buprenorphine and Psychomotor-Agitation

Behavioral disturbances and pain are common in nursing home (NH) patients with dementia. An association between pain and increased agitation has been suggested, and recently a significant reduction of agitation has been demonstrated by pain treatment in patients with moderate to severe dementia. We now examined which specific agitated behaviors respond to individualized pain treatment.. Cluster randomized clinical trial.. 60 clusters (i.e., clusters defined as single independent NH units) in 18 NHs within five municipalities of Western Norway.. 352 patients with moderate to severe dementia and clinically significant behavioral disturbances.. The control group received usual treatment and care. According to a predefined scheme for 8 weeks, all patients in the intervention group received individual daily pain treatment with acetaminophen, extended release morphine, buprenorphine transdermal patch, and/or pregabaline.. Cohen-Mansfield Agitation Inventory subscales and items.. Analyses demonstrated that Factor 3 (Verbally agitated behaviors) showed the largest significant difference (DF = 1204.0, t = -4.308, p <0.001), followed by Factor 2 (Physically non-aggressive behaviors) (DF = 1198.0, t = -2.672, p = 0.008), and Factor 1 (Aggressive behaviors) (DF = 1196.0, t = -2.093, p = 0.037) after 8 weeks, by a linear random intercept mixed model in two-way repeated-measures configuration with adjustment for heteroscedasticity.. We found that verbal agitation behaviors such as complaining, negativism, repetitious sentences and questions, constant request for attention, and cursing or verbal aggression responded to pain treatment. In addition, restlessness and pacing were sensible to analgesics. Such behaviors should therefore lead to an assessment of pain, and pain treatment. Further studies comparing how pain treatment should be balanced against other strategies including psychotropic drugs are needed.

Topics: Acetaminophen; Aged, 80 and over; Analgesics; Buprenorphine; Delayed-Action Preparations; Dementia; Female; gamma-Aminobutyric Acid; Humans; Male; Morphine; Norway; Nursing Homes; Pain; Pain Management; Pregabalin; Psychomotor Agitation; Transdermal Patch

Acute withdrawal syndromes, including agitation and a long weaning time, are common adverse effects after long-term sedation with midazolam. We performed this study to determine whether the sequential use of midazolam and propofol could reduce adverse effects as compared with midazolam alone. We studied 26 patients receiving mechanical ventilation for three or more days after surgery. Patients were randomly assigned to two groups. In Group M, patients were sedated with midazolam alone. In Group M-P, midazolam was switched to propofol approximately 24 h before the expected stopping of sedation. The level of sedation was maintained at 4 or 5 on the Ramsay sedation scale. The sedation agitation scale was evaluated for 24 h after extubation. The recovery time from stopping of sedation to extubation was significantly shorter in Group M-P (1.3 +/- 0.4 h) compared with Group M (4.0 +/- 2.4 h). The incidence of agitation in Group M-P (8%) was significantly less frequent than that in Group M (54%). The results indicate that sequential use of midazolam and propofol for long-term sedation could reduce the incidence of agitation compared with midazolam alone.. Our study indicates that sequential use of midazolam and propofol could reduce the incidence of agitation compared with midazolam alone.

Topics: Analgesics, Opioid; Buprenorphine; Conscious Sedation; Female; Humans; Hypnotics and Sedatives; Male; Midazolam; Middle Aged; Pain, Postoperative; Postoperative Period; Propofol; Psychomotor Agitation; Respiration, Artificial

Topics: Administration, Cutaneous; Aged; Aged, 80 and over; Aggression; Alzheimer Disease; Analgesics, Opioid; Buprenorphine; Dose-Response Relationship, Drug; Homes for the Aged; Humans; Nursing Homes; Psychomotor Agitation; Randomized Controlled Trials as Topic