Regional analgesia and surgical site infections after colorectal surgery: a retrospective cohort analysis

Abstract Background The effect of regional analgesia on perioperative infectious complications remains unknown. We therefore tested the hypothesis that a composite of serious infections after colorectal surgery is less common in patients with regional analgesia than in those given Intravenous Patient-Controlled Analgesia (IV-PCA) with opiates. Methods Patients undergoing elective colorectal surgery lasting one hour or more under general anesthesia at the Cleveland Clinic Main Campus between 2009 and 2015 were included in this retrospective analysis. Exposures were defined as regional postoperative analgesia with epidurals or Transversus Abdominis Plane blocks (TAP); or IV-PCA with opiates only. The outcome was defined as a composite of in-hospital serious infections, including intraabdominal abscess, pelvic abscess, deep or organ-space Surgical Site Infection (SSI), clostridium difficile, pneumonia, or sepsis. Logistic regression model adjusted for the imbalanced potential confounding factors among the subset of matched surgeries was used to report the odds ratios along with 95% confidence limits. The significance criterion was p < 0.05. Results A total of 7811 patients met inclusion and exclusion criteria of which we successfully matched 681 regional anesthesia patients to 2862 IV-PCA only patients based on propensity scores derived from potential confounding factors. There were 82 (12%) in-hospital postoperative serious infections in the regional analgesia group vs. 285 (10%) in IV-PCA patients. Regional analgesia was not significantly associated with serious infection (odds ratio: 1.14; 95% Confidence Interval 0.87‒1.49; p-value = 0.339) after adjusting for surgical duration and volume of intraoperative crystalloids. Conclusion Regional analgesia should not be selected as postoperative analgesic technique to reduce infections.

Riesgo de la prescripción de opioides para el manejo del dolor / Risk of Opioid Prescriptions for Management of Pain / Risco de prescrição de opioides para o tratamento da dor

actualmente existe una intensa prescripción de opioides para el manejo de todo tipo de dolor a nivel clínico, razón por la cual es importante considerar los posibles daños derivados de esta actividad, tales como tolerancia, adicción, dependencia y sobredosis. La medicación de opiáceos o sus derivados de manera irracional para el manejo del dolor agudo o crónico puede ser la puerta de entrada a las drogodependencias. Muchos adictos a opiáceos informaron haber estado expuestos por primera vez a los opioides a través de una prescripción médica para el tratamiento del dolor. Por ello, es importante evaluar por parte de los profesionales de la salud el uso a largo plazo de estos medicamentos para el manejo del dolor, porque estudios han evidenciado una relación entre el uso clínico y la dependencia de estos, sobre todo en adolescentes y adultos jóvenes sin experiencia en opiáceos que fueron sometidos a procedimientos quirúrgicos y dentales.

Currently, opioids for managing all types of pain are increasingly prescribed at the clinical level, which is why it is important to consider the potential harms derived from this practice, such as tolerance, addiction, dependence, and overdose. Irrational medication of opioids or opioid derivatives for acute or chronic pain management can be the gateway to drug dependence. Many opioid addicts reported first being exposed to opioids after receiving a physician's prescription for pain management. Therefore, health professionals need to evaluate the long-term use of these medications to manage pain because studies have shown a relationship between clinical use and opioid dependence, especially in adolescents and young adults who had never received opioid therapy and who underwent surgical and dental procedures

Atualmente existe uma intensa prescrição de opioides para o manejo de todos os tipos de dor em nível clínico, por isso é importante considerar os possíveis danos decorrentes dessa atividade, como tolerância, adição, dependência e overdose. A medicação de opiáceos ou seus derivados de forma irracional para o manejo da dor aguda ou crônica pode ser a porta de entrada para a adição a drogas. Muitos dependentes de opioides relataram ter sido expostos a opioides pela primeira vez por meio de uma receita médica para o tratamento da dor. Por esse motivo, é importante que os profissionais de saúde avaliem o uso prolongado desses medicamentos para o manejo da dor, pois estudos têm mostrado relação entre o uso clínico e a dependência dos mesmos, principalmente em adolescentes e adultos jovens sem experiência com opioides que foram submetidos a procedimentos cirúrgicos e odontológicos

Effects of naltrexone hydrochloride combined with trazodone on preventing relapse in heroin addicts after detoxification / 中国基层医药

Objective:To investigate the effects of naltrexone hydrochloride combined with trazodone on preventing relapse in heroin addicts after detoxification.Methods:A total of 274 opioid heroin addicts who received treatment in Beijing Gaoxin Hospital between June 2016 and January 2019 were included in this study. After detoxification with methadone, all patients were randomly assigned to receive either naltrexone hydrochloride combined with trazodone (group 1, n = 60) or naltrexone hydrochloride alone (group 2, n = 60) for preventing relapse in heroin addicts. The effects on relapse prevention were determined in each group. Results:There were no significant differences in age distribution, sex composition, marital status, and drug use between groups 1 and 2 (all P > 0.05). After 6 months of treatment, the non-relapse rate was 86.7% (52/60) and 6.7% (4/60) in groups 1 and 2 respectively, in the case of unchanged personal life status. There was significant difference in non-relapse rate between groups 1 and 2 ( χ2 = 77.1, P < 0.001). Conclusion:Naltrexone hydrochloride combined with trazodone exhibits superior efficacy in preventing relapse in opioid heroin addicts after detoxification to naltrexone hydrochloride alone.

Consumo de opioides en pacientes hospitalizados en un centro oncológico / Use of opioids in patients admitted to a cancer centre

Resumen Los opioides son medicamentos fundamentales para mitigar el sufrimiento y mejorarla calidad de vida a través del control del dolor en pacientes con patología oncológica. Objetivo: Determinar la prevalencia de periodo de consumo de medicamentos tipo opioides y describir las características de su prescripción en pacientes hospitalizados en un centro oncológico durante el 2013. Materiales y métodos: Estudio descriptivo de corte transversal para determinar la prevalencia y las características de consumo de medicamentos opioides en 1.231 pacientes con diagnóstico confirmado de cáncer sólido o hematológico, de ambos sexos y cualquier edad, que recibieron por lo menos una dosis de cualquier tipo de opiode. Resultados: La prevalencia del consumo de opioides fue de 61,4%, siendo más frecuente en mujeres (56,6%) que en hombres (43,3%), la mediana de dosis suministrada en estadios tempra nos fue de 15 mg de morfina oral/día con un rango de 5 a 600 mg; y en estadios tardíos de 20 mg de morfina oral/día (rango 1,25 a 1.050 mg). La indicación más común para la prescripción de opioides fue el dolor agudo con un 51,1%, entendiéndose por dolor agudo aquel producido por una lesión aguda (fractura, cefalea o postoperatorio), seguida de dolor crónico con un 43,7% y en menor proporción disnea de origen tumoral (3,5%). El principal opioide utilizado para dolor agudo fue tramadol (82,9%), seguido de morfina (16,4%). Conclusión: Los resultados sugieren una asociación al mayor consumo de medicamentos opioides en estadios tardíos de enfermedad oncológica, sin embargo, se requieren más estudios para establecer este hallazgo, por otra parte, se detectaron algunos problemas de prescripción en pacientes con enfermedad renal y una baja prescripción en población pediátrica en especial en menores de siete años donde es claro que la evaluación y diagnóstico de dolor es más difícil. © 2018 Instituto Nacional de Cancerología. Publicado por Elsevier España, S.L.U. Todos los derechos reservados.

Abstract Opioids are critical for pain management in oncology patients. This group of patients requires management with these drugs to mitigate suffering and to improve quality of life. Objective: To determine the prevalence of the use of opioid-type drugs and to describe the characteristics of their prescription in hospitalised patients in a cancer centre during the year 2013. Materials and methods: A cross-sectional descriptive study was conducted to determine the prevalence and characteristics of opioid drug use. The study included 1231 patients with con firmed diagnosis of cancer, a solid haematological tumour, of both genders, and of any age, who received at least one dose of any type of opiate. Results: The prevalence of opioid consumption was 61.4%, with it being more frequent in women (56.6%) than in men (43.3%). The median dose given in early stages was 15 mg oral morphine / day with a range of 5 to 600 mg. In the late stages oral morphine 20 mg / day (range of 1.25 to 1050 mg) was used. The most common indication for opioid prescription was acute pain in 51.1%, with acute pain being understood as pain produced by an acute fracture, headache, or post-operative). This was followed by chronic pain, with 43.7%, and to a lesser extent for dyspnoea of tumour origin (3.5%). The main opioid used for acute pain was tramadol (82.9%), followed by morphine (16.4%). Conclusion: The results suggest a greater association with the consumption of opioids in the late stages of oncological disease, although more studies are needed to establish this finding. On the other hand, some prescription problems are detected in patients with renal disease and low prescription in the paediatric population. This is mainly noted in children less than 7 years-old, where it is obvious that the evaluation and diagnosis of pain is more difficult.