nalbuphine and Abdominal-Pain

Topics: Abdominal Pain; Analgesics, Opioid; Cancer Pain; Carcinoma, Renal Cell; Hospice Care; Humans; Hydromorphone; Kidney Neoplasms; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Nalbuphine; Portal Vein; Urinary Retention; Venous Thrombosis

Neurotoxicity is frequent with vincristine treatment, but severe autonomic neuropathy is rare. A decreased activity of drug transporters in the presence of an interacting drug may favor such events by increasing systemic or tissue exposure to the drug. We encountered severe autonomic neuropathy and cholestasis in a child receiving vincristine, after the introduction of piperacillin-tazobactam. A causality assessment of the adverse reaction identified the antibiotic as the most probable cause of the observation. The patient was heterozygous for several common polymorphisms of ABCC2 (multidrug-related protein-2), CYP3A5, and ABCB1 (multidrug-related protein-1, P-glycoprotein), but their role in the toxicity cannot be ascertained.

Topics: Abdominal Pain; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; ATP Binding Cassette Transporter, Subfamily B; ATP Binding Cassette Transporter, Subfamily B, Member 1; Autonomic Nervous System Diseases; Biological Transport; Child; Cholestasis; Cyclophosphamide; Cytochrome P-450 CYP3A; Daunorubicin; Drug Combinations; Drug Interactions; Facial Pain; Female; Humans; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Multidrug Resistance-Associated Protein 2; Multidrug Resistance-Associated Proteins; Nalbuphine; Neoplasm Proteins; Neuralgia; Penicillanic Acid; Piperacillin; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Seizures; Tazobactam; Vincristine

Gallbladder stones are very common in patients with sickle cell disease and are the cause of recurrent abdominal pain. Their management has been highly controversial, especially for children. Nonoperated patients and those treated on an emergency basis have a very high rate of morbidity (>50%).. We performed a retrospective review of a series of 29 homozygous SS sickle cell children who underwent laparoscopic cholecystectomy between 1991 and April 1998.. Only in one case a conversion was necessary (early in the series). Exploration of the common bile duct was done via intraoperative cholangiography. There were no mortalities. The morbidity rate was 17%; (however, of the five patients concerned, four suffered from hyperthermia for 2 days. All of the children were improved and enjoyed resolution of their abdominal pain.. We believe that elective laparoscopic cholecystectomy at the earliest time possible, along with correct perioperative management, is the treatment of choice for cholelithiasis in children with sickle cell disease.

Topics: Abdominal Pain; Acetaminophen; Acute Disease; Anemia, Sickle Cell; Child; Child, Preschool; Cholecystectomy, Laparoscopic; Cholecystitis; Cholelithiasis; Female; Humans; Male; Nalbuphine; Pain, Postoperative

Despite physiological advances and recent progress in pain relief, early analgesia for patients with acute abdominal pain is not a conventional endpoint. In clinical practice, priority is often given to diagnosis and management decisions. There are few controlled trials to settle the issue and opinions are still divided. recent studies suggest than early and effective analgesia in acute abdomen does not interfere with diagnosis, and even facilitates initial examination. Various modes of analgesia can be considered.

Topics: Abdominal Pain; Analgesia, Epidural; Analgesics; Buprenorphine; Humans; Nalbuphine

Topics: Abdominal Pain; Adult; Autonomic Nerve Block; Celiac Plexus; Costs and Cost Analysis; Humans; Injections, Subcutaneous; Male; Mexico; Nalbuphine; Palliative Care; Phenol; Phenols