buprenorphine and Ischemia

Topics: Administration, Cutaneous; Analgesics, Opioid; Buprenorphine; Humans; Ischemia; Pain; Pain Management; Transdermal Patch

Topics: Buprenorphine; Hand; Humans; Ischemia; Male; Opioid-Related Disorders; Young Adult

Topics: Buprenorphine; Constriction, Pathologic; Fingers; Humans; Hydromorphone; Injections, Intra-Arterial; Ischemia; Male; Middle Aged; Naloxone; Opiate Substitution Treatment; Opioid-Related Disorders; Peripheral Vascular Diseases; Toes

Pain control in critical limb ischemia (CLI) varies considerably between individuals.. To evaluate pharmacogenetically the response to transdermal buprenorphine (BUP-TTS) in patients with CLI who are awaiting revascularization.. One hundred and seven patients with CLI were treated with BUP-TTS. The following were analyzed: (1) pain perception (visual analog scale (VAS) before and 4 days after treatment) and (2) genetics: glucuronosyltransferase (UGT2B7), cytochrome (CYP3A4), and μ-opioid receptor (OPRM1) gene polymorphisms.. Ninety-three patients completed the study. The VAS score by the fourth day of analgesia dropped from 6.82 to 3.38 (P < 0.05). The analgesic response to BUP-TTS was greater in men than in women (P = 0.019). Patients who were AA homozygotes for the CYP3A4 gene showed the best response to analgesic treatment (P = 0.003). The combination of the CYP3A4 gene with UGT2B7 or OPRM1 was favorable to the effect of the CYP3A4 gene (P = 0.045 and P = 0.026, respectively). The combination of UGT2B7 with OPRM1 was ineffective (P = 0.648). The 3 polymorphisms together had no effect on response to treatment (P = 0.461).. BUP-TTS is efficacious in the control of pain in patients with CLI. The homozygous AA carriers of the CYP3A4 gene respond better to treatment with BUP-TTS.

Topics: Administration, Cutaneous; Adult; Analgesics, Opioid; Buprenorphine; Cytochrome P-450 CYP3A; Female; Glucuronosyltransferase; Humans; Ischemia; Lower Extremity; Male; Middle Aged; Pain; Pain Management; Pain Measurement; Polymorphism, Single Nucleotide; Receptors, Opioid, mu

The diverted use of synthetic opioid buprenorphine by drug addicts can be responsible for serious ischemic and infectious complications, particularly in the case of intravenous injection.. We present a case of serious glans ischemia after buprenorphine injection directly into the deep dorsal vein of the penis. Analysis using new medical imaging techniques and treatments is detailed below.. A 26-year-old male drug addict presented with glans pain 4 days after self-injection of buprenorphine into the deep dorsal vein of the penis. The patient was apyretic and presented a urethral discharge. His glans was blue without discoloration on digital pressure. Additionally, his biologic and serologic tests were normal while bacteriology showed the presence of Enterobacter cloacae urethritis.. After 48 hours of intravenous antibiotic treatment without improvement, a specific medical treatment using enoxaparin and ilomedin was initiated, with the assumption that there was an ischemic complication. Laser speckle contrast imaging allowed confirmation of the presence of distal penis ischemia and provided an accurate mapping of the ischemic zone. A 28-day treatment combining antibiotics, subcutaneous heparin at curative dose, antiplatelet drug, ilomedin, and hyperbaric oxygen therapy resulted in clinical improvement of the lesions with no functional complications.. To date, no consensus exists on the proper diagnostic and treatment approach to severe glans ischemia due to buprenorphine injection into the deep dorsal vein of the penis. The results of laser speckle contrast imaging were of real interest during the process of diagnosis. In addition, the combination of ilomedin with hyperbaric oxygen therapy and anticoagulant and antiplatelet drugs appeared to be an effective therapy.

Topics: Adult; Analgesics, Opioid; Buprenorphine; Enterobacter cloacae; Enterobacteriaceae Infections; Humans; Injections, Intravenous; Ischemia; Male; Penis; Substance-Related Disorders; Urethritis

To retrospectively analyse injection drug users (IDUs) with complications after intra- or extra-vasal administration of dissolved tablets.. A retrospective study.. The hospital discharge registers were used to identify the patients admitted in different clinics in Helsinki University Central Hospital during 2000-2005. The patient demographics and social background were clarified. The type of the crushed drugs, the injection route and the timing of administration were registered. Medical interventions, examinations and surgical procedures were recorded.. Between January 2000 and December 2005, 24 patients had been treated on 30 occasions for manifestations caused by injecting crushed tablets. The main types of manifestations were acute limb ischaemia (16 patients) and infection (eight patients), and eight cases led to distal or proximal amputations. Men (19 of 24) were affected more frequently than were women (5 of 24). Their ages ranged between 20 and 39 years (mean: 26 years). All the patients had a previous history of intravenous drug abuse, and they lived in Greater Helsinki region. The incidence of seropositivity for hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) was 33% (n=8), 88% (n=21) and 4% (n=1), respectively. The time between injection and presentation to the Emergency Department varied between 3h and 10 days (mean: 62 h). Buprenorphine was the most commonly used drug in 10 of the 24 patients, and benzodiazepine derivatives were also used in 11 of the 24 patients.. Intra- or extra-vasal administration of dissolved tablets leads to serious consequences, including limb amputations. Vascular and soft-tissue imaging may be helpful in the diagnosis. Prompt drainage of any abscess and fasciotomies for compartment syndrome treatment are essential. Controversy exists over the best medical therapy.

Topics: Adult; Amputation, Surgical; Anticoagulants; Benzodiazepines; Buprenorphine; Combined Modality Therapy; Communicable Diseases; Compartment Syndromes; Debridement; Drug Users; Embolectomy; Extremities; Fasciotomy; Female; Finland; Hospitals, University; Humans; Injections; Ischemia; Male; Retrospective Studies; Skin Transplantation; Solubility; Substance Abuse, Intravenous; Tablets; Time Factors; Treatment Outcome; Vasodilator Agents; Young Adult

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