buprenorphine and Myocardial-Infarction

Morphine is known as the best analgesic for patients with acute myocardial infarction complicated by heart failure. In patients with uncomplicated acute myocardial infarction, buprenorphine has recently been indicated as an alternative to the widely used pentazocine. In order to verify if the haemodynamic effects of the two drugs differed, a randomized double-blind controlled trial was performed on 20 patients with uncomplicated acute myocardial infarction: 10 patients were treated with i.v. pentazocine 30 mg. and 10 patients with buprenorphine 0.30 mg. (equianalgesic doses). Right atrial, ventricular and pulmonary artery and capillary pressure, cardiac index, total pulmonary and total systemic resistance were measured before testing and 15', 30', 60', 180' and 240' after drug injection. PO2 was measured before drug injection and 30' and 60' later. Data were analyzed using the Wilcoxon test. All patients in each group showed uniform results: pentazocine increased total systemic resistance (mean increase 17%) while buprenorphine lowered it (mean reduction 12%) (P less than 0.05). Pentazocine lowered cardiac index (mean reduction 5.9%) while buprenorphine increased it (mean increase 9.3%) (P less than 0.05). Maximum changes occurred within 60' after the administration of both drugs. The other parameters did not change significantly from basal values. These results suggest that in patients with acute myocardial infarction uncomplicated by heart failure pentazocine and buprenorphine may be used in different haemodynamic situations. In the cases in which a reduction in total systemic resistance is desired, buprenorphine seems most suitable. However, in the presence of vagal reaction for instance, pentazocine may be administered.

Topics: Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Hemodynamics; Humans; Myocardial Infarction; Pentazocine; Random Allocation

Buprenorphine, a new powerful analgesic agent, was used to treat chest pain in patients with suspected myocardial infarction. Initial studies showed no significant changes in systemic or pulmonary artery blood pressure or in heart rate after intravenous buprenorphine. Sublingual buprenorphine also appeared effective in relieving pain, but its onset of action was considerably delayed compared with the intravenous route. A randomised double-blind controlled trial of equivalent doses of buprenorphine and diamorphine showed no significant difference between the drugs in terms of pain relief and duration of action. The occurrence of nausea, vomiting, and other side effects was similar in the two groups. The onset of action of buprenorphine was slightly but significantly slower than that of diamorphine. Since buprenorphine seems to be comparable with diamorphine in action and is not a controlled drug, it may prove useful in both general and hospital practice.

Topics: Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Female; Hemodynamics; Heroin; Humans; Male; Middle Aged; Morphinans; Myocardial Infarction; Random Allocation

Topics: Administration, Cutaneous; Aged; Analgesics, Opioid; Angioplasty, Balloon, Coronary; Arthralgia; Buprenorphine; Chest Pain; Humans; Male; Myocardial Infarction; Myocardial Ischemia; Osteoarthritis, Hip; Stents

Topics: Administration, Inhalation; Adult; Buprenorphine; Humans; Male; Myocardial Infarction; Narcotic Antagonists; Substance-Related Disorders

A fact-finding survey was conducted to ascertain the treatment of 298 patients with acute myocardial infarction (AMI) who were referred to our coronary care unit (CCU) from other medical facilities between May 1978 and December 1987. The controls consisted of 169 patients with AMI who were admitted directly to our CCU during the same period. The mean time from onset of AMI to admission to our CCU was 21.7 +/- 67.9 hours (mean +/- SD) for patients from other medical facilities, and it took longer than that of the controls (11.7 +/- 34.9 hours). However, the mortality was 19.8%, being lower than that of the controls (26.0%). By the Killip's classification, there was no significant differences between both patient groups who belonged to Killip groups I, II and IV, but the mortality of cases in Killip group III was 3.7%, which was lower than that of the controls (7.15%). Among the 298 cases, 169 (56.7%) had received some kind of emergency treatment, and their mortality was 29.9%. However, the mortality of the remaining 129 cases (43.3%) who had received no emergency treatment was only 17.1%. The reason for this contradictory result is attributed to the fact that the former group included relatively severe cases. The number of patients receiving emergency treatment has gradually increased recently; however, the overall results achieved were not satisfactory even with appropriate therapy. Since April 1984, conferences with local practitioners have been held concerning emergency treatment for ischemic heart disease. This resulted in better understanding of CCU among the practitioners, less time delay until admission, and increased frequency and higher quality of emergency treatment. However, the mortality in the CCU did not decline, probably because of the relatively high rate of severe cases. To reduce mortality of AMI, a communication network should be established between practitioners and the CCU.

Topics: Anti-Arrhythmia Agents; Buprenorphine; Coronary Care Units; Emergencies; Female; Humans; Male; Middle Aged; Myocardial Infarction; Narcotics

The analgesic, hemodynamic and respiratory effects of buprenorphine (0.3 mg i.v.) were monitored in 15 coronary care unit-admitted patients presenting with myocardial infarction who were in functional class I according to the Killip classification. At the time of the study, 8 of them had unequivocal precordial pain (group 1); the remaining 7 were painfree (group 2). The agent showed a prompt and potent analgesic action. It also induced a slight decrease in mean aortic pressure associated with a reduction in systemic vascular resistance and an increase in cardiac index, a rise in the pulmonary arterial pressure and arteriolar resistance and right atrial pressure, a reduction in arterial pO2 and pH and an increase in pCO2. Tension-time-indices of the left and right ventricles varied in parallel with variations in aortic and pulmonary artery pressure, respectively. These responses were probably unrelated to analgesia since they were similar in groups 1 and 2. Changes in systemic circulation were such as to possibly decrease the contractile effort and the oxygen need of the left ventricle and the size of infarction. On the contrary, the rise in pulmonary arterial pressure imposes a hemodynamic burden on the right ventricle that, depending on the patient's condition, may assume clinical importance. It is felt that the use of buprenorphine in myocardial infarction should be restricted to uncomplicated and selected cases.

Topics: Buprenorphine; Drug Evaluation; Hemodynamics; Humans; Myocardial Infarction; Pain; Pulmonary Circulation; Time Factors

Topics: Animals; Arrhythmias, Cardiac; Buprenorphine; Coronary Vessels; Dogs; Dose-Response Relationship, Drug; Female; Ligation; Male; Morphinans; Myocardial Infarction; Naloxone

Topics: Buprenorphine; Cost-Benefit Analysis; Heroin; Humans; Morphinans; Myocardial Infarction

1 The treatment of pain of cardiac origin requires a knowledge of the haemodynamic action of the analgesic agents used. 2 The haemodynamic effects of morphine, diamorphine, pavaveretum, pethidine and pentazocine are reviewed. 3 Clinical experience with the new antagonist analgesic buprenorphine is reported. 4 These studies indicate that buprenorphine may be the agent of choice for the relief of severe pain in patients with unstable circulation.

Topics: Buprenorphine; Heart Diseases; Humans; Myocardial Infarction; Narcotic Antagonists; Pain; Structure-Activity Relationship

Topics: Buprenorphine; Heroin; Humans; Morphinans; Myocardial Infarction; Respiratory Insufficiency