OBJECTIVE: To investigate the relationship between OPRM1 118A/G gene polymorphism and oxycodone analgesic dose in patients with cancer pain. METHODS: DNA sequencing was used to detect the genotypies of OPRM1 118 A/G site in 203 patients with moderate and severe cancer pain, and to compare the relationship between the pain degree and the dose of oxycodone at 3 and 30 days after treatment in patients with different genotypes. RESULTS: The fequencies of AA, AG and GG genotypes at the OPRM1 118 A/G site were 34.78%, 52.70%, and 12.52%, respectively. The dosage of oxycodone in GG genotype was significantly higher than that in AA genotype and AG genotype (15.44±10.19 vs. 10.25±4.53, 10.49±5.26; 89.15±27.69 vs. 43.59±12.19, 48.27±18.79) on the 3 and 30 day after treatment, difference was statistically significant (P< 0.05). CONCLUSION For cancer pain patients with GG genotype of OPRM1 118A/G site, if they need to achieve the same analgesic effect as patients with AA and AG genotype, the dose of oxycodone should be increased.
Analgesics, Opioid ; administration & dosage ; Cancer Pain ; drug therapy ; Dose-Response Relationship, Drug ; Genotype ; Humans ; Oxycodone ; administration & dosage ; Polymorphism, Single Nucleotide ; Receptors, Opioid, mu ; genetics

BACKGROUND: Intravenous patient controlled analgesia (IV-PCA) is a most common used delivery system for intravenous administration of opioids during acute post operative pain management. The objective of this study is to compare the rate of opioid induced adverse reactions and effectiveness among two IV-PCA opioids, morphine, fentanyl, in laparoscopic cholecystectomy pain management. METHODS: Sixty patients in ASA physical status 1 and 2 scheduled for laparoscopic cholecystectomy were allocated randomly to either morphine IV-PCA used (n = 30, Group M) group or fentanyl IV-PCA used (n = 30, Group F) group. In each group, numerical rating scale (NRS) score, sedation score and incidence of side effect were checked. RESULTS: NRS score of Group F showed lower than that of Group M during PACU and 3 hrs after the recovery room (P < 0.05). There were no significant differences in sedation score among two groups. The incidences of adverse reactions were similar in the two groups, though the incidence of nausea and pruritus were higher in the Group M. CONCLUSIONS: Fentanyl IV-PCA is more advantageous than morphine IV-PCA for laparoscopic cholecystectomy in view of early pain control and adverse reaction incidences.
Administration, Intravenous ; Analgesia, Patient-Controlled ; Analgesics, Opioid ; Cholecystectomy, Laparoscopic ; Fentanyl ; Humans ; Incidence ; Morphine ; Nausea ; Pain Management ; Pruritus ; Recovery Room

BACKGROUND: Ketorolac has been used to inhibit some types of postoperative pain and reduce opioids requirement. The purpose of this study is to determine if the intravenous administration of ketorolac immediately before surgery would reduce pain in the immediately postoperative period. METHODS: The children were divided into three groups randomly. Two groups were anesthetized with propofol and fentanyl. The children of one of these group (group 2) received ketorolac 1 mg/kg during the induction of anesthesia. The children of third group received ketorolac 1 mg/kg during the induction of anesthesia and anesthetized with enflurane. Pain was assessed on the arrival in the recovery room and 15minute, 30minute and 60minute thereafter. RESULTS: Pain behavior score (PBS) and faces scale (FS) on the arrival in the recovery room in group 2 were lower than those of group 1 significantly. PBS and FS at 15 min, 30 min and 60 min after arrival in the recovery room in group 3 were higher than those of group 2. CONCLUSIONS: Intravenous administration of ketorolac during anesthetic induction has postoperative analgesia after tonsillectomy and adenoidectomy in 87 children.
Adenoidectomy ; Administration, Intravenous ; Analgesia ; Analgesics, Opioid ; Anesthesia ; Child* ; Enflurane ; Fentanyl ; Humans ; Ketorolac* ; Pain, Postoperative* ; Postoperative Period ; Propofol ; Recovery Room ; Tonsillectomy*

BACKGROUND: Prostaglandin inhibitors have been successfully used to inhibit some types of postoperative pain and reduce opioids requirements in others. Antiprostaglandin activity may be ineffective unless the preparations are given at the appropriate time before surgery. This study aimed to determine if the intrarectal administration of acetaminophen immediately before surgery would markedly reduce pain in the postoperative period. METHODS: The children were divided to two groups. Each group was consisted of 15 children. The children in control group were administered intramuscularly glycopyrrolate(0.004 mg/kg) 20 minute. The children in experimental group were administered glycopyrrolate(0.004 mg/kg) intramuscularly and were administered acetaminophen(250 mg) rectally 20 minute before the children were taken to the operating theatre. RESULTS: In the recovery room, the children who had recived acetaminophen were signifcantlly quieter (p<0.01), agitated less(p<0.01) and cried less(p<0.01) painless(p<0.01) than those nonadministered group. There were no obvious differnces between the groups in intra-operative bleeding (as estimated by the surgeon), or in measured blood loss. No postopertive complications become evident. CONCLUSIONS: The preoperative rectal administration of acetaminophen for pain relief after tonsillectomy is safe and effective.
Acetaminophen* ; Administration, Rectal ; Analgesics, Opioid ; Child* ; Dihydroergotamine ; Hemorrhage ; Humans ; Pain, Postoperative* ; Postoperative Period ; Prostaglandin Antagonists ; Recovery Room ; Tonsillectomy*

PURPOSE: Nociceptin/orphanin FQ (N/OFQ) as an endogeneous hexadecapeptide is known to exert antinociceptive effects spinally. The aims of this study were to demonstrate the antinociceptive effects of i.t. N/OFQ and to investigate the possible interaction between N/OFQ and endogenous opioid systems using selective opioid receptor antagonists in rat formalin tests. MATERIALS AND METHODS: I.t. N/OFQ was injected in different doses (1-10 nmol) via a lumbar catheter prior to a 50 microL injection of 5% formalin into the right hindpaw of rats. Flinching responses were measured from 0-10 min (phase I, an initial acute state) and 11-60 min (phase II, a prolonged tonic state). To observe which opioid receptors are involved in the anti-nociceptive effect of i.t. N/OFQ in the rat-formalin tests, naltrindole (5-20 nmol), beta-funaltrexamine (1-10 nmol), and norbinaltorphimine (10 nmol), selective delta-, micro- and kappa-opioid receptor antagonists, respectively, were administered intrathecally 5 min after i.t. N/OFQ. RESULTS: I.t. N/OFQ attenuated the formalin-induced flinching responses in a dose-dependent manner in both phases I and II. I.t. administration of naltrindole and beta-funaltrexamine dose-dependently reversed the N/OFQ-induced attenuation of flinching responses in both phases; however, norbinaltorphimine did not. CONCLUSION: I.t. N/OFQ exerted an antinociceptive effect in both phases of the rat-formalin test through the nociceptin opioid peptide receptor. In addition, the results suggested that delta- and micro-opioid receptors, but not kappa-opioid receptors, are involved in the antinociceptive effects of N/OFQ in the spinal cord of rats.
Analgesics/administration & dosage/*pharmacology ; Animals ; Formaldehyde/toxicity ; Injections, Spinal ; Male ; Naltrexone/administration & dosage/analogs & derivatives/pharmacology ; Narcotic Antagonists/administration & dosage/*pharmacology ; Opioid Peptides/administration & dosage/*pharmacology ; Pain Measurement ; Rats ; Rats, Sprague-Dawley ; Receptors, Opioid/*agonists/drug effects

OBJECTIVETo investigate the preemptive analgesic efficiency of parecoxib in patients undergoing laparoscopic colorectal surgery.

METHODSForty ASA I-II patients aged 30 to 64 years undergoing laparoscopic colorectal surgery were randomized to receive either intravenous parecoxib sodium (40 mg) at anesthesia induction (group A) or intravenous parecoxib sodium (40 mg) 30 min before the completion of surgery (group B). Butorphanol was administered by patient-controlled analgesia for postoperative analgesia. The intensity of pain measured by VAS score was recorded at 2, 4, 6, 8, 12, and 24 h after the operation. The number of unsatisfied demand and the number of successfully delivered doses, butorphanol consumption at 12 h and 24 h after the operation, the patients' global evaluation of the postoperative analgesia and the number of the patients receiving rescue medication and adverse effects related to analgesia were recorded and compared between the two groups.

RESULTSThe VAS scores at different time points were significantly lower in group A than in group B (P<0.05). The number of unsatisfied demand and the number of successfully delivered doses were significantly higher and butorphanol consumption at 12 h and 24 h after the operation was significantly less in group A (P<0.05). The incidence of adverse events was similar between the two groups.

CONCLUSIONAdministration of 40 mg parecoxib sodium at anesthesia induction in the patients undergoing laparoscopic colorectal surgery can result in significant preemptive analgesia.

Adult ; Analgesia ; methods ; Analgesia, Patient-Controlled ; Analgesics, Opioid ; administration & dosage ; Butorphanol ; administration & dosage ; Colorectal Surgery ; Humans ; Isoxazoles ; administration & dosage ; Laparoscopy ; Middle Aged

OBJECTIVETo evaluate the effectiveness of the first eight pilot methadone maintenance treatment (MMT) clinics in China.

METHODSA questionnaire survey of the clients at the 8 pilot MMT clinics was performed at entry, 6 month and 12 month follow-up. Drug using behaviors, drug related crime behaviors, and relationships in families were compared among at entry, 6 and 12 months follow-up.

RESULTSThere were 585, 609 and 468 clients involved at baseline, 6 month and 12 month follow-up surveys, respectively. At entry, 6 month and 12 month follow-up, the proportion of clients whose injection of drugs reduced from 69.1% to 8.9% and 8.8%, and the frequency of injection in the past month had reduced from 90 times per month to 2 times per month. Employment rate increased from 22.9% to 43.2% and 40.6%, and self-reported criminal behaviors reduced from 20.7% to 3.6% and 3.8%. At 12 month follow-up, 65.8% of clients reported a healthy family relationship, increased from 46.8% at entry, 95.9% of clients reported that they were satisfied with the MMT service.

CONCLUSIONPilot MMT program reduced drug use, drug injecting behaviors, drug related criminal behaviors, and improved relationship with family members. Therefore, MMT clinic should be considered as a platform for providing comprehensive services to drug users.

Adult ; Analgesics, Opioid ; administration & dosage ; China ; Follow-Up Studies ; Humans ; Methadone ; administration & dosage ; Opioid-Related Disorders ; rehabilitation ; Outcome Assessment (Health Care) ; methods ; Program Evaluation ; methods ; Substance Abuse Treatment Centers ; organization & administration ; standards ; Surveys and Questionnaires

Adult ; Aged ; Analgesics, Opioid ; administration & dosage ; pharmacology ; Dose-Response Relationship, Drug ; Female ; Humans ; Injections, Spinal ; Male ; Middle Aged ; Pupil ; drug effects ; Sufentanil ; administration & dosage ; pharmacology

BACKGROUNDAwake intubation requires an anesthetic management that provides sufficient patient safety and comfort, adequate intubating conditions, and stable hemodynamics. In this prospective clinical study, our aim was to determine the median effective dose (ED(50)) of remifentanil in combination with midazolam and airway topical anesthesia for awake laryngoscopy and intubation.

METHODSThirty-six female adult patients, scheduled for elective plastic surgery under general anesthesia requiring orotracheal intubation were included in this study. Ten minutes after intravenous administration of midazolam 0.1 mg/kg, patients were assigned to receive remifentanil in bolus, followed by a continuous infusion. The bolus dose and infusion rate of remifentanil were adjusted by a modified Dixon's up-and-down method. Patient's reaction score at laryngoscopy and an Observer's Assessment of Alertness/Sedation Scale (OAA/S) were used to determine whether the remifentanil dosage regimen was accepted. During laryngoscopy, 2% lidocaine was sprayed into the airway to provide the topical anesthesia. ED(50) of remifentanil was calculated by the modified Dixon up-and-down method, and the probit analysis was then used to confirm the results obtained from the modified Dixon's up-and-down method. In the patients who were scored as "accept", patient's OAA/S and reaction scores at different observed points, intubating condition score and patient's tolerance to the endotracheal tube after intubation were evaluated and recorded. Blood pressure and heart rate at different measuring points were also noted.

RESULTSED(50) of remifentanil for awake laryngoscopy and intubation obtained by the modified Dixon's up-and-down method was (0.62 +/- 0.02) microg/kg. Using probit analysis, ED(50) and ED(95) of remifentanil were 0.63 microg/kg (95% CI, 0.54 - 0.70) and 0.83 microg/kg (95% CI, 0.73 - 2.59), respectively. Nineteen patients who were scored as "accept" had an OAA/S of > 15 and tolerated well laryngoscopy without significant discomfort or gagging. The mean intubating condition score was 1.8 +/- 0.8. The endotracheal tube was well tolerated. During awake laryngoscopy and intubation, blood pressure and heart rate were also kept stable. The postoperative follow up showed that no patient recalled discomfort and pain for airway manipulation.

CONCLUSIONSWhen combined with midazolam 0.1 mg/kg and airway topical anesthesia, ED(50) of remifentanil for successful awake laryngoscopy and intubation is 0.62 microg/kg in bolus followed by continuous infusion of 0.062 microg*kg(-1)*min(-1). This sedation and analgesia regimen can provide patient safety and comfort, ensure adequate intubating conditions, maintain hemodynamic stability, and prevent negative recall of the airway procedure.

Adolescent ; Adult ; Analgesics, Opioid ; administration & dosage ; Dose-Response Relationship, Drug ; Female ; Follow-Up Studies ; Humans ; Intubation, Intratracheal ; methods ; Laryngoscopy ; methods ; Piperidines ; administration & dosage ; adverse effects ; Prospective Studies ; Wakefulness

OBJECTIVETo evaluate the safety and analgesic efficacy of patient controlled intravenous analgesia (PCIA) with tramadol, and to compare its benefits and risks with combined spinal-epidural analgesia (CSEA)+ patient controlled epidural analgesia (PCEA).

METHODSEighty American Society of Anesthesiologist (ASA) I-II at term parturients in active labor were randomly divided into 3 groups: the control group (n = 30) received no analgesia; group A (n = 30) received spinal administration with ropivacaine 2.5 mg and fentanyl 5 microg, then with PCEA; group B (n = 20) received 1 mg/kg tramadol loading dose i.v. PCIA with 0.75% tramadol and it included: PCA dose 2 ml, lockout time 10 minutes, background infusion 2 ml/h, total dose no more than 400 mg. The intensity of pain was evaluated using Visual Analogue Scale (VAS).

RESULTSBoth group A and B showed good pain relief. VAS pain scores were significantly decreased in group A and B compared with those in the control group (P < 0.01). In comparison with group B, the VAS pain scores decreased in group A (P < 0.05). The onset times of analgesia in group A were shorter than those in group B (P < 0.05). Apgar scores in group B were lower than those in group A (P < 0.05). The periods of second stage of labor in group A were longer than those in the control group and group B (P < 0.05). The cesarean delivery rate was significantly higher in the control group (16.7%) than in group A (3.3%) and group B (5.0%), but it did not differ between group A and B. There were no significant differences in vital signs, fetal heart rate, degree of motor block, and uterine contractions among the 3 groups.

CONCLUSIONSPCIA with tramadol is now a useful alternative when patients are not candidates for CSEA for labor, or do not want to have a neuraxial block anesthesia. However, sometimes it may not provide satisfactory analgesic effect.

Adult ; Analgesia, Obstetrical ; methods ; Analgesia, Patient-Controlled ; Analgesics, Opioid ; administration & dosage ; Female ; Humans ; Pain ; prevention & control ; Pain Measurement ; Pregnancy ; Safety ; Tramadol ; administration & dosage