morphinans and Postoperative-Complications

In a randomized double-blind placebo-controlled trial involving 80 patients nalbuphine 10 mg and 20 mg were compared with pethidine 100 mg and a placebo given i.m. at least 90 min before minor gynaecological surgery. Nalbuphine proved a suitable alternative to pethidine, producing beneficial sedation which was maximum at 60 min after injection. Both nalbuphine and pethidine reduced the excitatory sequelae of methohexitone induction. Increasing the dose of nalbuphine from 10 mg to 20 mg produced no significant additional sedation or intraoperative benefit. Short-lived pain at the injection site was a feature of the use of nalbuphine in either dose. The main disadvantage of nalbuphine was nausea and vomiting of delayed onset, the frequency of which was similar after either dose.

Topics: Adult; Clinical Trials as Topic; Female; Humans; Meperidine; Morphinans; Nalbuphine; Nausea; Postoperative Complications; Preanesthetic Medication; Vomiting

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

Topics: Adult; Analgesics; Clinical Trials as Topic; Humans; Isonipecotic Acids; Middle Aged; Morphinans; Pain; Postoperative Care; Postoperative Complications

Postoperative ileus (POI) often decreases patients' QOL because of prolonged hospitalization and readmission. Alvimopan, a peripheral μ-opioid receptor antagonist, is currently the only therapeutic drug for POI. The aim of this study was to examine the efficacy of naldemedine (a peripheral μ-opioid receptor antagonist with a non-competitive pharmacological profile different from that of alvimopan) on postoperative intestinal hypomotility and adhesion in rodent models, and compare it with the effects of alvimopan. Oral administration of naldemedine (0.3 mg/kg) and alvimopan (3 mg/kg) significantly inhibited the decrease in intestinal motility induced by mechanical irritation in mice (p < 0.01, for both). Naldemedine (1 mg/kg) significantly shortened the adhesion length in chemical-induced postoperative adhesion model rats (p < 0.05). Alvimopan (3 mg/kg) also significantly reduced the adhesion ratio (p < 0.01). These findings suggest that naldemedine is effective for postoperative intestinal hypomotility and adhesions in rodents (i.e., as for alvimopan). Thus, naldemedine may be a useful option for the treatment of POI.

Topics: Analgesics, Opioid; Animals; Gastrointestinal Agents; Humans; Ileus; Mice; Morphinans; Narcotic Antagonists; Postoperative Complications; Quality of Life; Rats; Rodentia

The use of alvimopan at the time of cystectomy has been associated with improved perioperative outcomes. Naloxegol is a less costly alternative that has been used in some centers. This study aims to compare the perioperative outcomes of patients undergoing cystectomy with urinary diversion who receive the mu-opioid antagonist alvimopan versus naloxegol.. This was a retrospective review that included all patients who underwent cystectomy with urinary diversion at our institution between 2007-2020. Comparisons were made between patients who received perioperative alvimopan, naloxegol and no mu-opioid antagonist (controls).. In 715 patients who underwent cystectomy, 335 received a perioperative mu-opioid antagonist, of whom 57 received naloxegol. Control patients, compared to naloxegol and alvimopan patients, experienced a significantly (p < 0.05) delayed return of bowel function (4.3 vs. 2.5 vs. 3.0 days) and longer hospital length of stay (7.9 vs. 7.5 vs. 6.5 days), respectively. The incidence of nasogastric tube use (14.2% vs. 12.5% vs. 6.5%) and postoperative ileus (21.6% vs. 21.1% vs. 13.3%) was also most common in the control group compared to the naloxegol and alvimopan cohorts, respectively. A multivariable analysis revealed that when comparing naloxegol and alvimopan, there was no difference in return of bowel function (OR 0.88, p = 0.17), incidence of postoperative ileus (OR 1.60, p = 0.44), or hospital readmission (OR 1.22, p = 0.63).. Naloxegol expedites the return of bowel function to the same degree as alvimopan in cystectomy patients. Given the lower cost of naloxegol, this agent may be a preferable alternative to alvimopan.

Topics: Cystectomy; Gastrointestinal Agents; Humans; Ileus; Length of Stay; Morphinans; Narcotic Antagonists; Piperidines; Polyethylene Glycols; Postoperative Complications; Urinary Diversion

Topics: Adult; Female; Heart Rate; Humans; Infant, Newborn; Male; Middle Aged; Morphinans; Morphine; Nalbuphine; Nausea; Pain; Postoperative Complications; Respiration

Topics: Humans; Morphinans; Nalbuphine; Postoperative Complications; Respiratory Insufficiency; Time Factors

Topics: Adult; Aged; Female; Humans; Male; Morphinans; Nalbuphine; Postoperative Complications; Respiratory Insufficiency; Time Factors

Topics: Aged; Female; Heroin; Humans; Morphinans; Nalbuphine; Postoperative Complications; Respiratory Insufficiency; Time Factors

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

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

Topics: Anti-Bacterial Agents; Blood Pressure; Drainage; Duodenal Ulcer; Humans; Male; Meperidine; Middle Aged; Morphinans; Peptic Ulcer Perforation; Postoperative Complications; Radiography

Topics: Adult; Age Factors; Animals; Cattle; Choroid; Drainage; Humans; Hypertonic Solutions; Middle Aged; Morphinans; Myopia; Postoperative Complications; Sclera; Sodium Chloride; Tissue Extracts

Topics: Acid-Base Equilibrium; Aged; Anesthesia, Conduction; Anesthesia, Epidural; Anesthesia, General; Anesthesia, Local; Anilides; Capillaries; Carbon Dioxide; Cardiac Output; Humans; Male; Morphinans; Oxygen; Partial Pressure; Pentazocine; Pipecolic Acids; Postoperative Care; Postoperative Complications; Prostatectomy; Pulmonary Alveoli; Pulmonary Circulation; Respiration; Time Factors

Topics: Animals; Barium Sulfate; Bethanechol Compounds; Dogs; Duodenum; Emetics; Fluoroscopy; Gastrointestinal Motility; Morphinans; Muscle Contraction; Muscle, Smooth; Postoperative Complications; Pylorus; Stomach; Transducers; Vagotomy; Vomiting