buprenorphine and Postoperative-Complications

Opioid treatment of pain is generally safe with 0.5% or less events from respiratory depression. However, fatalities are regularly reported. The only treatment currently available to reverse opioid respiratory depression is by naloxone infusion. The efficacy of naloxone depends on its own pharmacological characteristics and on those (including receptor kinetics) of the opioid that needs reversal. Short elimination of naloxone and biophase equilibration half-lives and rapid receptor kinetics complicates reversal of high-affinity opioids. An opioid with high receptor affinity will require greater naloxone concentrations and/or a continuous infusion before reversal sets in compared with an opioid with lower receptor affinity. The clinical approach to severe opioid-induced respiratory depression is to titrate naloxone to effect and continue treatment by continuous infusion until chances for renarcotization have diminished. New approaches to prevent opioid respiratory depression without affecting analgesia have led to the experimental application of serotinine agonists, ampakines, and the antibiotic minocycline.

Topics: Buprenorphine; Humans; Minocycline; Naloxone; Narcotic Antagonists; Postoperative Complications; Respiratory Insufficiency; Serotonin Agents

The efficacy and safety of buprenorphine transdermal patch (BTP) has been well established in chronic pain, but data regarding acute postoperative pain relief is still very limited. Therefore, we design a prospective, randomized, controlled study to evaluate the effectiveness and safety of the BTP for postoperative analgesia in total hip arthroplasty.. This study is designed as a single-center, prospective, double-blind, randomized controlled trial. Group A receives a 10 mg patch of buprenorphine at the conclusion of surgery which is continued for 14 days. Group B receives a conventional analgesic regimen, that is, IV paracetamol 1 mg every 8 hours alternating with parenteral tramadol 50 mg every 8 hours for the first 2 postoperative days followed by oral administration of the same drug still the end of 2 weeks. A total of 160 patients are needed with an allowance for 10% drop-out. The primary outcome of this noninferiority study is opioid consumption within the first 24 hours following surgery. The secondary outcomes included numerical rating scale scores at rest, postoperative complications, length of hospital stay, and patient satisfaction.. This trial is expected to be the largest randomized trial assessing the efficacy of BTP after primary total hip arthroplasty and powered to detect a potential difference in the primary outcome.. This study protocol was registered in Research Registry (researchregistry5524).

Topics: Acetaminophen; Administration, Intravenous; Administration, Oral; Analgesics, Non-Narcotic; Analgesics, Opioid; Arthroplasty, Replacement, Hip; Buprenorphine; Case-Control Studies; Double-Blind Method; Female; Humans; Length of Stay; Male; Pain Measurement; Pain, Postoperative; Patient Satisfaction; Postoperative Complications; Prospective Studies; Tramadol; Transdermal Patch

To compare sedative and analgesic properties of buprenorphine or morphine for standing procedures combined with a detomidine continuous rate infusion (CRI).. Blinded, prospective, randomized clinical pilot study.. Ten horses presented for dental or sinus procedures.. Horses received 0.02 mg kg(-1) acepromazine intravenously (IV), followed 30 minutes later by detomidine 10 μg kg(-1) IV. Five minutes later, buprenorphine 0.01 mg kg(-1) (n = 6) or morphine 0.1 mg kg(-1) (n = 4) was administered IV. Detomidine was administered by CRI (0.2 μg kg(-1) minute(-1)) and adjusted to maintain appropriate sedation. Heart rate, respiratory frequency, gastrointestinal motility and rectal temperature were measured; pain, ataxia and sedation were scored. Sedation, pain scores and ataxia scores were analysed using a mixed linear model. Detomidine dose and procedure success scores were compared using Wilcoxon's rank sum test. Complications between groups were analysed using Fisher's exact test.. Two horses had incomplete data. Weights and ages were not different between groups (p = 0.15 and p = 0.42, respectively). The dose rate for detomidine was not different between groups (0.33 ± 0.02 μg kg(-1) minute(-1) in the buprenorphine group and 0.33 ± 0.05 μg kg(-1) minute(-1), in the morphine group p = 0.89). Intraoperative visual analogue scale scores were greater after buprenorphine than morphine (mean ± SD, buprenorphine 48 ± 4, morphine 40 ± 5, p = 0.0497). Procedure duration was not different between groups (buprenorphine 142 ± 33, morphine 140 ± 12 minutes). All horses treated with buprenorphine experienced complications compared with none in the morphine group (p = 0.0286).. At the doses used, buprenorphine produced greater sedation but more post-operative complications than morphine. However, Type I or Type II errors cannot be excluded and larger studies are required to confirm these findings.

Topics: Adrenergic alpha-2 Receptor Agonists; Analgesics, Opioid; Anesthesia; Animals; Buprenorphine; Drug Interactions; Equidae; Female; Heart Rate; Hypnotics and Sedatives; Imidazoles; Infusions, Intravenous; Male; Morphine; Pilot Projects; Postoperative Complications; Prospective Studies

To evaluate signs of postoperative pain and complications after forelimb onychectomy in cats receiving buprenorphine alone or with bupivacaine administered as a 4-point regional nerve block.. Prospective, randomized, double-blind clinical trial.. 20 cats.. All cats received buprenorphine (0.01 mg/kg [0.004 mg/lb], IM) preoperatively. One forelimb of each cat also received bupivacaine (1 mg/kg [0.45 mg/lb] of a 0.75% solution) administered as a 4-point regional nerve block. After onychectomy, discomfort (lameness, foot reaction, and pain) scores were evaluated by 2 experienced observers 2, 4, 6, 8, 24, and 168 hours postoperatively. Complication (hemorrhage, swelling, and infection) scores were evaluated 24 and 168 hours postoperatively. Surgeries were performed by 1 experienced veterinary surgeon. Rescue analgesia was provided if needed.. 6 cats required rescue analgesia postoperatively. There was no difference in discomfort or complication scores between control limbs and limbs in which a nerve block was administered. Additionally, there was no difference in discomfort and complication scores between cats that did or did not require rescue analgesia.. Bupivacaine administered as a 4-point regional nerve block in addition to a systemic analgesic did not decrease discomfort or complication scores in cats undergoing forelimb onychectomy.

Topics: Analgesia; Analgesics, Opioid; Anesthetics, Local; Animals; Bupivacaine; Buprenorphine; Cats; Drug Therapy, Combination; Female; Forelimb; Hoof and Claw; Injections, Intramuscular; Male; Pain, Postoperative; Postoperative Care; Postoperative Complications; Prospective Studies; Time Factors; Treatment Outcome

Nalbuphine (0.3 mg.kg-1) and buprenorphine (2.5 micrograms.kg-1) were compared as part of a total intravenous anaesthesia regimen using a propofol infusion in 60 patients undergoing laparoscopic cholecystectomy in a randomised double-blind study. Changes in haemodynamic variables greater than 20% from the baseline were noted. No difference was observed in blood pressure but the heart rate was significantly lower in the buprenorphine group. Intra-operative bradycardia (heart rate < 60 beat.min-1) occurred more often in the buprenorphine group. Recovery was fast and comparable with both drugs and no patient reported awareness. Quality of analgesia was similar in both groups. Both drugs provide suitable analgesic supplementation to total intravenous anaesthesia.

Topics: Adult; Analgesics, Opioid; Anesthesia, Intravenous; Bradycardia; Buprenorphine; Cholecystectomy, Laparoscopic; Double-Blind Method; Drug Administration Schedule; Hemodynamics; Humans; Middle Aged; Nalbuphine; Pain, Postoperative; Patient Satisfaction; Postoperative Complications

A double-blind study was carried out to assess the efficiency and possible side-effects of a single epidural injection of either morphine or buprenorphine at equipotent doses after elective thoracic surgery. The series included 24 patients aged 53.7 +/- 11.4 years; 13 underwent a lobectomy and 11 a pneumonectomy. 6 h after the last intravenous injection of fentanyl, the patients were randomly allocated to one of three equal groups. They received an epidural injection at T8-9 or T9-10 level of either 100 micrograms.kg-1 morphine (group M) or 6.6 micrograms.kg-1 buprenorphine (group B) or a subcutaneous injection of 0.1 ml.kg-1 normal saline placebo at the same level (group T). The following parameters were measured 20 and 60 min, and every 6 h up to 48 h after the injection: patient wakefulness, respiratory rate, blood gases, pain (according to a verbal scale), FVC and FEV1, adverse effects (euphoria, hallucinations, sweating, facial pruritus, nausea) and atelectasis. The duration of surgery, the anaesthetic protocol, the age, weight and height, as well as all the parameters before injection were similar in all three groups. There was a fall in pain intensity from the 20th min to the 24th hour in group M and from the 20th min to the 36th hour in group B, significant for both groups when compared with group T. Similarly, there was a prolonged increase in FEV1 in both groups M and B. There was no case of severe respiratory depression; PaCO2 was increased at the 1st hour (+0.3 +/- 0.6 kPa) in group B and at the 6th hour (+0.5 +/- 0.7 kPa) in group M.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Analgesia, Epidural; Blood Gas Analysis; Buprenorphine; Double-Blind Method; Humans; Lung Volume Measurements; Middle Aged; Morphine; Pain, Postoperative; Postoperative Complications; Pulmonary Atelectasis; Respiration; Thoracic Surgery

Sixty patients suffering from moderate to severe pain following either orthopaedic or gynaecological surgery were treated with intramuscular buprenorphine (0.3 mg) or an intramuscular combination of buprenorphine (0.3 mg)/naloxone (0.2 mg) and the analgesic efficacy and safety of the two treatments was compared. The evaluation of efficacy showed that both treatments provided good analgesia which was apparent at the first assessment time (10 minutes) and continued for approximately 10 hours. Only seven patients suffered from unwanted side-effects with only drowsiness/sleepiness and nausea being reported by more than one patient. Over-all analysis of the results showed that there were no significant differences between the two treatments with regard to efficacy and safety.

Topics: Adolescent; Adult; Aged; Analgesia; Buprenorphine; Drug Therapy, Combination; Female; Humans; Kinetics; Male; Middle Aged; Morphinans; Naloxone; Pain; Postoperative Complications

Using buprenorphine as sole intravenous analgesic in balanced anaesthesia, we tried to find the most suitable dose of buprenorphine, and compared it to fentanyl, regarding analgetic, circulatory and side effects. Initial doses of 5, 10 and 15 micrograms/kg buprenorphine and 10 micrograms/kg fentanyl were compared. Peroperative analgesia was adequate with both drugs and neither gave circulatory effects of clinical significance. After buprenorphine three of 60 patients and after fentanyl five of 11 patients were given naloxone. Nausea was more common after buprenorphine. Postoperative analgesia after the last dose of buprenorphine averaged 13 h, highly significantly longer than the 2 h after fentanyl. The overall course was considered good in 93% of buprenorphine and 100% of fentanyl cases. Buprenorphine doses are discussed.

Topics: Adolescent; Adult; Analgesia; Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Intraoperative Period; Male; Middle Aged; Morphinans; Naloxone; Postoperative Complications; Preanesthetic Medication; Respiration

Opioid dependence is an increasing public health problem. One of the complications of intravenous opioid use is hepatitis C virus infection, which, in turn, is one of the most common indications for liver transplantations throughout the world. Therefore, the treatment of opioid dependence in a liver transplant recipient requires special attention in terms of graft function, drug interactions, and patient compliance. Buprenorphine is a semi-synthetic opioid-derived agent with analgesic effects. To prevent buprenorphine abuse, it is combined with the opioid antagonist naloxone. This buprenorphine/naloxone combination is the only drug approved for the treatment of opioid dependence in Turkey. Although the literature includes data about the safe usage of buprenorphine in liver transplantation in animals, there is no such evidence in either case reports or clinical trials for the same in humans. In this article, we present a report of our treatment of 2 opioid-dependent patients with buprenorphine/naloxone after liver transplantation due to hepatitis C virus-induced liver cirrhosis.

Topics: Adult; Analgesics, Opioid; Buprenorphine; Drug Interactions; Hepatitis C; Humans; Injections, Intravenous; Liver Transplantation; Male; Medication Adherence; Naloxone; Narcotic Antagonists; Opioid-Related Disorders; Postoperative Complications

Postoperative cognitive dysfunction (POCD) often occurs in elderly patients and may involve neuroinflammation. This study was to determine whether anesthetic choice (intravenous vs. volatile anesthetics) affects cognitive impairment and neuroinflammation in elderly rat. Total 54 twenty-month old male Fischer 344 rats were assigned randomly to control, right carotid exposure under propofol-buprenorphine or isoflurane-buprenorphine anesthesia groups. They were tested by Barnes maze and fear conditioning from 6 days after the surgery. Their brains were harvested 24 h after the surgery for quantifying interleukin (IL) 1β, tumor necrosis factor (TNF)α and ionized calcium binding adaptor molecule 1 (Iba-1). We showed that the heart rates and mean arterial blood pressure were similar during surgery under propofol-buprenorphine or isoflurane-buprenorphine anesthesia. There was no difference in the surgery-induced increase of the plasma IL-1β and TNFα levels under these two types of anesthesia. Rats subjected to surgery took longer than control rats to identify the target hole 8 days after the completion of training sessions in Barnes maze [32 ± 23 s for control, 118 ± 64 s for propofol group (P < 0.05 vs. control), 107 ± 64 s for isoflurane group (P < 0.05 vs. control)] and had less freezing behavior in the fear conditioning test. Surgery and anesthesia increased IL-1β and Iba-1 but did not affect tau phosphorylated at S199/202 and S396 in the cerebral cortex and hippocampus. Our results suggest that surgery under general anesthesia induces neuroinflammation and cognitive impairment. Anesthetic choice may not be a significant modifiable factor for these effects.

Topics: Anesthetics, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Animals; Buprenorphine; Calcium-Binding Proteins; Fear; Inflammation; Interleukin-1beta; Isoflurane; Learning Disabilities; Male; Maze Learning; Memory Disorders; Microfilament Proteins; Postoperative Complications; Propofol; Rats; Rats, Inbred F344; Tumor Necrosis Factor-alpha

Surgery induces learning and memory impairment. Neuroinflammation may contribute to this impairment. Nuclear factor κB (NF-κB) is an important transcription factor to regulate the expression of inflammatory cytokines. We hypothesize that inhibition of NF-κB by pyrrolidine dithiocarbamate (PDTC) reduces neuroinflammation and the impairment of learning and memory. To test this hypothesis, four-month-old male Fischer 344 rats were subjected to right carotid exploration under propofol and buprenorphine anesthesia. Some rats received two doses of 50mg/kg PDTC given intraperitoneally 30min before and 6h after the surgery. Rats were tested in the Barnes maze and fear conditioning paradigm begun 6days after the surgery. Expression of various proteins related to inflammation was examined in the hippocampus at 24h or 21days after the surgery. Here, surgery, but not anesthesia alone, had a significant effect on prolonging the time needed to identify the target hole during the training sessions of the Barnes maze. Surgery also increased the time for identifying the target hole in the long-term memory test and decreased context-related learning and memory in fear conditioning test. Also, surgery increased nuclear expression of p65, a NF-κB component, decreased cytoplasmic amount of inhibitor of NF-κB, and increased the expression of interleukin-1β, interleukin-6, ionized calcium binding adaptor molecule 1 and active matrix metalloproteinase 9 (MMP-9). Finally, surgery enhanced IgG extravasation in the hippocampus. These surgical effects were attenuated by PDTC. These results suggest that surgery, but not propofol-based anesthesia, induces neuroinflammation and impairment of learning and memory. PDTC attenuates these effects possibly by inhibiting NF-κB activation and the downstream MMP-9 activity.

Topics: Anesthetics; Animals; Buprenorphine; Carotid Arteries; Cognition Disorders; Conditioning, Psychological; Encephalitis; Fear; Hippocampus; Male; Matrix Metalloproteinase 9; Maze Learning; Neuroprotective Agents; NF-kappa B; Postoperative Complications; Propofol; Pyrrolidines; Rats; Rats, Inbred F344; Thiocarbamates

We report a 25-year-old Malay man with Subutex-related endocarditis, complicated by protein-losing enteropathy from severe tricuspid regurgitation and congestive heart failure. The intestinal protein loss was reversed with surgical valvular intervention. This case highlights the importance of recognising the rare association between protein-losing enteropathy and congestive heart failure in the setting of endocarditis.

Topics: Adult; Biopsy; Buprenorphine; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Endocarditis, Bacterial; Follow-Up Studies; Heart Failure; Heart Valve Prosthesis Implantation; Humans; Jejunum; Male; Mitral Valve Insufficiency; Narcotics; Postoperative Complications; Prosthesis Failure; Protein-Losing Enteropathies; Reoperation; Sepsis; Staphylococcal Infections; Substance Abuse, Intravenous; Surgical Wound Dehiscence; Tricuspid Valve Insufficiency

The laboratory mouse is commonly used as a sophisticated model in biomedical research. However, experiments requiring major surgery frequently lead to serious postoperative complications and death, particularly if genetically modified mice with anatomical and physiological abnormalities undergo extensive interventions such as transmitter implantation. Telemetric transmitters are used to study cardiovascular physiology and diseases. Telemetry yields reliable and accurate measurement of blood pressure in the free-roaming, unanaesthetized and unstressed mouse, but data recording is hampered substantially if measurements are made in an exercising mouse. Thus, we aimed to optimize transmitter implantation to improve telemetric signal recording in exercising mice as well as to establish a postoperative care regimen that promotes convalescence and survival of mice after major surgery in general.. We report an optimized telemetric transmitter implantation technique (fixation of the transmitter body on the back of the mouse with stainless steel wires) for subsequent measurement of arterial blood pressure during maximal exercise on a treadmill. This technique was used on normal (wildtype) mice and on transgenic mice with anatomical and physiological abnormalities due to constitutive overexpression of recombinant human erythropoietin. To promote convalescence of the animals after surgery, we established a regimen for postoperative intensive care: pain treatment (flunixine 5 mg/kg bodyweight, subcutaneously, twice per day) and fluid therapy (600 microl, subcutaneously, twice per day) were administrated for 7 days. In addition, warmth and free access to high energy liquid in a drinking bottle were provided for 14 days following transmitter implantation. This regimen led to a substantial decrease in overall morbidity and mortality. The refined postoperative care and surgical technique were particularly successful in genetically modified mice with severely compromised physiological capacities.. Recovery and survival rates of mice after major surgery were significantly improved by careful management of postoperative intensive care regimens including key supportive measures such as pain relief, administration of fluids, and warmth. Furthermore, fixation of the blood pressure transmitter provided constant reliable telemetric recordings in exercising mice.

Topics: Analgesics; Animals; Buprenorphine; Clonixin; Erythropoietin; Humans; Laboratory Animal Science; Mice; Mice, Transgenic; Physical Conditioning, Animal; Postoperative Care; Postoperative Complications; Surgical Procedures, Operative; Telemetry

The objective of this study was to establish effective postoperative analgesia for Dark Agouti rats undergoing liver transplantation with minimal additional stress due to handling and no adverse effect on transplant outcome. Oral administration of buprenorphine (0.5 mg/kg/dose) or aspirin (100 mg/kg/dose) in raspberry-flavoured gelatine were compared to controls receiving no treatment or plain gelatine. The drugs were presented five times: immediately on recovery from anaesthesia and at 12 h intervals thereafter. All rats underwent right nephrectomy and replacement of their liver by an arterialized liver isograft preserved optimally for 24 h. All groups had reversible hepatic damage, lost weight and demonstrated severely reduced dark cycle activity after surgery. Neither treatment appeared to ameliorate the loss of body weight that probably reflected hepatic insufficiency during the first week as well as pain and surgical stress. In the second week, when liver function was 'normal', rats began to regain weight at the pre-transplant rate. Aspirin treatment significantly increased activity during the first and second dark cycles after surgery, whereas buprenorphine significantly increased activity during the second dark cycle only. Neither drug had any apparent adverse effects on the rats or on graft function. Postoperative oral administration of aspirin should be incorporated into future programmes of liver transplantation in rodents. More effective treatment in the immediate postoperative period may require oral administration of analgesia prior to surgery or a single subcutaneous injection of an analgesic agent on completion of surgery in addition to postoperative oral administration of aspirin.

Topics: Activity Cycles; Administration, Oral; Analgesics, Opioid; Animals; Aspirin; Body Weight; Buprenorphine; Creatinine; Female; Hepatectomy; Liver; Liver Function Tests; Liver Transplantation; Male; Motor Activity; Nephrectomy; Postoperative Complications; Rats; Rats, Inbred Strains; Time Factors

Rats subjected to hypophysectomy make up one of the largest groups of experimental animals in Europe, since there is a legal demand for batch testing of industrially produced growth hormones. To describe the clinical performance of rats having undergone hypophysectomy, animals were examined postoperatively by monitoring behaviour, body temperature and food intake. Behavioural changes were observed in rats that had only been anaesthetized, as well as in sham-operated rats, while no behavioural deviations could be shown in hypophysectomized rats. On the first day after surgery all rats had declining body temperature and food intake; and this change was not reversed by treatment with carprofen, buprenorphine or oxytetracycline. The mortality rate in rats treated with buprenorphine was increased, as was the mortality rate in rats hypophysectomized when weighing more than 100 g. As there seemed to be no differences whether methohexital or a combination of fentanyl, fluanison and midazolam was used, the latter anaesthesia is recommended due to its analgesic potential. For post-surgical analgesic treatment, carprofen is recommended rather than buprenorphine. At best, the use of hypophysectomized rats should be replaced in industrial batch testing by an existing in vitro method.

Topics: Analgesics, Opioid; Anesthesia, Intravenous; Anesthetics, Intravenous; Animal Welfare; Animals; Behavior, Animal; Body Temperature; Buprenorphine; Butyrophenones; Carbazoles; Eating; Fentanyl; Hypophysectomy; Male; Methohexital; Midazolam; Oxytetracycline; Postoperative Complications; Rats; Rats, Inbred Strains

Although buprenorphine sometimes causes severe emesis, its relation to the menstrual cycle has not been reported.. We conducted a prospective study on 68 reproductive-age women following lower extremity surgery under epidural anesthesia plus buprenorphine, to assess the effect of the day of the menstrual cycle on the incidence of postoperative nausea and vomiting. The patients were divided according to the phase of the menstrual cycle into four groups: day 1-7 group, day 8-14 group, day 15-24 group and day 25 to end of the cycle group.. Nausea and vomiting were reported in 46 patients (67.6%), and the incidence was higher in the day 25 to end of the cycle group than in the day 8-14 or day 15-24 groups, and higher in the day 1-7 group than in the day 8-14 group.. We conclude that emesis after epidural buprenorphine is related to the menstrual cycle.

Topics: Adult; Analgesia, Epidural; Analgesics, Opioid; Anesthesia, Epidural; Anesthetics, Local; Antiemetics; Buprenorphine; Female; Humans; Incidence; Leg; Menstrual Cycle; Mepivacaine; Metoclopramide; Nausea; Postoperative Complications; Prospective Studies; Single-Blind Method; Vomiting

To clarify the prophylactic effect of epidural anesthesia with buprenorphine on postoperative pulmonary complications, the incidence of pulmonary complications after chest surgery was evaluated in 2 groups: the group that underwent epidural anesthesia, namely the test group, and the control group. Pulmonary complications were classified as follows: mild complications, sustained wheezing and/or small atelectasis-like shadows seen on chest x-rays. These improved by conventional methods except for bronchial toilet. Moderate complications included pneumonia and/or respiratory failure and/or atelectasis which needed bronchial toilet. There were 56 cases (58%) with no pulmonary complications in the control group and 89 cases (77%) in the test group. The number of patients with pulmonary complications were 40 (42%) in the control group and 27 (23%) in the test group, respectively (p less than 0.01). Those with mild or moderate complications were 25 (26%), 15 (16%) in the control group and 21 (18%), 6 (5%) in the test group, respectively. There was significant difference between no complication group and moderate complication group (p less than 0.01). These results show that epidural anesthesia is useful in preventing pulmonary complications after chest surgery.

Topics: Anesthesia, Epidural; Buprenorphine; Female; Humans; Lung Diseases; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Thoracic Surgery

The influence of different lung resection methods on pulmonary function was studied in 34 patients suffering from bronchial carcinoma. Daily measurements from the 1st to 10th postoperative day reveal the greatest losses of function after right upper lobectomy. Lower lobectomies or left upper lobectomy resulted in a less extensive loss of function. Recovery of function mainly occurs in the first 4 days after operation. Centrally acting analgetics are followed by a loss in pulmonary function whereas locally applied analgetics improve early postoperative function.

Topics: Adult; Aged; Airway Resistance; Analgesics; Buprenorphine; Carcinoma, Bronchogenic; Female; Humans; Lung Neoplasms; Lung Volume Measurements; Male; Meperidine; Middle Aged; Nerve Block; Pain, Postoperative; Pneumonectomy; Postoperative Complications; Respiratory Insufficiency

Topics: Buprenorphine; Humans; Intraoperative Complications; Male; Middle Aged; Postoperative Complications; Respiratory Insufficiency; Temazepam

Epidural injections of buprenorphine were given for postoperative pain relief to a patient with pulmonary carcinoma who underwent a right upper lobectomy. Paraplegia occurred postoperatively and the patient's neurological status deteriorated after each injection of epidural narcotic. Laminectomies on the third postoperative day revealed an expanded oxidized cellulose (Oxycel) pledget in the epidural space. Neurologic dysfunction after epidural narcotic administration was caused by the oxidized cellulose which had migrated into the epidural space following use for surgical haemostasis and subsequently expanded with the narcotic solution and blood.

Topics: Aged; Buprenorphine; Humans; Injections, Epidural; Lung Neoplasms; Male; Pain, Postoperative; Paraplegia; Postoperative Complications

The majority of hemorrhages occurring during open prostatectomy are induced during the steps for removal of adenoma. However, the hemorrhage during transurethral prostatic resection (TURP) usually takes place at its initial stage, and approx. 50% of the amount of the hemorrhage during the operation occurred within 30 minutes after initiating the operation. When the resection of the adenoma advanced near the surgical capsule, the amount of hemorrhage decreased sharply. This was interpreted to indicate that many of the blood vessels are cut at the initial stage of the operation and that the steps for resection are processed at that stage without special attempt to stop the hemorrhage. We have discussed some aspects for improvement of the methodology for the operation of this kind. The postoperative progress of hemorrhage revealed that the operative cases can be classified into three groups; one was the group with smooth hemostasis since immediately after the operation (Type I and II) and the others were the group with satisfactory hemostasis during the operation and yet with resumption of substantial hematuria (Type III and IV) and the group with continued hemorrhage of substantial amount since immediately after the operation (Type V). It was demonstrated that those showing hematuria of more than 2% at 2-4 hours after the operation and 0.5-1.9% at 6-8 hours after the operation can be rated as falling under the latter two groups and that the check at an early stage and early counter-treatment would induce favorable postoperative progress.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Buprenorphine; Hematuria; Hemorrhage; Humans; Intraoperative Complications; Male; Morphine; Postoperative Complications; Prostatectomy; Prostatic Hyperplasia

Topics: Anti-Anxiety Agents; Benzodiazepines; Buprenorphine; Humans; Morphinans; Postoperative Complications; Respiratory Insufficiency

The endocrine and metabolic response to anaesthesia and surgery was studied in 12 men and eight women undergoing elective total hip replacement using buprenorphine as the intra- and postoperative analgesic. Plasma glucose, cortisol and prolactin were measured, and the results obtained for men and women compared. Statistically significant difference between men and women were found for prolactin during and after operation, and also for cortisol postoperatively. Men, but not women, demonstrated a significant fall in plasma cortisol following a dose of buprenorphine after operation. These results are discussed in relation to known procedures for ablating the stress response and to the neuroendocrine effects of opiate agonists and partial agonists.

Topics: Aged; Blood Glucose; Buprenorphine; Female; Humans; Hydrocortisone; Intraoperative Period; Male; Middle Aged; Postoperative Complications; Postoperative Period; Prolactin; Sex Factors; Stress, Physiological

Topics: Acidosis; Blood Proteins; Buprenorphine; Female; Humans; Middle Aged; Morphinans; Postoperative Complications; Protein Binding; Respiratory Insufficiency; Time Factors