buprenorphine and Pruritus

Buprenorphine appears to have a ceiling effect on respiratory depression, but not analgesia in healthy young patients. However, the efficacy and side-effects of buprenorphine in the setting of acute pain are poorly characterized. The aim of this study was to characterize the analgesic efficacy and adverse effects of buprenorphine compared with morphine in the acute pain setting. A systematic review of five databases was performed. Randomised controlled trials (RCTs) comparing buprenorphine with morphine in acute pain management were included. Studies performed outside of the hospital setting were excluded. The a priori primary outcomes included pain, respiratory depression, and sedation. Secondary outcomes included requirement for rescue analgesia, time to rescue analgesia, nausea, vomiting, dizziness, hypotension, and pruritus. Twenty-eight RCTs with 2210 patients met the inclusion criteria. There was no difference in pain [visual analogue scale weighted mean difference (WMD)=-0.29; 95% confidence interval (CI)=-0.62 to 0.03; I

Topics: Acute Pain; Analgesics, Opioid; Buprenorphine; Dizziness; Humans; Hypotension; Nausea; Pain Management; Pruritus; Randomized Controlled Trials as Topic; Respiration; Treatment Outcome; Vomiting

For the hundreds of thousands of patients who undergo total knee arthroplasty (TKA) in the United States each year, early mobilization has been demonstrated to improve functional outcomes and reduce complications. Management of postoperative pain is a critical factor in achieving early mobilization. Recent studies have shown that the use of an adductor canal block (ACB) after TKA results in increased preservation of quadriceps muscle strength, without significant difference in postoperative pain when compared to femoral nerve block. This increased preservation of quadriceps muscle strength leads to earlier mobilization. Studies have also demonstrated a prolongation of analgesia with the addition of buprenorphine to local anesthetic for regional block placement. This study examined the effect on postoperative opioid consumption when adding buprenorphine to an ACB vs an ACB with local anesthetic alone, for postoperative analgesia after unilateral TKA.. A total of 100 patients scheduled for TKA were randomized to receive postoperative ACB with local anesthetic alone or with local anesthetic and buprenorphine. The primary outcome examined was total opioid analgesic (milligrams of hydrocodone equivalent) consumption in the first 24 hours postsurgery. The secondary outcomes examined were the reported incidence of the opioid side effects nausea, vomiting, and pruritis.. Postoperative opioid consumption decreased significantly in the group that received an ACB with local anesthetic and buprenorphine compared to an ACB with local anesthetic only (25.34±2.62 vs 35.84±2.86; P=.0076). Secondary outcomes showed no statistical difference between the 2 groups in terms of the incidence of nausea, vomiting, or pruritus.. The addition of buprenorphine to an adductor canal block decreases postoperative opioid consumption when compared to an ACB with local anesthetic alone. This reduction in opioid consumption, without significant increase in side effects, makes this an attractive anesthetic adjunct for TKA.

Topics: Aged; Analgesics, Opioid; Anesthesia, Local; Anesthetics, Local; Arthroplasty, Replacement, Knee; Buprenorphine; Female; Femoral Nerve; Humans; Male; Middle Aged; Muscle Strength; Nerve Block; Pain Measurement; Pain, Postoperative; Postoperative Nausea and Vomiting; Pruritus; Treatment Outcome

This study aimed to compare the efficacy and side-effects of sublingual buprenorphine, a synthetic opioid agonist antagonist, with those of subcutaneous morphine. Fifty ASA class 1 patients were included in the study after having given their informed consent. Caesarean section was carried out under epidural block with 0.5% bupivacaine; no opioids were used during the procedure. The first dose of opioid was given 2 h after the first dose of bupivacaine. Patients were randomly given either 10 mg morphine (n = 25) or 0.4 mg buprenorphine (n = 25), followed by the same dose every 6 h for 36 h. When analgesia was insufficient, tablets containing dextropropoxyphene and paracetamol were given. No attempt was made to blind the study to the patient, but the investigator assessing pain was unaware of the drug given to the patient. Pain intensity was assessed before, and 2 h after each dose of opioid with a 100 mm visual scale, as well as systolic, diastolic and mean arterial blood pressures, heart and breathing rates, and SpO2. Side-effects (pruritus, nausea, vomiting, drowsiness) were also noted. In 2 patients in each group, the protocol was stopped before the 36th h, but after the fourth dose, either because of side-effects, or at the patient's request. Results were similar in both groups of patients, whether for degree of pain relief, or physiological effects. There was no clinically detectable respiratory depression. Duration and intensity of episodes of arterial oxygen desaturation, and the incidence of nausea, were similar in the 2 groups; pruritus was more common in the morphine group.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Buccal; Adult; Blood Pressure; Buprenorphine; Cesarean Section; Female; Heart Rate; Humans; Injections, Subcutaneous; Morphine; Nausea; Oxygen; Pain, Postoperative; Pregnancy; Pruritus

Epidural morphine is associated with a high incidence of pruritus when used for pain control in the post-Caesarean section population. The purpose of this study was to compare the incidence of pruritus associated with epidural morphine, fentanyl, buprenorphine and butorphanol. Sixty healthy Caesarean section patients were studied in a double-blind randomized fashion. Patients were questioned at 1, 3, 12 and 24 hours postpartum for the incidence of pruritus. This study demonstrated that the incidence of pruritus was significantly higher following the use of epidural morphine and fentanyl. Even though epidural butorphanol and buprenorphine exhibited a low incidence of pruritus, their duration of analgesia was not long enough to make either attractive for single-dose administration.

Topics: Adult; Analgesia, Epidural; Analgesics, Opioid; Buprenorphine; Butorphanol; Cesarean Section; Clinical Trials as Topic; Double-Blind Method; Female; Fentanyl; Humans; Morphine; Pain, Postoperative; Pregnancy; Pruritus; Random Allocation

Topics: Administration, Topical; Aged; Analgesics, Opioid; Buprenorphine; Cholestasis; Chronic Disease; Drug Combinations; Female; Humans; Injections, Intravenous; Naloxone; Narcotic Antagonists; Neoplasms; Pain; Pain Measurement; Palliative Care; Pruritus; Treatment Outcome

Topics: Administration, Cutaneous; Aged; Analgesics, Opioid; Buprenorphine; Fatal Outcome; Female; Humans; Liver Cirrhosis, Biliary; Pruritus

Severe pruritus is a frequent complication of cholestasis. Both serotonin and opioids play an important role in the development of this symptom. Guidelines to provide rational management of pruritus of cholestasis do not exist. We describe a patient with complex and malignant course of pruritus. She responded to several measures proposed (among other naltrexone), but rapidly became tolerant to them. Buprenorphine with an ultra low dose of naloxone was able to control her symptoms without development of tolerance until her death.

Topics: Aged; Buprenorphine; Cholestasis; Colonic Neoplasms; Drug Therapy, Combination; Fatal Outcome; Female; Humans; Liver Neoplasms; Naloxone; Narcotic Antagonists; Pruritus

Topics: Adult; Analgesia, Epidural; Buprenorphine; Humans; Male; Morphine; Pruritus

Topics: Administration, Sublingual; Aged; Buprenorphine; Drug Eruptions; Female; Humans; Pruritus

The scratching caused by a standard, submaximal dose of bombesin (0.10 microgram i.c.v.) in rats is antagonized in a stereospecific and dose-related manner by systemically (but not centrally) administered benzomorphan analgesics; other commonly used opioids and opioid peptides are ineffective at behaviorally nondepressent doses. Naloxone attenuates the antibombesin effect of ethylketocyclazocine in a stereospecific, potent and dose-related manner. Tolerance develops to the inhibitory action of ethylketocyclazocine (and phenazocine). Multiple injections of morphine do not influence the ability of ethylketocyclazocine or of phenazocine to antagonize bombesin. Furthermore, when mu opiate receptors are occluded by buprenorphine, ethylketocyclazocine and phenazocine can still antagonize bombesin-induced scratching. Benzomorphan-selective binding sites have previously been postulated; we suggest that this test provides evidence of such sites in vivo. The model affords a simple, yet novel, behavioral endpoint that can be used when defining the pharmacological profile of new benzomorphans and their antagonists.

Topics: Analgesics, Opioid; Animals; Benzomorphans; Bombesin; Buprenorphine; Cyclazocine; Dose-Response Relationship, Drug; Drug Tolerance; Ethylketocyclazocine; Male; Morphinans; Morphine; Naloxone; Phenazocine; Pruritus; Rats; Rats, Inbred Strains; Receptors, Opioid