buprenorphine and Vomiting

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

To evaluate the efficacy and safety of transdermal buprenorphine in patients with diabetic peripheral neuropathic pain (DPNP).. This multicenter, randomized, double-blind, placebo-controlled, parallel-group trial enrolled patients with type 1 or type 2 diabetes and stable glycemic control who had been experiencing moderate to severe DPNP for at least 6 months on maximal tolerated conventional therapy. Patients were randomly assigned to receive buprenorphine (5 μg/h) or placebo patches. The dose was titrated to effect to a maximum of 40 μg/h. Paracetamol was available as rescue analgesia. The severity of pain and other symptoms of DPNP were assessed daily in a patient diary and at clinic visits.. One hundred eight-six patients were enrolled, with 93 randomized to either buprenorphine or placebo. A high proportion of patients did not complete the study (buprenorphine 37 of 93, placebo 24 of 93). The main reason for premature withdrawal in the buprenorphine group was adverse events commonly due to untreated nausea and/or vomiting. Among the per-protocol population, more patients in the buprenorphine group (86.3%) experienced a 30% reduction in average versus baseline pain at week 12 than those in the placebo group (56.6%, P < 0.001). A nonsignificant trend favored the buprenorphine group within the intention-to-treat analysis of the same end point (51.7% vs. 41.3%, P = 0.175).. Transdermal buprenorphine, when tolerated, is an effective therapy for DPNP and provides another option to manage this challenging painful condition. Nausea and constipation need to be managed proactively to optimize treatment outcomes.

Topics: Acetaminophen; Administration, Cutaneous; Adult; Aged; Analgesics, Non-Narcotic; Analgesics, Opioid; Buprenorphine; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Double-Blind Method; Female; Humans; Intention to Treat Analysis; Male; Middle Aged; Nausea; Neuralgia; Treatment Outcome; Vomiting; Withholding Treatment

To determine the effect of ondansetron on the incidence of vomiting in cats pre-medicated with dexmedetomidine and buprenorphine.. Randomized, blinded, controlled trial.. Eighty-nine female domestic shorthair cats, aged 3-60 months (median, 12 months) and weighing 1.2-5.1 kg.. Each cat received dexmedetomidine (40 μg kg(-1)) plus buprenorphine (20 μg kg(-1)), intramuscularly as pre-anesthetic medication. Cats were assigned to three treatment groups: ondansetron (0.22 mg kg(-1), intramuscular [IM]), either 30 minutes before the pre-anesthetic medication (ONDA group, n = 31) or with the pre-anesthetic medication (OPM group, n = 30) mixed with the pre-anesthetic medications in the same syringe, or not to receive the antiemetic (control group, n = 28). Emesis was recorded as an all-or-none response. The number of episodes of emesis and the time until onset of the first emetic episode were recorded for each cat. Clinical signs of nausea were recorded whenever they occurred, and a numerical rating scale was used to quantify these signs. Data were analyzed using Kruskal-Wallis and Chi-square test; a Bonferroni correction was made for six comparisons; thus, the two-sided p for significance was 0.05/6 = 0.008.. There was a significant reduction in the number of cats vomiting, in the episodes of vomiting/cat, the time elapsed between the premedication and the first vomiting and the severity of nausea in the OPM group compared to the ONDA and control groups.. In cats, the administration of ondansetron (0.22 mg kg(-1)) ameliorates and reduced the severity of dexmedetomidine-induced nausea and vomiting only when it was administered in association with this drug.

Topics: Analgesics, Opioid; Animals; Antiemetics; Buprenorphine; Cat Diseases; Cats; Dexmedetomidine; Drug Administration Schedule; Female; Hypnotics and Sedatives; Injections, Intramuscular; Ondansetron; Prospective Studies; Single-Blind Method; Vomiting

The purpose of this trial was to evaluate the effect of long-term treatment with oral sustained-release hydromorphone, transdermal fentanyl, and transdermal buprenorphine on nausea, emesis and constipation.. Randomly selected outpatients with cancer pain receiving one of the study medications were enrolled in a prospective, open-labeled, controlled trial (n=174). Mobility, pain, and gastrointestinal symptoms were assessed directly and per selected item on the ECOG (Eastern Cancer Oncology Group), EORTC (European Organisation for Research and Treatment of Cancer) questionnaires, NRS (Numerical Rating Scales), and analyzed statistically.. Demographic and medical data were comparable in all groups. Only 15% of patients suffered from constipation. 59% took the prescribed laxatives. The incidence of stool free periods >72 h was significantly higher with transdermal opioids (transdermal fentanyl: 22%; transdermal buprenorphine: 21%; oral hydromorphone: 2%; p=0.003). 21% of patients revealed nausea and emesis. The mean NRS for nausea (transdermal fentanyl:1.3; transdermal buprenorphine: 1.2; oral hydromorphone: 1.5; p=0.6), the consumption of antiemetics (transdermal fentanyl: 42%; transdermal buprenorphine: 33%; oral hydromorphone: 36%; p=0.6) and laxatives (transdermal fentanyl:53%; transdermal buprenorphine:66%; oral hydromorphone: 61%; p=0.2) did not differ significantly, in contrast to the score for emesis (transdermal fentanyl: 16%; transdermal buprenorphine:13%; oral hydromorphone: 33%; p=0.02). Morphine equivalent opioid doses differed (mg/d transdermal fentanyl: 183; transdermal buprenorphine: 89; oral hydromorphone: 143; p=0.001), because of obvious tolerance varying after long-term treatment.. Gastrointestinal symptoms of cancer pain patients undergoing an opioid therapy are related to multifactorial causes. Transdermal opioids showed no benefit over oral controlled-release hydromorphone with regard to gastrointestinal symptoms. The conversion ratios for transdermal fentanyl, transdermal buprenorphine, and oral hydromorphone did not accord to the literature, because of differing occurrences of opioid tolerance after long-term therapy.

Topics: Administration, Cutaneous; Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Antiemetics; Buprenorphine; Cohort Studies; Constipation; Delayed-Action Preparations; Female; Fentanyl; Gastrointestinal Diseases; Humans; Hydromorphone; Laxatives; Male; Middle Aged; Nausea; Neoplasms; Pain, Intractable; Prospective Studies; Vomiting

The objective of this study was to investigate medetomidine-buprenorphine preanaesthetic medication in cats.. Forty American Society of Anesthesiologists (ASA) I female cats were enrolled in this prospective, blinded, clinical study. Cats were randomised into one of four groups: group M30 were injected intramuscularly with 30 microg/kg medetomidine, groups M10+B, M30+B and M50+B received 10, 30 and 50 microg/kg of medetomidine, respectively, each in combination with 20 microg/kg buprenorphine. After 30 minutes, a sedation score was allocated. Anaesthesia was induced using intravenous propofol and maintained using isoflurane in oxygen, while cats underwent ovariohysterectomy. Heart rate, respiratory rate, end-tidal carbon dioxide tension and oxygen saturation of haemoglobin were recorded. Atipamezole was administered intramuscularly at volatile agent discontinuation. Time taken to lift their head, sit in sternal and stand were recorded along with quality of recovery.. M30+B cats required significantly less isoflurane compared with M30 cats. Heart rate and oxygen saturation of haemoglobin were significantly lower in M50+B cats than in M30 cats. All M+B groups experienced significantly better recoveries compared with the medetomidine only M30 control group.. The addition of buprenorphine to medetomidine preanaesthetic medication in cats reduces volatile agent vaporiser setting and improves the quality of recovery from anaesthesia.

Topics: Anesthetics, Inhalation; Anesthetics, Intravenous; Animals; Buprenorphine; Cats; Drug Therapy, Combination; Female; Heart Rate; Hypnotics and Sedatives; Isoflurane; Medetomidine; Narcotic Antagonists; Ovariectomy; Preanesthetic Medication; Propofol; Time Factors; Vomiting

This study was undertaken to evaluate the adverse consequences of recently introduced higher strength (0.4 and 2.0 mg per tablet) buprenorphine in Indian market. Buprenorphine, a partial opiate agonist and antagonist, is an emerging alternative to methadone as an agent for long-term treatment of opiate dependence.. The current investigation was conducted through a multi-centric post-marketing surveillance (PMS) study using a structured performa from patients receiving buprenorphine as routine therapy from de-addiction centres. Evaluation included subjective and objective assessments and recording of adverse events.. Of the 5551 observations from ten centres, common subjective symptoms were generalised weakness (48.9%), sense of high (euphoria) (44.5%), muscle aches (39.5%) and relief from pain (37.2%). About 5% observations recorded systolic hypertension. Among 55 subjects where laboratory tests were conducted, 12 showed raised levels of AST ad 9 had elevated ALT. Twelve adverse events reported included seizure, epistaxis, panic attacks, constipation and dyspnoea. Significant relation was seen between duration of use and time since last dose, and total number of subjective symptoms reported.. Majority of the adverse effects could be understood as either effects related to intoxication or withdrawal from agonists.

Topics: Administration, Sublingual; Adult; Buprenorphine; Dose-Response Relationship, Drug; Humans; Narcotic Antagonists; Nausea; Product Surveillance, Postmarketing; Receptors, Opioid; Sleep Stages; Substance-Related Disorders; Tablets; Vomiting

Combined spinal-epidural anesthesia is a useful technique. However, there has been no attempt to investigate the risk of epidural opioid, especially buprenorphine, flux through the dural hole. The purpose of this study was to compare the effect of epidural buprenorphine administered across the dura into subarachnoid space, between two different methods of administration; bolus injection (Group I) and continuous infusion (Group II). Sixty patients for transvaginal hysterectomy were divided into two groups. Group I received buprenorphine 0.1-0.2 mg with 0.25% bupivacaine, and Group II 0.4 mg with 0.25% bupivacaine 40 ml continuously (infusion rate was 1.7 ml.h-1). Pain relief was similar in both groups, but the total buprenorphine requirement was lower in Group I than in Group II. The incidence of nausea and vomiting was significantly higher in Group I than that in Group II, 73% and 16%, respectively. It indicates that the increase of nausea and vomiting is predominantly determined by a high rate of flux into subarachnoid space and only partly determined by blood concentrations. In contrast to continuous infusion, the drug movement through the dural hole may increase by bolus injection due to its higher pressure. We recommend careful injection of epidural buprenorphine such as by continuous infusion with low pressure after combined spinal-epidural anesthesia.

Topics: Adult; Analgesics, Opioid; Anesthesia, Epidural; Anesthesia, Spinal; Buprenorphine; Female; Humans; Hysterectomy, Vaginal; Injections, Epidural; Middle Aged; Nausea; Pain, Postoperative; Vomiting

For 120 young patients who had undergone reconstruction of anterior cruciate ligament of the knee, we investigated the effect of epidural administration of buprenorphine on the incidence of nausea or vomiting, and the anti-emetic effect of epidural administration of droperidol. In the group who had received bolus injection of buprenorphine 0.1 mg, nausea or vomiting occurred early most often, and the injection was not useful to prolong analgesic effect. In the another group who had received continuous epidural infusion of buprenorphine 0.3 mg, nausea or vomiting occurred late. Bolus injection of droperidol 2.5 mg was not useful to prevent nausea or vomiting caused by continuous epidural infusion of buprenorphine. While, continuous infusion of droperidol 5 mg was effective in decreasing nausea or vomiting caused by continuous epidural infusion of buprenorphine. In conclusion, continuous epidural administration of droperidol is useful to prevent nausea or vomiting.

Topics: Adolescent; Adult; Analgesics, Opioid; Anesthesia, Epidural; Anesthesia, General; Anterior Cruciate Ligament; Antiemetics; Buprenorphine; Droperidol; Female; Humans; Injections, Epidural; Male; Nausea; Pain, Postoperative; Vomiting

Caudal buprenorphine was investigated as a postoperative analgesic in a randomized double blind study in thirty children aged 5-12 years undergoing lower abdominal and lower limb surgery. Comparison was made between two groups of patients, one group receiving plain bupivacaine and the other a combination of plain bupivacaine with buprenorphine. Postoperative analgesia was assessed using a linear analogue scale, and by the response to direct questioning of children using an illustration of sequence of faces. Any untoward side effects and the need for additional analgesics were recorded. The degree and duration of analgesia was far superior in the buprenorphine group and there was a highly significant difference in the requirement of postoperative analgesia between the two groups. There were no major adverse side effects and no motor weakness in either groups, however the incidence of nausea and vomiting was higher in the buprenorphine group. It is concluded that a combination of bupivacaine with buprenorphine administered through the caudal epidural space is a safe and reliable means of providing postoperative pain relief in children for up to 24 h.

Topics: Abdomen; Analgesia, Epidural; Analgesics, Opioid; Anesthesia, Epidural; Anesthetics, Local; Bupivacaine; Buprenorphine; Child; Child, Preschool; Double-Blind Method; Humans; Incidence; Leg; Meperidine; Nausea; Pain Measurement; Pain, Postoperative; Time Factors; Vomiting

This study was conducted on 44 children aged 1-10 years, who had undergone lower extremity orthopaedic surgery under general anaesthesia. Patients were divided into two groups: Group 1 (n = 23) received buprenorphine caudally and Group 2 (n = 21) received buprenorphine intramuscularly, at the completion of the surgery. The dose of buprenorphine used in both the groups was 4 micrograms.kg-1 body weight. The quality and duration of postoperative analgesia were evaluated by a single observer using a 5-point score for the first 24 h postoperatively. The time until the patient required postoperative analgesic was recorded. The duration of analgesia was significantly greater with caudal buprenorphine (median 20.20 h) than with intramuscular buprenorphine (median 5.20 h). Of the patients in the caudal group, 43% did not require any supplemental analgesia during the first 24 h, whereas all the patients in the intramuscular group required supplements within 10 h postoperatively. Caudal buprenorphine (4 micrograms.kg-1 body weight) provided 10.8 h to more than 24 h of analgesia in children, with fewer side effects.

Topics: Ambulatory Surgical Procedures; Analgesia, Epidural; Anesthesia Recovery Period; Buprenorphine; Child; Child, Preschool; Double-Blind Method; Female; Humans; Infant; Injections, Intramuscular; Leg; Male; Nausea; Pain Measurement; Pain, Postoperative; Time Factors; Vomiting

We conducted a trial to evaluate the histamine-releasing characteristics of morphine, meperidine, and buprenorphine when administered intravenously to 20 healthy adults without pain. Substantially more nausea and vomiting occurred with buprenorphine than with the other compounds, and was more intense on ambulation. High-affinity receptor binding may play a role in the long duration of nausea and vomiting after a single dose of this agent.

Topics: Adult; Buprenorphine; Double-Blind Method; Drug Evaluation; Histamine Release; Humans; Male; Meperidine; Middle Aged; Morphine; Nausea; Vomiting

A randomized double-blind cross-over study was performed to evaluate the possible anti-emetic effect of the partial opiate antagonist buprenorphine in comparison to domperidone in chemotherapy-induced nausea and vomiting. Emesis was of significantly shorter duration on domperidone treatment. Most patients preferred domperidone, mainly due to adverse side-effects of buprenorphine. Nevertheless, emesis in buprenorphine treatment was less disabling. Therefore, it might be useful to search for new alternatives in this group of drugs or to use them in a combination regimen of anti-emetic agents.

Topics: Adult; Aged; Antiemetics; Antineoplastic Agents; Buprenorphine; Clinical Trials as Topic; Domperidone; Double-Blind Method; Female; Humans; Male; Middle Aged; Morphinans; Nausea; Pilot Projects; Random Allocation; Vomiting

Topics: Acetaminophen; Adult; Buprenorphine; Cocaine-Related Disorders; Diagnosis, Differential; Diarrhea; Drug Combinations; Female; Humans; Illicit Drugs; Naloxone; Narcotic Antagonists; Nausea; Opioid-Related Disorders; Oxycodone; Substance Abuse Detection; Vomiting

Suboxone, a combination of buprenorphine and naloxone in sublingual tablet form, was recently approved in the United States for management of opioid dependence. Little information exists regarding the potential for opioid toxicity after Suboxone exposure in the pediatric population. We report a case of opioid toxicity after exposure to Suboxone in a pediatric patient and a review of other cases of pediatric Suboxone ingestion in the literature.. A previously healthy 2-year-old boy was found with 1 tablet of Suboxone (8 mg buprenorphine/2 mg naloxone) in his mouth. Remnants of the partly dissolved tablet were immediately removed from the child's oropharynx. The child experienced 1 episode of spontaneous emesis and became drowsy en route to the emergency department 30 minutes after the exposure. The patient was observed in the emergency department; no interventions were necessary, and the child was discharged asymptomatic and stable 6 hours post ingestion.. Suboxone, a combination of buprenorphine and naloxone, may produce opioid toxicity via sublingual absorption or ingestion by children. We present the case of a child with mild central nervous system depression after exposure to Suboxone. Pediatric case reports that demonstrate more significant central nervous system and respiratory depressant effects from Suboxone ingestion are emerging.

Topics: Buprenorphine; Buprenorphine, Naloxone Drug Combination; Child, Preschool; Humans; Male; Naloxone; Narcotic Antagonists; Vomiting

New methods of ultra-rapid opiate detoxification (URD) under intravenous sedation have been criticized because of limited data on safety and long-term follow-up. Premedication with buprenorphine has been advocated to improve safety by decreasing vomiting. Prior research has not explored URD in socially impaired patients.. Sixteen patients were detoxified with URD and prospectively evaluated over at least 30 months. Data of this procedure were compared with those of our previous study without buprenorphine preparation (Drug Alcohol Depend. 52(3) (1998) 243). The 16 patients were followed up by a general practitioner (GP) before and after URD. The GPs also supervised the 7-day course of buprenorphine treatment prescribed for the 16 patients prior to URD.. During the procedure, only one episode of vomiting occurred instead of 13 out of 20 in our previous study. Post-procedure, only two patients experienced moderate withdrawal symptoms, such as persistent nausea, abdominal cramps and vomiting lasting from 24 to 48 h, in comparison with most patients in the previous study without buprenorphine. After a period of at least 30 months (36.0+/-6.38), the 16 patients were still alive and were regularly monitored by their GP. Only two of the 16 never relapsed after URD and reported total opiate abstinence. Fourteen patients relapsed; 12 of these were prescribed a licensed methadone substitution program and two were still using heroin.. In this small sample, the data indicated that URD with buprenorphine preparation was safe and that it markedly decreased post-procedure morbidity. No patient died over a minimum 30-month follow-up period. Furthermore, the procedure was employed with socially impaired patients. In the long term, a few patients were still free of opiates, while the majority opted for a methadone maintenance program, showing that URD can serve as one possible step in a long-term treatment program.

Topics: Adult; Buprenorphine; Conscious Sedation; Family Practice; Female; Follow-Up Studies; Heroin Dependence; Humans; Male; Naltrexone; Narcotic Antagonists; Narcotics; Opioid-Related Disorders; Outcome and Process Assessment, Health Care; Premedication; Recurrence; Substance Withdrawal Syndrome; Time Factors; Vomiting

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

Postoperative analgesia with epidurally injected buprenorphine and its side effects were investigated in 100 patients who had received lower abdominal surgery. All patients received initially 8 ml of bupivacaine and 0.1 mg of buprenorphine. Following bolus epidural injection, five different groups of 20 patients each received either bupivacaine alone (group A), 5 micrograms.ml-1 buprenorphine.bupivacaine mixture (group B), 8 micrograms.ml-1 buprenorphine.bupivacaine mixture (group C), 12 micrograms.ml-1 buprenorphine.bupivacaine mixture (group D), or 15 micrograms.ml-1 buprenorphine.bupivacaine mixture (group E) by a portable disposable device at a rate of 1 ml.h-1 for 48 h. The analgesic efficacy in group E was superior to those in groups A, B, C or D. No significant difference in the incidence of side-effect was found among groups C, D, E. We conclude that a dose of a approximately 15 micrograms.h-1 might be optimal for postoperative pain relief after lower abdominal surgery.

Topics: Abdomen; Analgesia, Epidural; Bupivacaine; Buprenorphine; Female; Humans; Male; Middle Aged; Nausea; Pain, Postoperative; Vomiting

This study examined analgesic efficacy and adverse effects of buprenorphine and fentanyl for the postoperative pain relief by continuous epidural infusion. Fifty patients after upper or lower abdominal surgeries were assigned to two groups and buprenorphine and fentanyl were epidurally administered postoperatively. Buprenorphine (B) group received bolus injection of B 0.1mg + saline 8 ml and continuous infusion of B 0.8 mg+saline 92 ml (2 ml.h-1). Fentanyl group received bolus injection of F 0.1 mg+saline 6 ml and continuous infusion of F 0.6 mg+saline 84 ml (2 ml.h-1). There was no significant difference between the two groups in the analgesic efficacy, which became lower from 2 to 12 hours postoperatively. However, compared with buprenorphine group, the incidence of nausea or vomiting and dizziness was significantly less in the fentanyl group (11 vs. 4 cases and 7 vs. 1 cases). These results imply that the major site of action of epidurally administered fentanyl is the spinal cord. In contrast, analgesic effect of epidural buprenorphine appears to be enhanced by the supraspinal action. We conclude that fentanyl is superior to buprenorphine for postoperative pain relief by continuous epidural infusion.

Topics: Abdomen; Aged; Buprenorphine; Dizziness; Female; Fentanyl; Humans; Injections, Epidural; Male; Middle Aged; Nausea; Pain, Postoperative; Vomiting

Buprenorphine, a partial opiate-receptor agonist with potent analgesic properties, was given to 7548 patients in the immediate postoperative period. Ninety per cent of patients had good or adequate pain relief for at least 4 hours; there were few adverse effects and the incidence of drug-associated respiratory depression was estimated at less than 1%. There were no other side-effects of clinical note.

Topics: Adolescent; Adult; Aged; Buprenorphine; Child; Child, Preschool; Drug Evaluation; Female; Humans; Male; Middle Aged; Morphinans; Nausea; Pain, Postoperative; Respiratory Insufficiency; Time Factors; Vomiting