Methadone is safe for treating hospitalized patients with severe pain
Child; Female; Hospitalization; Humans; Male; Adult; Analgesics; Aged; Middle Aged; Analgesia; adolescent; Preschool; infant; Administration; Oral; retrospective studies; Pain/drug therapy; Pain Measurement/drug effects; Epidural; Methadone/administration & dosage/adverse effects/therapeutic use; Monitoring; Opioid/administration & dosage/adverse effects/therapeutic use; Physiologic
PURPOSE: Methadone is still regarded as a second line opioid for patients suffering from severe pain, and is rarely used in hospitalized patients. The infrequent use of methadone is probably due to its long plasma half-life that could lead to accumulation and toxicity. In the present study we report that clinically effective analgesic doses of methadone, given either epidurally or orally, can be used safely for prolonged treatment in hospitalized patients. Clinical features: Over a five-year period we administered methadone at Hadassah Hospital in Jerusalem to 3,954 in-patients with severe pain, 12% of whom were younger than 17 yr. Satisfactory pain relief was recorded in more than 85% of the patients. None of the patients treated with oral methadone developed serious side effects. Three patients, treated with epidural methadone (0.09%), developed a clinically significant respiratory depression. In all three cases, epidural pump failure or pump misprogramming resulted in methadone overdose. None of the children or adults treated with methadone developed addiction during hospitalization. CONCLUSION: Based on its analgesic properties and marked safety profile, we suggest that methadone could be added to the analgesic armamentarium of in-hospital health-care providers. Moreover, methadone could serve as the opioid of first choice in some in-patient populations.
2001
Shir Y; Rosen G; Zeldin A; Davidson EM
Canadian Journal Of Anaesthesia
2001
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1007/bf03020377" target="_blank" rel="noreferrer">10.1007/bf03020377</a>
Influence of pain treatment by epidural fentanyl and bupivacaine on homing of opioid-containing leukocytes to surgical wounds
Female; Humans; Male; Pain; Analgesics; Aged; Middle Aged; Longitudinal Studies; Analgesia; Anesthetics; Biomarkers of Pain; Anesthesia; Epidural; Enkephalin; Adjuvants; Anesthesia/immunology/pharmacology; beta-Endorphin/drug effects/immunology/metabolism; Bupivacaine/immunology/therapeutic use; Cell Movement/drug effects/immunology; Fentanyl/immunology/therapeutic use; Leukocytes/drug effects/immunology/metabolism; Local/immunology/therapeutic use; Methionine/drug effects/immunology/metabolism; Nociceptors/drug effects/immunology; Opioid/immunology/therapeutic use; Patient-Controlled; Pirinitramide/therapeutic use; Postganglionic/drug effects/immunology; Postoperative/immunology/prevention & control; Subcutaneous Tissue/immunology; Sympathetic Fibers; Wound Healing/drug effects/immunology
Endogenous opioids released from leukocytes extravasating into injured tissue can interact with peripheral opioid receptors to inhibit nociception. Animal studies have shown that the homing of opioid-producing leukocytes to the injured site is modulated by spinal blockade of noxious input. This study investigated whether epidural analgesia (EDA) influences the migration of beta-endorphin (END) and/or met-enkephalin (ENK)-containing leukocytes into the subcutaneous wound tissue of patients undergoing abdominal surgery. In part I patients received general anesthesia combined either with intra- and postoperative EDA (with bupivacaine and fentanyl) or with postoperative patient controlled intravenous analgesia (PCIA; with the opioid piritramide). In part II patients received general anesthesia combined with either epidural fentanyl or bupivacaine which was continued postoperatively. Samples of cutanous and subcutanous tissue were taken from the wound site at the beginning, at the end and at various times after surgery, and were examined by immunohistochemistry for the presence of END and ENK. We found that (i) epidural bupivacaine, fentanyl and PCIA provided similar and clinically acceptable postoperative pain relief; (ii) compared to PCIA, epidural bupivacaine or fentanyl did not change the gross inflammatory reaction within the surgical wound; (iii) opioid-containing leukocytes were almost absent in normal subcutaneous tissue but migrated to the inflamed wound tissue in ascending numbers within a few hours, reaching a peak at about 24 h after surgery; (iv) compared to PCIA, EDA resulted in significantly decreased homing of END-containing leukocytes to the injured site at 24 h after surgery; and (v) the magnitude of this decrease was similar regardless of the epidural medication. These findings suggest that nociceptive but not sympathetic neurons are primarily involved in the attraction of opioid-containing leukocytes during early stages of inflammation.
2007
Heurich M; Mousa SA; Lenzner M; Morciniec P; Kopf A; Welte M; Stein C
Brain, Behavior, And Immunity
2007
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/j.bbi.2006.10.014" target="_blank" rel="noreferrer">10.1016/j.bbi.2006.10.014</a>