management and to alleviate preventable side effects in women delivering via CS.

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POST-OPERATIVE PAIN RELIEF FOR LOWER ABDOMINAL SURGERY

The Professional Medical Journal ◽

10.29309/tpmj/2005.12.03.5134 ◽

2005 ◽

Vol 12 (03) ◽

pp. 340-345

Author(s):

ROBINA FIRDOUS

Keyword(s):

Pain Management ◽

Side Effects ◽

Pain Relief ◽

Abdominal Surgery ◽

Opioid Receptors ◽

Acute Pain ◽

Alternate Route ◽

Parenteral Route ◽

Group I ◽

Post Operative Pain

The severity of post-operative pain and the lack of efforts in relievingit have led to the involvement of Anaesthesiologists in the management of post-operative and acute pain. Parenteralopiates have been utilized for post-operative pain management. The identification of the opioid receptors on substantiagelatinosa has provided an alternate route i.e 1 the epidural route - for administering opiates. Objectives: To evaluateand compare the efficacy and side effects of parenteral Buprenorphine with those of Extradural Buprenorphine.Setting: Department of Anaesthesia, District Headquarter Hospital, Faisalabad. Period: The data was collected duringthe last three and a half years. Materials and Methods: Sixty adult patients of either sex and ages ranging from 35-45years, who underwent lower abdominal surgery, were randomly selected for the study. They were equally divided intotwo groups. Group I patients were administered Buprenorphine 0.3 mg through the epidural catheter in extraduralspace. Group II patients were given Buprenorphine 0.3 mg intramuscularly. Results: Buprenorphine through theepidural route gives better analgesia with fewer side effects as compared with the parenteral route.

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Comparative Study in the Management of Postoperative Pain with High Dose Intravenous Paracetamol versus Tramadol

Reproductive Medicine Gynaecology & Obstetrics ◽

10.24966/rmgo-2574/100056 ◽

2021 ◽

Vol 5 (4) ◽

pp. 1-6

Author(s):

Tanudeep Kaur ◽

Keyword(s):

Pain Management ◽

Side Effects ◽

Postoperative Pain ◽

Pain Relief ◽

Emotional Experience ◽

Postoperative Pain Management ◽

Economic Benefits ◽

High Dose ◽

Postoperative Patient ◽

Intravenous Paracetamol

Pain is an unpleasant sensory and emotional experience causing agony and several side effects in a postoperative patient. Thus effective postoperative pain management has a humanitarian role with additional medical and economic benefits Paracetamol (PCM) has been widely used as an effective analgesic and antipyretic for over a century with an established safety profile, and Tramadol is a commonly used intravenous drug for postoperative pain relief.

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Oral Oxycodone for Acute Postoperative Pain: A Review of Clinical Trials

January 2018 - Pain Physician ◽

10.36076/ppj.2017.se52 ◽

2017 ◽

Vol 2 (20;2) ◽

pp. sE33-sE52 ◽

Cited By ~ 17

Author(s):

Chi-Wai Cheung

Keyword(s):

Clinical Trials ◽

Pain Management ◽

Side Effects ◽

Postoperative Pain ◽

Pain Relief ◽

Hospital Stay ◽

Spine Surgery ◽

Analgesic Efficacy ◽

Postoperative Pain Management ◽

Acute Postoperative Pain

Background: Opioids are the mainstay of pain management for acute postsurgical pain. Oral oxycodone is an opioid that can provide effective acute postoperative pain relief. Objectives: To evaluate the use of oral oxycodone for acute postoperative pain management. Study Design: This is a narrative review based on published articles searched in PubMed and Medline from 2003 to 2015 on oral oxycodone for acute postoperative pain management. Methods: Clinical trials related to the use of oral oxycodone for acute postoperative pain management were searched via PubMed and Medline from 2003 to 2015. The search terms used were “oral strong opioids,” “postsurgical,” “postoperative,” “post-surgical,” and “postoperative.” Treatment interventions were compared for analgesic efficacy, rescue medication use, side effects, recovery, length of hospital stay, and patient satisfaction. Results: There were 26 clinical trials included in the review. Oral oxycodone showed superior postoperative analgesic efficacy compared with placebo in patients undergoing laparoscopic cholecystectomy, abdominal or pelvic surgery, bunionectomy, breast surgery, and spine surgery. When compared with intravenous opioids, oral oxycodone provided better or comparable pain relief following knee arthroplasty, spine surgery, caesarean section, laparoscopic colorectal surgery, and cardiac surgery. One study of dental postsurgery pain reported inferior pain control with oral oxycodone versus rofecoxib. (withdrawn from the US market due to cardiac safety concerns). In many studies, the demand for rescue analgesia and total opioid consumption were reduced in the oxycodone treatment arm. Patients receiving oral oxycodone experienced fewer opioid-related side effects than those on other opioids, and had a similar occurrence of postoperative nausea and vomiting as patients on placebo. Furthermore, oral oxycodone did not prolong hospital stay and was associated with lower drug costs compared with epidural and intravenous analgesics. Oxycodone administered as part of a multimodal analgesic regimen produced superior pain relief with fewer side effects and a reduced hospital stay. Limitation: There is a limited number of randomized double blinded studies in individual surgical operations, thus making it more difficult to come up with definitive conclusions. Conclusion: Oral oxycodone appears to offer safe and effective postoperative analgesia, and is a well-accepted and reasonable alternative to standard intravenous opioid analgesics. Key words: Postoperative, pain, analgesia, oral oxycodone, opioid

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Multimodal Pain Management in the Setting of Palliative Care

10.5772/intechopen.96579 ◽

2021 ◽

Author(s):

Marija V. Sholjakova ◽

Vesna M. Durnev

Keyword(s):

Palliative Care ◽

Pain Management ◽

Side Effects ◽

Pain Relief ◽

Additional Treatment ◽

Therapeutic Approaches ◽

Multimodal Pain Management ◽

Addictive Drugs ◽

Analgesic Therapy ◽

Good Organization

Pain as an integral part of palliative care (PC) is often present at the end of the life. Today, many different analgesics from opioids and non- opioids origin are in use. The integration of their use is the most effective method for pain relief. The aim of this chapter is to discuss different therapeutic approaches to pain management in palliative care. Palliative care is being confronted between the expectations and the possibilities to provide an efficient relief from the symptoms, the pain and the stress. The possibility to use opioids for pain management, with all side effects, and non-addictive drugs as additional treatment, improves the quality and the duration of life for the patients in palliative care. Since the origin of the pain is different, the use of analgesic therapy should be individualized and adapted to the real need of every person. Finally, only a good organization and institutionalization of palliative care in the society could allow for better prevention of suffering at the end of the life.

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Trigeminal Neuralgia: Outcomes after Gamma Knife Radiosurgery

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100006351 ◽

2009 ◽

Vol 36 (1) ◽

pp. 78-82 ◽

Cited By ~ 8

Author(s):

Henri Knafo ◽

Brendan Kenny ◽

David Mathieu

Keyword(s):

Quality Of Life ◽

Side Effects ◽

Pain Relief ◽

Trigeminal Neuralgia ◽

Gamma Knife ◽

Cox Regression ◽

Statistical Significance ◽

Gamma Knife Radiosurgery ◽

Cox Regression Analysis

Background:Trigeminal neuralgia (TN) often remains difficult to treat despite multiple available medications, and can severely impact on the quality of life of affected patients. Gamma knife radiosurgery has recently emerged as a minimally-invasive alternative to surgery for patients suffering from drug-resistant TN. The goal of this study was to report the short-term efficacy of gamma knife radiosurgery for TN and assess its impact on the quality of life of patients treated in the first 18 months of our experience.Methods:Patients with medically-refractory TN or with unacceptable drug side effects were considered for radiosurgery. A maximum dose of 80 Gy was administered to the affected nerve using a single 4-mm isocenter. Follow-up assessments were made at 2, 4 and 6 months, with evaluation of pain relief, drug reduction and quality of life. Factors impacting treatment response were assessed using Cox regression analysis.Results:A total of 67 patients were treated. Significant pain relief was seen in 77.6% of patients, including 32.6% who became pain-free. Patients were able to discontinue all medications in 34.3% or reduce drug intake by more than 50% in an additional 28.4% of cases. No variable was found to predict pain relief although older age (>66 years) approached statistical significance. Sensory side effects were seen in 14.9% of patients. Quality of life improved in the majority of patients after radiosurgery.Conclusions:Gamma knife radiosurgery is a safe and effective management alternative for trigeminal neuralgia, providing good or excellent pain relief and improvement in quality of life in the majority of patients with few side effects.

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Utilization of Non-Pharmacological Methods and the Perceived Barriers for Adult Postoperative Pain Management by the Nurses at Selected National Hospitals in Asmara, Eritrea

10.21203/rs.3.rs-39743/v1 ◽

2020 ◽

Author(s):

Betiel Yihdego Kidanemariam ◽

Traudl Elsholz ◽

Laban L. Simel ◽

Eyasu H. Tesfamariam ◽

Yonatan M. Andemeskel

Keyword(s):

Health Care ◽

Pain Management ◽

Postoperative Pain ◽

Pain Relief ◽

Health Care Professionals ◽

Work Experience ◽

Administrative Support ◽

Statistical Significance ◽

Demographic Data ◽

Perceived Barriers

Abstract Background Postoperative pain remains a concern to both patients and health care professionals. Non-pharmacological pain relief methods have the potential to complement pharmacological interventions and may offer alternative treatment options. The aim of the study was to assess nurses’ utilization of postoperative nurses’ non-pharmacological pain relief methods and the perceived barriers for their implementation in the National Hospitals. Methods Descriptive cross sectional study was conducted among 154 nurses working at the National Referral Hospitals and Sembel Private Hospital. A standardized five-point Likert-scale questionnaire which assesses nurses' utilization of selected non-pharmacological methods and the perceived barriers for the implementation of those methods were used to collect data. Descriptive statistics for the demographic data, independent samples t-test and one way ANOVA for the nurses’ utilization of the non-pharmacological methods and perceived barriers were used to analyze the data. Statistical significance level was set at P < 0.05. Results The study found that emotional support (45.5%), helping with daily activities (67.5%) and creating a comfortable environment (61%) were reported to be the most frequently used methods, whereas the cognitive-behavioral (5.9%) and physical methods (5.8%) were found with less frequency. The results also show that characteristics, such as the nurses' age (p = 0.013), education (p = 0.012), work experience (p = 0.001) and place of work (p = 0.001), were significantly related to the use of non-pharmacological methods. Among the various perceived barriers, health care system related barriers such as heavy work load (87.7%), shortage of time (84.4%), limited resources (82.5%), deficit in the guidelines for pain management (77.3%), lack of administrative support (76.6%) followed by patient related barriers such as patients uncooperative behavior (57.1%) were identified. Conclusion Only few of the non-pharmacological methods were found to be utilized by the nurses as pain relieving strategies and various perceived barriers are existing among the nurses towards the utilization of these methods. Nurses in these settings need training and education on non-pharmacological pain relief methods, particularly on methods that are utilized less often.

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Factors Associated With Postoperative Opioid Prescribing After Primary Elective Cesarean Section

Military Medicine ◽

10.1093/milmed/usab263 ◽

2021 ◽

Author(s):

Michael S Patzkowski ◽

Kevin L Hammond ◽

Germaine Herrera ◽

Krista B Highland

Keyword(s):

Pain Management ◽

Cesarean Section ◽

Medical Center ◽

Elective Cesarean Section ◽

Adult Women ◽

Electronic Health Record Data ◽

Present Sample ◽

Factors Associated ◽

Opioid Prescribing ◽

Medical Factors

ABSTRACT Introduction Guidelines indicate the need to balance the risks of opioid prescribing with the need to adequately manage pain after cesarean section (CS). Although guidelines suggest the need for tailored opioid prescribing, it is unclear whether providers currently tailor opioid prescribing practices given patient-related factors. Thus, research is needed to first understand post-CS pain management and opioid prescribing. The objective of the present study was to identify factors related to CS discharge opioid prescriptions. Material and Methods This retrospective cohort study was approved by the Brooke Army Medical Center Institutional Review Board (San Antonio, Texas; #C.2020.094e) on June 23, 2020. Electronic health record data of healthy adult women undergoing primary elective CS, performed under regional neuraxial anesthesia at a single, academic, tertiary medical center from 2018 to 2019, were included. Multivariable regression examined patient and medical factors associated with post-CS opioid prescriptions. Results In the present sample (N = 169), 23% (n = 39) of patients did not use opioids postoperatively, while inpatient and almost all of those patients (n = 36) received a discharge prescription for opioids with a median amount of 225 morphine milligram equivalent doses. There was a lack of evidence indicating that patient and medical factors were associated with discharge opioid dose. Conclusion Patient and medical factors were not associated with post-CS opioid prescribing. Larger studies are needed to better elucidate optimal post-CS pain management in the days and months that follow CS. Such findings are needed to better tailor opioid prescribing, consistent with clinical practice guidelines.

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Analgesic combinations as a strategy for pain relief and isobolographic analysis

Mexican Journal of Medical Research ◽

10.29057/mjmr.v3i6.1843 ◽

2015 ◽

Vol 3 (6) ◽

Author(s):

Aracely Evangelina Chávez-Piña ◽

Arlette Guadalupe Arroyo-Lira

Keyword(s):

Natural Products ◽

Pain Management ◽

Side Effects ◽

Pain Relief ◽

Adverse Effects ◽

Therapeutic Effect ◽

Fixed Ratio ◽

Opioid Analgesics ◽

Isobolographic Analysis ◽

Inflammatory Drugs

Pain is a multidimensional sensory experience that is intrinsically unpleasant and associated with hurting and soreness, it is essentially a sensation. Pain has strong, cognitive and emotional components, it is linked to, or described in terms of suffering. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) and opioid analgesics are two of the most common types of drugs used for pain management. However, the use of these analgesics is limited by the presence of significant adverse effects. A useful practice is a combination of two agents with the same therapeutic effect wherein each agent is administered to obtain additive, synergistic or subadditive interaction in a fixed ratio. If the combination resulted in addition or synergism, the doses employed by each agent are reduced, then the side effects are absent; this kind of study is named isobolographic analysis. In this review, the authors summarized previous reports of the combination of NSAIDs with opioids and natural products as an alternative in the pain management.

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