buprenorphine and Acute-Disease

Managed withdrawal is a necessary step prior to drug-free treatment or as the endpoint of substitution treatment.. To assess the effects of buprenorphine versus tapered doses of methadone, alpha. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 11, 2016), MEDLINE (1946 to December week 1, 2016), Embase (to 22 December 2016), PsycINFO (1806 to December week 3, 2016), and the Web of Science (to 22 December 2016) and handsearched the reference lists of articles.. Randomised controlled trials of interventions using buprenorphine to modify the signs and symptoms of withdrawal in participants who were primarily opioid dependent. Comparison interventions involved reducing doses of methadone, alpha. We used standard methodological procedures expected by Cochrane.. We included 27 studies involving 3048 participants. The main comparators were clonidine or lofexidine (14 studies). Six studies compared buprenorphine versus methadone, and seven compared different rates of buprenorphine dose reduction. We assessed 12 studies as being at high risk of bias in at least one of seven domains of methodological quality. Six of these studies compared buprenorphine with clonidine or lofexidine and two with methadone; the other four studies compared different rates of buprenorphine dose reduction.For the comparison of buprenorphine and methadone in tapered doses, meta-analysis was not possible for the outcomes of intensity of withdrawal or adverse effects. However, information reported by the individual studies was suggestive of buprenorphine and methadone having similar capacity to ameliorate opioid withdrawal, without clinically significant adverse effects. The meta-analyses that were possible support a conclusion of no difference between buprenorphine and methadone in terms of average treatment duration (mean difference (MD) 1.30 days, 95% confidence interval (CI) -8.11 to 10.72; N = 82; studies = 2; low quality) or treatment completion rates (risk ratio (RR) 1.04, 95% CI 0.91 to 1.20; N = 457; studies = 5; moderate quality).Relative to clonidine or lofexidine, buprenorphine was associated with a lower average withdrawal score (indicating less severe withdrawal) during the treatment episode, with an effect size that is considered to be small to moderate (standardised mean difference (SMD) -0.43, 95% CI -0.58 to -0.28; N = 902; studies = 7; moderate quality). Patients receiving buprenorphine stayed in treatment for longer, with an effect size that is considered to be large (SMD 0.92, 95% CI 0.57 to 1.27; N = 558; studies = 5; moderate quality) and were more likely to complete withdrawal treatment (RR 1.59, 95% CI 1.23 to 2.06; N = 1264; studies = 12; moderate quality). At the same time there was no significant difference in the incidence of adverse effects, but dropout due to adverse effects may be more likely with clonidine (RR 0.20, 95% CI 0.04 to 1.15; N = 134; studies = 3; low quality). The difference in treatment completion rates translates to a number needed to treat for an additional beneficial outcome of 4 (95% CI 3 to 6), indicating that for every four people treated with buprenorphine, we can expect that one additional person will complete treatment than with clonidine or lofexidine.For studies comparing different rate. Buprenorphine is more effective than clonidine or lofexidine for managing opioid withdrawal in terms of severity of withdrawal, duration of withdrawal treatment, and the likelihood of treatment completion.Buprenorphine and methadone appear to be equally effective, but data are limited. It remains possible that the pattern of withdrawal experienced may differ and that withdrawal symptoms may resolve more quickly with buprenorphine.It is not possible to draw any conclusions from the available evidence on the relative effectiveness of different rates of tapering the buprenorphine dose. The divergent findings of studies included in this review suggest that there may be multiple factors affecting the response to the rate of dose taper. One such factor could be whether or not the initial treatment plan includes a transition to subsequent relapse prevention treatment with naltrexone. Indeed, the use of buprenorphine to support transition to naltrexone treatment is an aspect worthy of further research.Most participants in the studies included in this review were male. None of the studies reported outcomes on the basis of sex, preventing any exploration of differences related to this variable. Consideration of sex as a factor influencing response to withdrawal treatment would be relevant research for selecting the most appropriate type of intervention for each individual.

Topics: Acute Disease; Buprenorphine; Clonidine; Female; Humans; Male; Methadone; Narcotic Antagonists; Opiate Substitution Treatment; Opioid-Related Disorders; Randomized Controlled Trials as Topic; Substance Withdrawal Syndrome

Acute pancreatitis is an acute inflammatory process of the pancreas that may also involve adjacent tissues and/or remote organ systems. Abdominal pain is the main symptom and is usually accompanied by nausea, vomiting and fever. Opoids are commonly used to manage pain in acute pancreatitis but there are still some uncertainties about their clinical effectiveness and safety.. To assess the effectiveness and safety of opioids for treating acute pancreatitis pain.. The search strategy included the Cochrane Upper Gastrointestinal and Pancreatic Diseases Review Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2013, Issue 6), MEDLINE (from 1950 to June 2013) and EMBASE (from 1980 to June 2013). There were no restrictions by language or publication status.. We considered randomised clinical trials (RCTs) assessing the effectiveness of any opioid drug used for treating acute pancreatitis pain.. Two review authors independently selected studies, assessed risks of bias and extracted data. We estimated risk ratios (RRs) for dichotomous data and calculated a 95% confidence interval (CI) for each RR. We performed an intention-to-treat (ITT) analysis. We undertook meta-analysis for some outcomes.. We included five RCTs with a total of 227 participants (age range 23 to 76 years; 65% men) with acute pancreatitis pain. The opioids assessed were intravenous and intramuscular buprenorphine, intramuscular pethidine, intravenous pentazocine, transdermal fentanyl and subcutaneous morphine.One RCT, comparing subcutaneous morphine with intravenous metamizole reported non-significant reduction in the number of participants with improvements in pain intensity (primary outcome) (RR 0.50, 95% CI 0.19 to 1.33). Three studies compared analgesia using opioids with non-opioid treatments. After excluding one study that used opioids through continuous intravenous infusion, there was a decrease in the number of patients requiring supplementary analgesia (RR 0.53, 95% CI 0.30 to 0.93). In a single study, there were no differences in the number of patients requiring supplementary analgesia between buprenorphine and pethidine (RR 0.82, 95% CI 0.61 to 1.10).Pancreatitis complications were not associated with a significant difference between the drugs tested. No clinically serious or life-threatening adverse events occurred related to treatment. No differences for this outcome were found between opioid and non-opioid treatments, or for type of adverse event (nausea-vomiting and somnolence-sedation). One death in the procaine group was reported across all the trials.One RCT comparing pethidine with intramuscular buprenorphine reported non-significant differences of supplementary analgesic, adverse events or deaths. One RCT comparing fentanyl with placebo found no difference in adverse events.The findings of this review are limited by the lack of information to allow full appraisal of the risk of bias, the measurement of relevant outcomes and the small numbers of participants and events covered by the trials.. Opioids may be an appropriate choice in the treatment of acute pancreatitis pain. Compared with other analgesic options, opioids may decrease the need for supplementary analgesia. There is currently no difference in the risk of pancreatitis complications or clinically serious adverse events between opioids and other analgesia options.Future research should focus on the design of trials with larger samples and the measurement of relevant outcomes for decision-making, such as the number of participants showing reductions in pain intensity. The reporting of these RCTs should also be improved to allow users of the medical literature to appraise their results accurately. Large longitudinal studies are also needed to establish the risk of pancreatitis complications and adverse events related to drugs.

Topics: Abdominal Pain; Acute Disease; Analgesics, Opioid; Buprenorphine; Fentanyl; Humans; Meperidine; Morphine; Pancreatitis; Pentazocine; Randomized Controlled Trials as Topic

In Australia and New Zealand, in parallel with other developed countries, the number of patients prescribed opioids on a long-term basis has grown rapidly over the last decade. The burden of chronic pain is more widely recognised and there has been an increase in the use of opioids for both cancer and non-cancer indications. While the prevalence of illicit opioid use has remained relatively stable, the diversion and abuse of prescription opioids has escalated, as has the number of individuals receiving methadone or buprenorphine pharmacotherapy for opioid addiction. As a result, the proportion of opioid-tolerant patients requiring acute pain management has increased, often presenting clinicians with greater challenges than those faced when treating the opioid-naïve. Treatment aims include effective relief of acute pain, prevention of drug withdrawal, assistance with any related social, psychiatric and behavioural issues, and ensuring continuity of long-term care. Pharmacological approaches incorporate the continuation of usual medications (or equivalent), short-term use of sometimes much higher than average doses of additional opioid, and prescription of non-opioid and adjuvant drugs, aiming to improve pain relief and attenuate opioid tolerance and/or opioid-induced hyperalgesia. Discharge planning should commence at an early stage and may involve the use of a 'Reverse Pain Ladder' aiming to limit duration of additional opioid use. Legislative requirements may restrict which drugs can be prescribed at the time of hospital discharge. At all stages, there should be appropriate and regular consultation and liaison with the patient, other treating teams and specialist services.

Topics: Acute Disease; Analgesics; Analgesics, Opioid; Animals; Australia; Buprenorphine; Buprenorphine, Naloxone Drug Combination; Drug Tolerance; Humans; Hyperalgesia; Illicit Drugs; Methadone; Naloxone; Narcotic Antagonists; Narcotics; New Zealand; Opiate Substitution Treatment; Opioid-Related Disorders; Pain; Pain, Postoperative; Patient Discharge; Preoperative Care; Substance Withdrawal Syndrome

Patients on drug-assisted rehabilitation have the same right to pain relief as others. Techniques that reduce the need for opioids should be used when possible in opioid-dependent individuals who need treatment of acute and post-operative pain. Substitution treatment should always be continued. In some situations a switch to a different opioid or route of administration is required. Higher doses of opioids than those needed in other patients may be required for analgesia. Well-designed clinical studies are lacking in this field.

Topics: Acetaminophen; Acute Disease; Analgesics, Non-Narcotic; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Buprenorphine; Glucocorticoids; Humans; Ketamine; Methadone; Opioid-Related Disorders; Pain; Pain, Postoperative; Surgical Procedures, Operative

The following is a summary of the official guidelines of the Italian Association for the Study of the Pancreas regarding the medical, endoscopic and surgical management of acute pancreatitis.. Clinical features together with elevation of the plasma concentrations of pancreatic enzymes are the cornerstones of diagnosis (recommendation A). Contrast-enhanced computed tomography (CT) provides good evidence for the presence of pancreatitis (recommendation C) and it should be carried out 48-72 h after the onset of symptoms in patients with predicted severe pancreatitis. Severity assessment is essential for the selection of the proper initial treatment in the management of acute pancreatitis (recommendation A) and should be done using the APACHE II score, serum C-reactive protein and CT assessment (recommendation C). The etiology of acute pancreatitis should be able to be determined in at least 80% of cases (recommendation B). An adequate volume of intravenous fluid should be administered promptly to correct the volume deficit and maintain basal fluid requirements (recommendation A); analgesia is crucial for the correct treatment of the disease (recommendation A). Enteral feeding is indicated in severe necrotizing pancreatitis and it is better than total parenteral nutrition (recommendation A). The use of prophylactic broad-spectrum antibiotics reduces infection rates in CT-proven necrotizing pancreatitis (recommendation A). Infected pancreatic necrosis in patients with clinical signs and symptoms of sepsis is an indication for intervention, including surgery and radiological drainage (recommendation B).. The participants agreed to revise the guidelines every 3 years in order to re-evaluate each question on the management of acute pancreatitis patients according to the most recent literature.

Topics: Acute Disease; Alanine Transaminase; Analgesics; APACHE; Buprenorphine; Cholecystectomy; Enteral Nutrition; Humans; Lipase; Pancreas; Pancreatitis; Pancreatitis, Acute Necrotizing; Tomography, X-Ray Computed

Several decades ago, the analgesic properties of buprenorphine were discovered. Its approval for the use as an agent for the treatment of opioid abuse has led to increasing numbers of patients presenting for surgery on buprenorphine. This article describes the challenges, advantages, and disadvantages of the use of buprenorphine as an analgesic for postoperative pain in patients with and without preoperative maintenance therapy.

Topics: Acute Disease; Analgesics, Opioid; Buprenorphine; Chronic Disease; Humans; Pain, Postoperative; Receptors, Opioid

Managed withdrawal is a necessary step prior to drug-free treatment or as the end point of substitution treatment.. To assess the effectiveness of interventions involving the use of buprenorphine to manage opioid withdrawal, for withdrawal signs and symptoms, completion of withdrawal and adverse effects.. We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2008), MEDLINE (January 1966 to July 2008), EMBASE (January 1985 to 2008 Week 31), PsycINFO (1967 to 7 August 2008) and reference lists of articles.. Randomised controlled trials of interventions involving the use of buprenorphine to modify the signs and symptoms of withdrawal in participants who were primarily opioid dependent. Comparison interventions involved reducing doses of methadone, alpha(2)-adrenergic agonists, symptomatic medications or placebo, or different buprenorphine-based regimes.. One author assessed studies for inclusion and methodological quality, and undertook data extraction. Inclusion decisions and the overall process was confirmed by consultation between all authors.. Twenty-two studies involving 1736 participants were included. The major comparisons were with methadone (5 studies) and clonidine or lofexidine (12 studies). Five studies compared different rates of buprenorphine dose reduction.Severity of withdrawal is similar for withdrawal managed with buprenorphine and withdrawal managed with methadone, but withdrawal symptoms may resolve more quickly with buprenorphine. It appears that completion of withdrawal treatment may be more likely with buprenorphine relative to methadone (RR 1.18; 95% CI 0.93 to 1.49, P = 0.18) but more studies are required to confirm this.Relative to clonidine or lofexidine, buprenorphine is more effective in ameliorating the symptoms of withdrawal, patients treated with buprenorphine stay in treatment for longer (SMD 0.92, 95% CI 0.57 to 1.27, P < 0.001), and are more likely to complete withdrawal treatment (RR 1.64; 95% CI 1.31 to 2.06, P < 0.001). At the same time there is no significant difference in the incidence of adverse effects, but drop-out due to adverse effects may be more likely with clonidine.. Buprenorphine is more effective than clonidine or lofexidine for the management of opioid withdrawal. Buprenorphine may offer some advantages over methadone, at least in inpatient settings, in terms of quicker resolution of withdrawal symptoms and possibly slightly higher rates of completion of withdrawal.

Topics: Acute Disease; Buprenorphine; Clonidine; Humans; Narcotic Antagonists; Opioid-Related Disorders; Randomized Controlled Trials as Topic; Substance Withdrawal Syndrome

Sublingual buphrenorphine is a unique opioid medication based on its pharmacokinetics and pharmacodynamic properties. It may be used "on label" as an alternative choice to methadone for the treatment of opioid addiction or "off-label" for the treatment of both acute and chronic pain. Because of high mu receptor affinity and resultant blockade, it has been suggested that this might interfere with the management of moderate to severe pain in patients on opioid agonist treatment. The following article will offer strategies and approaches to address some of these real and perceived challenges.

Topics: Acute Disease; Administration, Sublingual; Adult; Analgesics, Opioid; Buprenorphine; Chronic Disease; Drug Synergism; Female; Humans; Male; Middle Aged; Opioid-Related Disorders; Pain, Intractable; Receptors, Opioid

More patients with opioid addiction are receiving opioid agonist therapy (OAT) with methadone and buprenorphine. As a result, physicians will more frequently encounter patients receiving OAT who develop acutely painful conditions, requiring effective treatment strategies. Undertreatment of acute pain is suboptimal medical treatment, and patients receiving long-term OAT are at particular risk. This paper acknowledges the complex interplay among addictive disease, OAT, and acute pain management and describes 4 common misconceptions resulting in suboptimal treatment of acute pain. Clinical recommendations for providing analgesia for patients with acute pain who are receiving OAT are presented. Although challenging, acute pain in patients receiving this type of therapy can effectively be managed.

Topics: Acute Disease; Adult; Analgesics, Opioid; Buprenorphine; Female; Heroin Dependence; Humans; Methadone; Narcotic Antagonists; Pain; Recurrence; Ulna Fractures

Managed withdrawal is a necessary step prior to drug-free treatment. It may also represent the end point of maintenance treatment.. To assess the effectiveness of interventions involving the use of buprenorphine to manage opioid withdrawal, for withdrawal signs and symptoms, completion of withdrawal and adverse effects.. We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, including the Cochrane Drugs and Alcohol Group trials register, Issue 3, 2005), MEDLINE (January 1966 to August 2005), EMBASE (January 1985 to August 2005), PsycINFO (1967 to August 2005), CINAHL(1982 to July 2005) and reference lists of articles.. Experimental interventions involved the use of buprenorphine to modify the signs and symptoms of withdrawal in participants who were primarily opioid dependent. Comparison interventions involved reducing doses of methadone, alpha2 adrenergic agonists, symptomatic medications or placebo, or different buprenorphine-based regimes.. One reviewer assessed studies for inclusion and methodological quality, and undertook data extraction. Inclusion decisions and the overall process was confirmed by consultation between all three reviewers.. Eighteen studies (14 randomised controlled trials), involving 1356 participants, were included. Ten studies compared buprenorphine with clonidine; four compared buprenorphine with methadone; one compared buprenorphine with oxazepam; three compared different rates of buprenorphine dose reduction; two compared different starting doses of buprenorphine. (Two studies included more than one comparison.)Relative to clonidine, buprenorphine is more effective in ameliorating the symptoms of withdrawal, patients treated with buprenorphine stay in treatment for longer, particularly in an outpatient setting (SMD 0.82, 95% CI 0.57 to 1.06, P < 0.001), and are more likely to complete withdrawal treatment (RR 1.73, 95% CI 1.21 to 2.47, P = 0.003). At the same time there is no significant difference in the incidence of adverse effects, but drop-out due to adverse effects may be more likely with clonidine. Severity of withdrawal is similar for withdrawal managed with buprenorphine and withdrawal managed with methadone, but withdrawal symptoms may resolve more quickly with buprenorphine. There is a trend towards completion of withdrawal treatment being more likely with buprenorphine relative to methadone (RR 1.30, 95% CI 0.97 to 1.73, P = 0.08).. Buprenorphine is more effective than clonidine for the management of opioid withdrawal. There appears to be no significant difference between buprenorphine and methadone in terms of completion of treatment, but withdrawal symptoms may resolve more quickly with buprenorphine.

Topics: Acute Disease; Buprenorphine; Clonidine; Humans; Narcotic Antagonists; Opioid-Related Disorders; Randomized Controlled Trials as Topic; Substance Withdrawal Syndrome

Managed withdrawal (detoxification) is a necessary step prior to drug-free treatment. It may also represent the end point of long-term opioid replacement treatment such as methadone maintenance. The availability of managed withdrawal is essential to an effective treatment system.. To assess the effectiveness of interventions involving the use of buprenorphine to manage opioid withdrawal, in terms of withdrawal signs and symptoms, completion of withdrawal and adverse effects.. Multiple electronic databases (including Medline, Embase, PsycINFO, Australian Medical Index, Cochrane Clinical Trials Register) were systematically searched to October 2003. Reference lists of retrieved studies, reviews and conference abstracts were handsearched.. Controlled trials comparing buprenorphine with reducing doses of methadone, alpha2 adrenergic agonists, symptomatic medications or placebo, or comparing different buprenorphine-based regimes, to modify the signs and symptoms of withdrawal in participants who were primarily opioid dependent.. One reviewer assessed studies for inclusion and undertook data extraction. Inclusion decisions and the overall process were confirmed by consultation between all three reviewers. Included studies were assessed for methodological quality. Meta-analysis was undertaken where possible, with sensitivity analyses used to assess the impact of methodological quality.. Thirteen studies (10 RCTs), involving 744 participants, met the criteria for inclusion in the review. Seven studies compared buprenorphine with clonidine; 3 compared buprenorphine with methadone; 1 compared buprenorphine with oxazepam; 2 compared rapid and slow rates of tapering buprenorphine dose; 1 compared 3 different starting doses of buprenorphine. For groups treated with buprenorphine, withdrawal severity was less than that in groups treated with clonidine; peak severity was similar to those treated with methadone, but withdrawal symptoms may resolve more quickly with buprenorphine. Withdrawal is probably more severe when doses are tapered rapidly following a period of maintenance treatment. Buprenorphine is associated with fewer adverse effects than clonidine, and completion of withdrawal is significantly more likely with buprenorphine (Relative Risk 1.35, 95% confidence interval 1.13, 1.62). In the two available studies, there was no statistically significant difference in rates of completion of withdrawal for buprenorphine compared to methadone in reducing doses. Completion of withdrawal following buprenorphine maintenance treatment may be more likely when doses are reduced gradually.. Buprenorphine is more effective than clonidine for the management of opioid withdrawal. There appears to be no significant difference between buprenorphine and methadone in terms of completion of withdrawal, but withdrawal symptoms may resolve more quickly with buprenorphine. Many aspects of treatment protocol and relative effectiveness need to be investigated further in order to determine the most effective way of using buprenorphine to manage opioid withdrawal.

Topics: Acute Disease; Buprenorphine; Clonidine; Humans; Narcotic Antagonists; Opioid-Related Disorders; Randomized Controlled Trials as Topic; Substance Withdrawal Syndrome

Acute pancreatitis is a disease with a wide variety of pathophysiologies, ranging from mild to severe condition. In about 80% to 90% of cases, acute pancreatitis presents as a mild inflammation with low morbidity and mortality, self-reversing to normal condition within 3-4 days. However, the natural course of severe pancreatitis progresses into SIRS and necrosis of the pancreas and its surrounding tissue. And infection of the necrotic tissue develops in sepsis and organ failures. Therefore, the initial management for acute pancreatitis would significantly contribute on the early prognosis. The first step includes not only diagnosis but also initial treatment according to etiological assessment and severity stratification. The summarization of initial management revealed as follows: monitorings of temperature, pulse rate, blood pressure, urine output volume, abdominal pain etc, and treatments of cardio-pulmonary care with sufficient fluid resuscitation, pain control, resting of pancreas etc. As the treatment of the initial management after initial onset, the significances of nasogastric tube drainage, prophylactic use of broadspectrum antibiotics, continuous infusion of protease inhibitors, use of H2 receptor antagonists, control by enteral nutrition and so on have been discussed. And also the indications of total parenteral nutrition, selective digestive decontamination and the efficacies of peritoneal lavage, continuous hemodiafiltration and continuous arterial infusion of protease inhibitor and antibiotics have been reviewed. For those events, the evidences were collected by a systemic search of MEDLINE and Japan Centra Revues Medicina. And then practical recommendations were also graded and introduced to provide a framework for clinitians to manage acute pancreatitis as a guideline. This paper described a part of those recommendations.

Topics: Acute Disease; Analgesics, Opioid; Antibiotic Prophylaxis; Biopsy, Fine-Needle; Buprenorphine; Critical Care; Debridement; Diagnosis, Differential; Drainage; Fasting; Fluid Therapy; Gabexate; Histamine H2 Antagonists; Humans; Pancreatitis; Parenteral Nutrition; Patient Transfer; Practice Guidelines as Topic; Serine Proteinase Inhibitors

Managed withdrawal (detoxification) is a necessary step prior to drug-free treatment. It may also represent the end point of long-term opioid replacement treatment such as methadone maintenance. The availability of managed withdrawal is essential to an effective treatment system.. To assess the effectiveness of interventions involving the short-term use of buprenorphine to manage the acute phase of opioid withdrawal.. Multiple electronic databases were searched using a strategy designed to retrieve references broadly addressing the management of opioid withdrawal. Reference lists of retrieved studies, reviews and conference abstracts were handsearched.. Randomised or quasi-randomised controlled clinical trials or prospective controlled cohort studies that compared different buprenorphine regimes, or that compared buprenorphine with another form of treatment (or placebo) to modify the signs and symptoms of withdrawal in participants who were primarily opioid dependent.. Potentially relevant studies were assessed for inclusion by one reviewer. Inclusion decisions were confirmed by consultation between reviewers. One reviewer undertook data extraction with the process confirmed by consultation between all three reviewers.. Six studies (5 RCTs and 1 controlled prospective study), involving 357 participants, met the criteria for inclusion in the review. Four studies compared buprenorphine with clonidine. All found withdrawal to be less severe in the buprenorphine treatment group. In three of these studies all participants were withdrawing from heroin. Participants in one study were withdrawing from methadone (10mg/day). Aches, restlessness, yawning, mydriasis, tremor, insomnia, nausea and mild anxiety were reported as being experienced by some participants. Rates of completion of withdrawal ranged from 65% to 100%. None of the studies included in the review reported adverse effects. However a single-group study which therefore did not meet the inclusion criteria, reported the occurrence in some participants of headaches, sedation, nausea, constipation, anxiety, dizziness and itchiness, particularly in the first 2-3 days of treatment. In one of the six studies, and in two studies that did not meet the inclusion criteria, treatment was provided on an outpatient basis.. Buprenorphine has potential as a medication to ameliorate the signs and symptoms of withdrawal from heroin, and possibly methadone, but many aspects of treatment protocol and relative effectiveness need to be investigated further.

Topics: Acute Disease; Buprenorphine; Humans; Narcotic Antagonists; Opioid-Related Disorders; Randomized Controlled Trials as Topic; Substance Withdrawal Syndrome

Managed withdrawal, or detoxification, is not in itself a treatment for opioid dependence, but it is a required first step for many forms of longer-term treatment. It may also represent the end point of an extensive period of treatment such as methadone maintenance. As such, managed withdrawal is an essential component of an effective treatment system. This review is one of a series that aims to assess the evidence as to the effectiveness of the variety of approaches to managing opioid withdrawal.. To assess the effectiveness of interventions involving the short-term use of buprenorphine to manage the acute phase of opioid withdrawal.. Multiple electronic databases, including Medline, Embase, Psychlit, Australian Medical Index and Current Contents, were searched using a strategy designed to retrieve references broadly addressing the management of opioid withdrawal. Reference lists of retrieved studies, reviews and conference abstracts were handsearched.. We included randomised or quasi-randomised controlled clinical trials or prospective controlled cohort studies comparing buprenorphine (treatment 10 days or less) with another form of treatment. Studies were required to provide detailed information on the type and dose of drugs used and the characteristics of patients treated. Studies were also required to provide information on the nature of withdrawal signs and symptoms experienced, the occurrence of adverse effects OR rates of completion of the withdrawal episode.. Potentially relevant studies were assessed for inclusion by one reviewer (LG). Inclusion decisions were confirmed by consultation between reviewers. Included studies were assessed by all reviewers. One reviewer (LG) undertook data extraction with the process confirmed by consultation between all three reviewers.. Five studies met the criteria for inclusion in the review. No data tables are included in this review and no meta-analysis has been undertaken because of differences in treatment regimes and the assessment of outcomes in these studies. Four studies compared buprenorphine with clonidine. All found withdrawal to be less severe in the buprenorphine treatment group. In three of these studies all participants were withdrawing from heroin. Participants in one study were withdrawing from methadone, with doses reduced to 10mg/day prior to treatment with buprenorphine. Three of the studies commented on residual symptoms experienced by participants treated with buprenorphine to manage heroin withdrawal. Aches, restlessness, yawning, mydriasis, tremor, insomnia, nausea and mild anxiety were reported as being experienced by some participants. Rates of completion of withdrawal were able to be calculated for all studies included in the review but the definition of completion varied between studies. Rates ranged from 65% to 100%. None of the studies included in the review reported adverse effects. However, approximately approximately Lintzeris 1999a approximately approximately (a single-group study which therefore did not meet the inclusion criteria) reported 50% of participants withdrawing from heroin experienced headaches, 28% sedation, 21% nausea, 21% constipation, 21% anxiety, 17% dizziness and 17% itchiness during withdrawal. These adverse effects were most common in the first 2-3 days of treatment and then subsided. In four of the five studies treatment was undertaken on an inpatient basis. Only approximately approximately O'Connor 1997 approximately approximately provided outpatient treatment. However, two studies that did not meet the inclusion criteria ( approximately approximately Diamant 1998 approximately approximately and approximately approximately Lintzeris 1999a approximately approximately ) also provided outpatient treatment. The findings of these studies support the feasibility of heroin withdrawal being managed with buprenorphine on an outpatient basis

Topics: Acute Disease; Buprenorphine; Humans; Narcotic Antagonists; Opioid-Related Disorders; Randomized Controlled Trials as Topic; Substance Withdrawal Syndrome

The aim of this study was to assess the safety of buprenorphine administered intravenously for the treatment of opioid withdrawal in medically ill hospitalized patients. Data regarding demographic information, number of doses of buprenorphine, and measures of buprenorphine's effects were collected via chart reviews for 30 heroin-dependent patients who received buprenorphine intravenously during their hospitalization for an acute medical problem. No respiratory depression was observed, and no patients reported feeling "high." All patients reported that buprenorphine decreased withdrawal symptoms. Thus, intravenous administration of buprenorphine appears to be safe for the treatment of opioid withdrawal.

Topics: Acute Disease; Adult; Buprenorphine; Female; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Middle Aged; Narcotic Antagonists; Substance Withdrawal Syndrome

To assess the analgesic efficacy and side effects of buprenorphine and procaine in patients with acute pancreatitis.. Forty patients (average age, 50 years; 23 male) with acute pancreatitis or an acute bout of a chronic pancreatitis were prospectively randomized to receive buprenorphine or procaine for pain relief. Both analgesics were administered as constant intravenous (i.v.) infusions and additional analgesics were given on demand. Pain scores were assessed on a visual analogue scale. Close clinical control and laboratory checks were performed during the three-day study period.. Patients receiving buprenorphine were significantly less likely to demand additional analgesics (1 versus 14 patients; P < 0.0001). The pain scores for patients in the buprenorphine group were significantly lower over the treatment period in comparison to procaine (P < 0.05). The reduction of pain score was significantly greater during the initial two treatment days using buprenorphine (day 1: 55 versus 25, P < 0.0001; day 2: 62 versus 40, P = 0.005). Side effects were comparable for both groups with the exception of a slightly higher sedation rate under buprenorphine.. Constant i.v. application of buprenorphine is more effective than the recommended procaine for pain relief in acute pancreatitis.

Topics: Acute Disease; Adult; Aged; Analgesics; Analgesics, Opioid; Buprenorphine; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Pain; Pain Measurement; Pancreatitis; Procaine; Prospective Studies

Topics: Acute Disease; Analgesia; Buprenorphine; Humans; Meperidine; Morphinans; Pancreatitis

Topics: Acute Disease; Ambulatory Care; Buprenorphine; Clinical Trials as Topic; Colic; Female; Humans; Indomethacin; Male; Meperidine; Palliative Care; Pentazocine; Random Allocation; Ureteral Calculi

Naloxone is a frequently utilized and effective treatment to reverse the life-threatening effects of illicit opioid intoxication. Excessive naloxone dosing in these circumstances, however, may lead to naloxone-precipitated opioid withdrawal in individuals with opioid dependence. Buprenorphine, a partial mu-opioid agonist, is increasingly utilized in the Emergency Department (ED) for the treatment of opioid withdrawal syndrome but little is known regarding its utility in cases of naloxone-precipitated opioid withdrawal. We report a case of naloxone-precipitated opioid withdrawal that was effectively treated with sublingual buprenorphine. An older male was brought into the ED with signs and symptoms of opioid toxicity that was successfully treated with pre-hospital naloxone by Emergency Medical Services. He had a clinical opioid withdrawal scale (COWS) or 10 with abdominal cramping and unintentional defecation. After a discussion of treatment options and possible adverse effects with the patient, the decision was made to administer 4 mg/1 mg of sublingual buprenorphine/naloxone film. The patient reported a rapid improvement in symptoms and at 30 min posttreatment, his COWS was 4. His COWS decreased to 3 at 1 h and this was sustained for 4 h of observation. The patient was subsequently discharged to a treatment facility for opioid use disorder. This case highlights the potential of buprenorphine as a treatment modality for acute naloxone-precipitated opioid withdrawal. Due to the risks of worsening or sustained buprenorphine-precipitated opioid withdrawal, further research is warranted to identify patients who may benefit from this therapy.

Topics: Acute Disease; Administration, Sublingual; Aged; Buprenorphine; Humans; Male; Naloxone; Narcotic Antagonists; Opioid-Related Disorders; Substance Withdrawal Syndrome

The result of the increase in drug abuse is a growing number of patients receiving methadone or buprenorphine\ substitution therapy. Physicians are increasingly confronted with patients on substitution therapy at the time when they\ are developing acute pain conditions or when they need surgery. Although pain has sensory qualities, it is a very personal\ and complex experience. The intensity and duration of pain are influenced by numerous factors. Poorly controlled pain\ leads to unnecessary suffering of the patients with the possibility of permanent changes in behavior and reduced quality\ of life. Efficacious pain treatment is considered a basic right of every patient. Because of the complex mechanisms of the\ emergence and transmission of pain and the emotional components that are involved in the experience of pain, appropriate\ pain relief in patients on substitution therapy is a major challenge for both the physicians and the patients. The article gives\ an overview of issues related to the treatment of acute pain and perioperative treatment in patients on substitution therapy\ with methadone and buprenorphine. The article highlights the wrong common misconception about pain treatment in these\ patients, which also are the most common cause of their inadequate treatment.

Topics: Acute Disease; Buprenorphine; Humans; Methadone; Opiate Substitution Treatment; Pain; Pain Management; Quality of Life

Urinary retention is associated with buprenorphine, particularly with epidural/intrathecal delivery. However, it is rare with oral administration. This case report illustrates an occurrence of acute urinary retention after initiation of oral buprenorphine/naloxone.

Topics: Acute Disease; Buprenorphine; Humans; Male; Middle Aged; Opiate Substitution Treatment; Urinary Retention

Certain behavioral features of buprenorphine, including a bell-shaped curve for antinociception and attenuation of alcohol consumption, are thought to be mediated by activation of nociceptin/orphanin FQ peptide (NOP) receptors, despite moderate affinity and low efficacy at NOP receptors. We hypothesized that ligands with buprenorphine's physical properties, but possessing increased NOP receptor affinity and efficacy, would improve the profile as a drug abuse medication and reduce addiction liability. Using this strategy, we designed several compounds with universally high affinity, i.e., less than 10 nM at μ, δ, κ, and NOP receptors. Among these, (2S)-2-[(5R,6R,7R,14S)-N-cyclopropylmethyl-4,5-epoxy-6,14-ethano-3-hydroxy-6-methoxymorphinan-7-yl]-3,3-dimethylpentan-2-ol (BU08028) has high affinity at all opioid receptors and increased NOP receptor efficacy in vitro in the [³⁵S]GTPγS binding assay, however, while still being a partial agonist. In vivo, BU08028 was evaluated in an acute thermal antinociception assay, for its ability to induce conditioned place preference (CPP), and for its effect on cocaine-induced CPP. BU08028 is a very potent long-lasting analgesic. It produces an increase in locomotor activity and a significant CPP. As a pretreatment to cocaine, BU08028 does not alter cocaine CPP but causes a further increase in cocaine-induced locomotor activity. The analgesic, rewarding, and stimulant effects are probably caused by μ receptor stimulation. It is likely that with BU08028, a partial agonist at both NOP and μ receptors, μ-mediated activity overpowers NOP-mediated effects. Thus, it is possible that a different buprenorphine analog that is a universal high-affinity opioid ligand but with "full agonist" activity at NOP may counteract traditional opioid-mediated effects such as antinociception and reward.

Topics: Acute Disease; Analgesics, Opioid; Animals; Buprenorphine; CHO Cells; Cocaine; Cricetinae; Cricetulus; Disease Models, Animal; Humans; Ligands; Male; Mice; Mice, Inbred ICR; Pain; Pain Measurement; Protein Binding; Receptors, Opioid; Reward

Leukoencephalopathies have been reported after heroin inhalation or ingestion, and buprenorphine injection, but the physiopathology remains unclear. We report here the first case of leukoencephalopathy caused by buprenorphine ingestion in a 2-year-old child who was admitted for coma and fever. Due to technical problems, the toxicology screen was delayed, and infectious disease was first suspected. A brain MRI found bilateral and symmetric white matter damages in the cerebral hemispheres and the cerebellum. Rapid recovery and positive toxicology screen for buprenorphine on day 4 confirmed the diagnosis of acute intoxication.

Topics: Acute Disease; Analgesics, Opioid; Brain Damage, Chronic; Buprenorphine; Child, Preschool; Coma; Fever; Humans; Leukoencephalopathies; Magnetic Resonance Imaging; Male

To report 2 cases of acute hepatitis related to intravenous administration of buprenorphine in hepatitis C-infected patients.. Two patients, aged 33 and 50 years, respectively, who were hepatitis C virus (HCV) carriers were treated with sublingual buprenorphine 8 mg/day for addiction. Several years after initiation of buprenorphine, they were hospitalized because of clinical hepatitis with jaundice that developed after intravenous injection of buprenorphine. Serum alanine aminotransferase rose to 100 times the upper limit of normal (ULN) in the first patient and to 21 times the ULN in the second. As cofactors, the first patient had consumed alcohol, and the second patient took aspirin 600 mg in addition to the injection of buprenorphine 20 mg 4 days before the onset of jaundice. After stopping the intravenous injections, both patients continued sublingual buprenorphine therapy, with no relapse of hepatitis. Interestingly, in these 2 patients, buprenorphine-induced hepatitis was followed by the disappearance of HCV RNA.. Most cases of hepatotoxicity related to buprenorphine have occurred in hepatitis C-infected patients. The main mechanism for buprenorphine-induced hepatitis is a mitochondrial defect, exacerbated by cofactors with additional potential to induce mitochondria dysfunction (eg, HCV, alcohol, concomitant medications). According to the Naranjo probability scale, buprenorphine was found to be the probable cause of acute hepatitis in both patients. In addition, we assessed the relationship between intravenous buprenorphine and acute hepatitis using 2 scales for causality assessment of hepatotoxicity (the Council for International Organizations of Medical Sciences scale and the Maria & Victorino scale). The diagnosis of intravenous buprenorphine-induced hepatitis was classified as probable in both cases. In addition, these 2 cases illustrate that acute hepatitis in a carrier of chronic HCV may occasionally facilitate the clearance of virus.. Although buprenorphine is well tolerated when used at recommended sublingual doses, patients should be informed about the risk of acute hepatitis with misuse of the drug by the intravenous route. These cases illustrate that, in carriers of chronic HCV, acute hepatitis may modify the host's immunotolerance and facilitate clearance of the virus.

Topics: Acute Disease; Administration, Sublingual; Adult; Buprenorphine; Carrier State; Hepacivirus; Hepatitis C; Humans; Injections, Intravenous; Male; Middle Aged; Narcotic Antagonists; Virus Replication

Empirical evidence is needed to guide adequate postpartum pain relief of methadone and buprenorphine stabilized patients.. To first determine the adequacy of pain control using non-opioid and opioid medication in participants stabilized on buprenorphine or methadone before a vaginal delivery. Second, to compare the amount of non-opioid and opioid medication needed for adequate pain control for buprenorphine-and methadone-maintained patients during the immediate postpartum period.. Pain control adequacy and amount of non-opioid and opioid medication needed in buprenorphine- (n = 8) and methadone-maintained (n = 10) patients over the first five days postpartum were examined.. Pain ratings and number of opioid medication doses decreased over time in both medication groups. While the buprenorphine and methadone groups began with similar mean daily ibuprofen (IB) doses, the buprenorphine group decreased its IB use, while the methadone group increased its IB use.. Patients treated daily with either buprenorphine or methadone can have adequate pain control postpartum with opioid medication and IB. Pain control is dependent on the opioid-agonist medication in use at delivery, and must be individualized.

Topics: Acute Disease; Adult; Analgesics, Non-Narcotic; Analgesics, Opioid; Buprenorphine; Controlled Clinical Trials as Topic; Double-Blind Method; Female; Humans; Ibuprofen; Methadone; Opioid-Related Disorders; Pain; Pain Measurement; Postpartum Period; Pregnancy; Pregnancy Complications

Buprenorphine has been approved for heroin detoxification, but little is known about its impact on everyday practice. Concerns about buprenorphine include expense, limited knowledge about its use, patient limits, and social and clinical attitudes regarding opioid treatment for heroin dependence. On the other hand, randomized clinical trials suggest that buprenorphine is superior to clonidine with regard to withdrawal symptom relief. In June 2004, a community-based residential medical detoxification center switched from clonidine to buprenorphine treatment for all new and returning heroin clients. This study is a retrospective chart review of subject outcomes with clonidine (n = 100) versus buprenorphine (n = 100). Bivariate analysis suggested few cohort differences in pretreatment demographics and client characteristics. In contrast, buprenorphine was significantly associated with increased length of stay and treatment completion. The positive associations between buprenorphine and both treatment completion and length of stay persisted and were slightly enhanced after regression analysis adjusted for potential confounders. Additionally, clinical staff reported better subject engagement in treatment and psychosocial group sessions. This single-site study is an example of successful integration of an evidence-based treatment into community-based practice.

Topics: Acute Disease; Adult; Buprenorphine; Clonidine; Diffusion of Innovation; Female; Heroin; Heroin Dependence; Humans; Length of Stay; Male; Middle Aged; Narcotics; Oregon; Patient Acceptance of Health Care; Retrospective Studies; Substance Withdrawal Syndrome; Treatment Outcome

Topics: Acute Disease; Adult; Analgesics, Opioid; Antineoplastic Agents, Alkylating; Buprenorphine; Humans; Ifosfamide; Male; Osteosarcoma; Pain; Pelvic Neoplasms; Respiratory Insufficiency; Skull Neoplasms

Buprenorphine is a potent opioid analgesic clinically used to treat moderate to severe pain. The present study assessed its analgesic efficacy in a broad range of rodent models of acute and chronic pain. In the phenylquinone writhing, hot plate, and tail flick mouse models of acute pain, full analgesic efficacy was obtained (ED50 values: 0.0084-0.16 mg/kg i.v.). Full analgesic efficacy was also obtained in yeast- and formalin-induced inflammatory pain (ED50 values: 0.0024-0.025 mg/kg i.v., rats and mice) and in mustard-oil-induced spontaneous pain, referred allodynia, and referred hyperalgesia in mice (ED50 values: 0.018-0.025 mg/kg i.v.). Buprenorphine strongly inhibited mechanical and cold allodynia in mononeuropathic rats, as well as mechanical hyperalgesia and cold allodynia in polyneuropathic rats (ED50 values: 0.055 and 0.036 mg/kg i.v. and 0.129 and 0.038 mg/kg i.p., respectively). It is concluded that buprenorphine shows a broad analgesic profile and offers the opportunity to treat different pain conditions, including neuropathic pain.

Topics: Acute Disease; Analgesics, Opioid; Animals; Buprenorphine; Chronic Disease; Disease Models, Animal; Dose-Response Relationship, Drug; Male; Mice; Pain; Pain Measurement; Rats; Rats, Sprague-Dawley

Groups of mice were infected with tachyzoites of the RH strain of Toxoplasma gondii, treated with the opioid analgesic buprenorphine, sodium sulfadiazine, a combination of buprenorphine and sodium sulfadiazine, or nothing in the drinking water, on days -1 to 12 postinfection. Mice in the T. gondii-infected buprenorphine-treated group did not live significantly longer (P > 0.05) than mice given T. gondii and not treated with buprenorphine. Clinical observations of mice indicated that buprenorphine treatment reduced distress and pain in mice with acute toxoplasmosis. Mice treated with sodium sulfadiazine alone or sodium sulfadiazine combined with buprenorphine survived the 28-day study. Mice treated with buprenorphine and not infected with T. gondii also survived the 28 days. This study demonstrates that buprenorphine does not adversely interfere with acute T. gondii infection and indicates that buprenorphine can be given to mice to alleviate pain and distress associated with a T. gondii infection, and not adversely influence the results of toxoplasmosis studies. Analgesic (buprenorphine) treatment should now be the standard of care for mice in acute toxoplasmosis studies.

Topics: Acute Disease; Analgesics, Opioid; Animals; Buprenorphine; Cell Line; Chlorocebus aethiops; Coccidiostats; Disease Models, Animal; Female; Mice; Pain; Sulfadiazine; Toxoplasma; Toxoplasmosis, Animal

Topics: Acute Disease; Adult; Analgesics, Opioid; Buprenorphine; Female; Heroin Dependence; Humans; Pancreatic Function Tests; Pancreatitis; Substance-Related Disorders

Buprenorphine, a synthetic molecule derived from thebaine, has been commercialized in France since 1987 as a substitute treatment for pharmacodependence on opiates. Hepatotoxicity is poorly documented, since only few cases of hepatic injury have been reported.. We report seven cases of acute cytolytic hepatitis due to buprenorphine. All patients were former drug addicts by the parenteral route and had been receiving withdrawal therapy with buprenorphine for an average of 91 days at a daily dosage ranging from 2 to 12 mg. Liver tests, complete viral screening and an abdominal computerized tomography scan were performed in each patient.. Five out of seven subjects presented with acute icteric hepatitis without abdominal pain or fever. Average alanine aminotransferase levels were 39 times the normal rate. There was no sign of liver failure. All patients had anti-hepatitis C virus-positive serology and two had positive hepatitis C virus-RNA. Although no specific treatment was administered, buprenorphine doses were reduced whenever possible. Cytolysis and jaundice resolved rapidly in all cases, although treatment was continued at the same doses in four cases and the dosage was reduced by 50% in three other cases.. Although buprenorphine hepatitis is uncommon and has spontaneously good evolution, we suggest better monitoring of hepatic profiles in patients whose mitochondrial function is already impaired by viral infections or other toxic factors.

Topics: Acute Disease; Administration, Sublingual; Adult; Buprenorphine; Causality; Female; Hepatitis C; Humans; Injections, Intravenous; Male; Mitochondria, Liver; Narcotic Antagonists; Substance-Related Disorders

Topics: Acute Disease; Adult; Buprenorphine; Chemical and Drug Induced Liver Injury; Female; Heroin Dependence; Humans; Injections, Intravenous

Continuous epidural anesthesia was used in a 34 year-old pregnant woman with acute pancreatitis related to hypertriglyceridemia. She underwent an emergency cesarean section due to severe pancreatitis under spinal anesthesia. After delivery, extended incision was made to examine the pancreas and to perform drainage. Epidural infusion using 1% mepivacaine and buprenorphine was started to reduce pain and improve microcirculation. After starting epidural infusion with other therapies, clinical feature and data improved. This case suggests that reduction of severe pain and improvement of microcirculation are important in therapies of severe pancreatitis.

Topics: Acute Disease; Adult; Anesthesia, Epidural; Anesthesia, Obstetrical; Buprenorphine; Cesarean Section; Emergencies; Female; Humans; Mepivacaine; Pancreatitis; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Third

Intraarterial injection may result in acute ischemia and amputation. The authors describe the case of a 27-year-old man with an acute hand ischemia following intraarterial injection of a suspension of buprenorphine. Despite its initial severity, this case was successfully treated with iloprost, a stable prostacyclin analogue, and dextran-40, a low-molecular-weight dextran.

Topics: Acute Disease; Adult; Anticoagulants; Buprenorphine; Dextrans; Hand; Humans; Iloprost; Infusions, Intravenous; Injections, Intra-Arterial; Injections, Intravenous; Ischemia; Male; Narcotics; Vasodilator Agents

Adequate dosage of sublingual buprenorphine is now recommended for substitution treatment of severe opioid dependance. We report two cases of acute discomfort, probably linked to withdrawal syndrome, after an IV injection of high doses of buprenorphine in opiate dependant patients. Data on the pharmacokinetics and neurobiochemical aspects of buprenorphine are compared with those of other opiates. A major issue of this work is a guideline for inducing substitution treatment with this "unique" partial agonist/antagonist of endorphinic receptors.

Topics: Acute Disease; Adult; Buprenorphine; Female; Humans; Injections, Intravenous; Male; Narcotics; Opioid-Related Disorders; Substance Withdrawal Syndrome

Pancreatic enzyme secretion is inhibited during acute pancreatitis, resulting in an increase in acinar zymogen content. Since the premature activation of zymogens has been assigned a central role in the pathogenesis of acute pancreatitis, minimizing the amount of stored zymogens might lead to less severe acute pancreatitis. Inhibition of enzyme synthesis or stimulation of enzyme secretion would result in reduction of zymogen stores. Opiates have a varying effect on pancreatic secretion, depending on the dosage, site of administration, and presence of pancreatic stimulants. The effect of opiates and acute pancreatitis on individual pancreatic enzyme synthesis is unknown. The following study was undertaken in order to examine the effects of an opiate on pancreatic enzyme secretion and synthesis during experimental acute pancreatitis. Four groups of rats were studied. Group I received cerulein (25 micrograms/kg); group II received an opiate, buprenorphine (BPN, 0.5 mg/kg); and group III received cerulein and BPN. Drugs were dissolved in gelatin/saline and injected subcutaneously. A control group (group IV) received only gelatin/saline. Rats were sacrificed 4 hr after injection, and pancreatic mass was measured. Pancreatic acini were prepared and assayed for amylase and DNA content. Amylase, trypsinogen, chymotrypsinogen and lipase synthesis, and amylase secretion were measured for 2 hr. Results showed that, compared to controls, acini of rats with AP had increased amylase content, a finding consistent with decreased in vivo amylase secretion. Total protein and individual enzyme synthesis rates were significantly lower in the acini of the rats with AP than in those of the controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Amylases; Animals; Buprenorphine; Ceruletide; Chymotrypsinogen; Edema; Lipase; Male; Pancreas; Pancreatitis; Rats; Rats, Inbred Strains; Trypsinogen

A 21-year-old woman developed noncardiogenic pulmonary edema within 90 min after the use of buprenorphine, 0.2 mg, sublingually for severe dysmenorrhea. No organic cardiovascular illness was detected. The pulmonary edema resolved spontaneously with conservative treatment. The mechanism of pulmonary edema may be an allergic reaction to buprenorphine.

Topics: Acute Disease; Administration, Sublingual; Adult; Buprenorphine; Dysmenorrhea; Female; Humans; Lung; Pulmonary Edema; Radiography

Topics: Acute Disease; Buprenorphine; Humans; Male; Middle Aged; Naloxone; Respiratory Insufficiency

Buprenorphine (15 micrograms/kg b.wt. per hour) distinctly reduced pain sensitivity in acute 3% sodium-taurocholate pancreatitis in male Wistar rats without interfering with the course of the disease. This was seen by assessment of enzyme elevation in serum and ascites and by histological evaluation of the pancreas. Buprenorphine is therefore recommended for animal experiments to study the effect of therapeutic principles in acute pancreatitis.

Topics: Acute Disease; Animals; Buprenorphine; Male; Pain; Pancreatitis; Rats; Rats, Inbred Strains; Taurocholic Acid

Topics: Acute Disease; Alfentanil; Analgesics, Opioid; Buprenorphine; Fentanyl; Humans; Infusions, Parenteral; Intraoperative Period; Pain; Postoperative Period; Sufentanil