Non-narcotic Analgesics Research Articles

Metamizole in the Management of Musculoskeletal Disorders: Current Concept Review.

Metamizole, or dipyrone, has been used for decades as a non-narcotic analgesic, providing pain relief from musculoskeletal disorders and antipyretic and antispasmolytic properties. Despite being in use since the 1920s, its mechanism of action still needs to be discovered. Despite causing fewer adverse effects when compared to other analgesics, its harmful effects on the blood and lack of evidence regarding its teratogenicity make the usage of the drug questionable, which has led to it being removed from the drug market of various countries. This narrative review aims to provide a detailed insight into the mechanism of action and efficacy, comparing its effectiveness and safety with other classes of drugs and the safety profile of metamizole.

It's complicated: The relationship of non-narcotic medications and postoperative opioid use in radical cystectomy patients

IntroductionThe effect of individual non-narcotic analgesics in cystectomy enhanced recovery after surgery (ERAS) is unknown. Additionally, many non-narcotic medications are associated with side effects pertinent to the cystectomy population. To better understand the actual use and utility of these medications, we sought to characterize the association between non-narcotic medications and milligram morphine equivalent (MME) narcotic score during the postoperative inpatient stay. MethodsWe reviewed 260 consecutive ERAS cystectomy patients. The MME impact of non-narcotic compliance and cumulative dose of medication received was evaluated separately with general linear models. We also assessed relationship of non-narcotic compliance to patient reported pain score, length of stay (LOS), and time to return of bowel function (ROBF) and performed manual review of postoperative documentation to identify reasons for medication noncompliance. ResultsCompliance with postoperative acetaminophen, gabapentin, and ketorolac was low. There was an inverse relationship between ketorolac dose and MME on postoperative day 1 (−0.026 MME/mg; P = 0.004) and postoperative day 2 (−0.33 MME/mg; P < 0.001). Compliance with ketorolac was associated with lower MME on postoperative day 1 (26.1 MME v. 33.6 MME; P = 0.023). There were no such associations identified with gabapentin or acetaminophen. Gabapentin compliance was associated with earlier ROBF (3.7 days v. 4.3 days; P = 0.006). Ketorolac compliance was associated with lower pain score on POD1 (3.25 VAS v. 4.07 VAS; P = 0.019) and POD2 (3.05 VAS v. 3.85 VAS; P = 0.040) There was no association between medication compliance and LOS. The most common reasons identified for non-compliance with gabapentin and ketorolac were renal function concerns (38% and 40% respectively), bleeding concerns with ketorolac (20%) and concerns for neurologic adverse effect with gabapentin (16%). ConclusionCompliance with non-narcotic medications in our ERAS cystectomy protocol was poor. There was a modest association with ketorolac and postoperative MME but no association with gabapentin or acetaminophen. Further study will clarify the role of these medications for cystectomy patients. Component specific analysis of protocolized care is valuable and may alter care pathways.

Impact of different types of pain on organizational decisions in palliative medicine

In press This short scientific report reveals important aspects of palliative medicine use of narcotic and non-narcotic analgesics, antidepressants, and anticonvulsants. Specific indications and restrictions on their use, routes of drug administration (oral, intravenous, intramuscular, subcutaneous, transdermal, intrarectal) are defined. The issues of monitoring the dosage of narcotic painkillers by medical personnel and patients themselves, the administration of bolus doses, and the medical equipment necessary for this were discussed. Special attention is paid to such pharmaceuticals as morphine, oxycodone, buprenorphine, butorphanol, morphine. The study of pathogenesis, clinical manifestations, diagnostic methods and the arsenal of therapeutic agents for overcoming acute and chronic pain in palliative patients is important for the organization of hospice and palliative care (HPC). Different types of pain are described depending on the nosological forms, individual sensitivity to pain, sensitization to pain, ways of transmitting the pain signal from the peripheral to the central part of the nervous system, humoral mechanisms of increasing and decreasing the sensation of pain, pain assessment on the Visual Analogue Scale. The need for organizational solutions to improve the situation with analgesia in Ukrainian palliative and hospice institutions, in particular to increase the availability of effective analgesia for palliative patients, was identified. Improving the situation with pain relief corresponds to the national strategy of Ukraine for the development of the HPC system. The report makes a comparison with the development of such a system in Great Britain on the way to one of the best systems of medical care for palliative patients, and on the basis of the futuristic development models described in the literature, it is assumed that Ukraine is on a similar path. Keywords: nociception, somatic pain, visceral pain, neuropathic pain, narcotic analgesics, non-narcotic analgesics.

Practical aspects of pain relief in palliative medicine

Background. Treatment of chronic pain in adults and children is regulated by the national standard of Ukraine, which recommends adherence to the choice of painkillers in accordance with the WHO three-step protocol. But the treatment standard does not detail the use of painkillers according to nosological units. The aim of the work was to determine the need for different types of analgesia in palliative patients depending on the main palliative diagnosis. Materials and Methods. System analysis, aggregation and bibliosemantic methods were used. The list of palliative diagnoses was determined when studying the need and forecasting the need for palliative and hospice care according to the methodology of the Ukrainian Center for Social Data (2019), improved by us in 2021–2024. Results and Conclusions. The conducted research made it possible to determine the predominant types of pain, their possible intensity and corresponding groups of pharmaceutical drugs with an analgesic effect in the units from the list of palliative diseases proposed by us. Neuropathic pain is mainly present in diabetes (diabetic polyneuropathy) and phenylketonuria. Predominantly nociceptive pain is present in cardiovascular diseases of palliative stages, tuberculosis, rheumatoid arthritis, cystic fibrosis and chronic hepatitis in children. Predominantly mixed (nociceptive and neuropathic types of pain at the same time) characteristic of HIV/AIDS, epilepsy, dementia, multiple sclerosis, fibrosis and cirrhosis of the liver, chronic obstructive pulmonary disease, palliative stage kidney disease in adults, cerebral palsy, inflammatory diseases of the central nervous system and mucopolysaccharidoses in children. We proposed to clarify the national standard for treatment of chronic pain in adults and children, and to define the necessary non-steroidal anti-inflammatory drugs, non-narcotic analgesics, weak and strong opioids, anticonvulsants, antidepressants, and other adjuvants with an analgesic effect. The perspective of further studies is to detail the dosage of drugs with an analgesic effect and to calculate the need at the national level for reimbursement under the "Affordable Medicines" program. Keywords: neuropathic pain, nociceptive pain, analgesics, opioids, reimbursement.

The controllability of pain in palliative medicine as a factor in the medical and social impact on the patients’ quality of life at the end-of-life

Availability and adequacy of analgesia is one of the factors that significantly influence the quality of life of palliative patients. At the current stage of development, the system of palliative and hospice care in Ukraine will not provide clear pain relief for the majority of patients. We conducted a study of PubMed and Google Scholar’s sources and legal acts of Ukraine at the list and content of pain management in palliative patients, which should be considered in their work by medical and social workers providing palliative care, as well as health care managers. We proposed to expand the scientific discussion about types of pain and their corresponding analgesia. The study of regulatory documentation on the palliative care in Ukraine and the protocol for the treatment of chronic pain in palliative patients revealed their compliance with modern protocols and rules of systems with developed systems of palliative care. However, we also found that the practical implementation of the existing rules varies significantly in the direction of their non-enforcement. We came to a conclusion about the need to expand the use of narcotic and non-narcotic pain relievers in Ukrainian palliative medicine, to strengthen the material and technical base of hospices and to eliminate their staff shortage. The article covers a number of issues of the pathophysiology of pain. We determined that both the causes of pain and its perception, which can be evaluated on several scales in points, are important in the issue of pain perception by palliative patients. We came to the conclusion that an adequate reaction of patients to pain simplifies the diagnosis and the appointment of adequate treatment, and an excessive and "stoic" reaction complicates them. We noted that the treatment of chronic pain involves the use of drug therapy, hypnosis, cognitive-behavioral therapy, physical exercises, and physio­therapeutic procedures. Keywords: chronic pain, nociception, pharmacotherapy, narcotic analgesics, non-narcotic analgesics.

Long-term postoperative regional analgesia of the lower third of the face in patients with tumors of the oral cavity

Pain has a certain number of physical, psychological and social consequences. Pain is of particular importance in the postoperative period for patients with tumors of the oral cavity and of the oropharynx. The effectiveness of analgesia in the postoperative period is a serious problem in maxillofacial surgery. Postoperative pain is not always removable, sometimes it becomes chronic. Pronounced pain syndrome in the postoperative period is experienced by 40 to 75% of patients, but 50% of patients experience pain of medium and high intensity. The aim of this study was a comparative assessment of the effectiveness of a new alternative method of a long-term postoperative regional analgesia and the use of non-narcotic analgesics in patients with tumors of the oral cavity and oropharynx in the postoperative period. The study was conducted in 48 patients (38 men, 10 women, average age 58,05±12,31 years) with tumors of the oral cavity and oropharynx. Patients were divided into two groups depending on the method of postoperative analgesia. In the main group (22 patients) pain was suppressed by a long-term postoperative regional analgesia. In the control group (26 patients) analgesia was performed with non-narcotic analgesics. To control the effectiveness of analgesia, a visual analog scale was used, the duration of analgesia and the manifestation of dysphagia on the day 1, 3 and 10 after surgical intervention as well as similar effects were assessed. On the day 10 of using a long-term postoperative regional analgesia, a positive trend towards a reduction in pain syndrome was observed (2.0±0.63), in contrast to drugs of general action (p&lt;0.05). Over the course of a long-term postoperative regional analgesia it was noted that analgesic effect increases from blockade to blockade. In 80% of patients of the main group, stage II-IVa the act of swallowing was nearly restored, only in 2 patients 2 degree of dysphagia was observed (p&lt;0.05). The advantage of the proposed method in the adequacy and duration of analgesia was established (p&lt;0.05), as well as a lower frequency of side effects – 9.1% and 23.3%, and restoration of act of swallowing (p&lt;0.05). The technique of long-term postoperative regional analgesia allows reducing the invasiveness of the manipulation.

Our Experience with the Use of Dexmedetomidine in the Postoperative Period in Surgical Patients

The problem of treatment of postoperative pain syndrome remains very relevant, despite the large selection of analgesics of various types, as well as the development of various methods of pain relief. Providing complete pain relief after surgery remains a desirable but not always achievable goal. According to the literature, from 50 to 80% of patients who underwent surgery suffer from severe pain in the postoperative period. Purpose of the study: To study the efficacy and safety of pain relief technique using intravenous prolonged infusion of dexmedetomidine in combination with NSAIDs and opioids in the early postoperative period in surgical patients. Material and Methods: The study was conducted in the surgical clinic of the AMU. The clinical study included 156 patients aged 10 to 35 years after elective abdominal surgery (cholecystectomy, hemicolectomy, etc.). To assess the adequacy of analgesia and the need for the introduction of narcotic analgesics, we used a visual analogue scale (VAS) of pain intensity. Results of the study: The criterion for the effectiveness of analgesia performed in the postoperative period was the reduction of pain according to VAS to 3 and below. The criterion for the introduction of opioids was considered to be an increase in the intensity of pain according to the VAS up to 6-7 points. Mean pain scores between groups at various stages are presented. Conclusions: The use of prolonged intravenous infusion of dexmedetomidine in combination with non-narcotic analgesics in the early postoperative period in patients undergoing elective abdominal surgery can significantly reduce the need for repeated injections of both non-narcotic and narcotic analgesics, improves patient comfort and safety.

Pharmacological Treatments and Therapeutic Drug Monitoring in Patients with Chronic Pain.

Pain is an unpleasant sensory and emotional experience that affects every aspect of a patient's life and which may be treated through different pharmacological and non-pharmacological approaches. Analgesics are the drugs most commonly used to treat pain, and in specific situations, the use of opioids may be considered with caution. These drugs, in fact, do not always induce optimal analgesia in patients, and several problems are associated with their use. The purpose of this narrative review is to describe the pharmacological approaches currently used for the management of chronic pain. We review several aspects, from the pain-scale-based methods currently available to assess the type and intensity of pain, to the most frequently administered drugs (non-narcotic analgesics and narcotic analgesics), whose pharmacological characteristics are briefly reported. Overall, we attempt to provide an overview of different pharmacological treatments while also illustrating the relevant guidelines and indications. We then report the strategies that may be used to reduce problems related to opioid use. Specifically, we focus our attention on therapeutic drug monitoring (TDM), a tool that could help clinicians select the most suitable drug and dose to be used for each patient. The actual potential of using TDM to optimize and personalize opioid-based pain treatments is finally discussed based on recent scientific reports.

Pain Control and Sedation in Neuro Intensive Critical Unit

Neurocritical patients who can self-report pain use the 0-10 numerical rating scale (NRS, verbal or visual form). However, critically ill patients whose nervous systems cannot express pain use the behavioral pain scale (BPS) and the critical care pain observation tool (CPOT) behavioral pain assessment tools. These tools reveal pain-related changes in movement, facial expression, posture, and physiological indicators such as heart rate, blood pressure, and respiratory rate. In pain control, it is first essential to reduce unnecessary painkillers through non-drug therapy and maximize the effect of the administered analgesics. For nonneuropathic pain, narcotic analgesics such as fentanyl, hydromorphone, morphine, and remifentanil are administered intravenously. Gabapentin, pregabalin, and carbamazepine are recommended along with narcotic analgesics for neuropathic pain control. In addition, nonnarcotic analgesics for multi-modal analgesia are used to reduce the use of narcotic analgesics or the side effects of narcotic analgesics. In the intensive care unit (ICU), the sedation-agitation scale (SAS) and the Richmond agitation-sedation scale (RASS) are used to determine the depth of sedation to be maintained during shallow or deep sedation, considering the condition of the critically ill patient. When selecting sedatives for critically ill patients, preferentially consider nonbenzodiazepines such as propofol or dexmedetomidine rather than benzodiazepines such as midazolam or lorazepam. In addition, patients use painkillers or sedatives for over a week, and neurological changes or physiological dependence may occur. Therefore, clinicians should evaluate the critically ill patient’s condition, and sedatives and painkillers should be reduced or discontinued.

Transverse abdominis plane block as a method of anesthesia after caesarean section

Although we have various methods of analgesia, the prevalence of severe pain after caesarean section remains high. Therefore, it is necessary to look for new reliable technologies for optimal postoperative anesthesia.The objective was to compare the efficiency of postoperative wound infiltration with a local anesthetic and transverse abdominis plane block (TAP-block) as a component of multimodal analgesia in the postoperative period after cesarean section.Materials and methods. A prospective randomized study was conducted. It included 91 patients after elective caesarean section under spinal anesthesia. Patients were divided into 3 groups depending on the method of postoperative analgesia. In group 1 (n = 30), we used wound analgesia. In group 2 (n = 32), transverse abdominis plane block was performed. In group 3 (n = 29), intravenous infusion of paracetamol in combination with intramuscular injection of tramadol 0.5 mg/kg were used for postoperative analgesia.Results. Pain syndrome was less severe after wound analgesia and TAP-block for 24 hours compared to analgesia with systemic analgesics. Moreover, during wound analgesia, lower points of the visual analogue scale (VAS) were traced for three days. The minimum consumption of paracetamol was on the background of wound analgesia, while no patient required the introduction of narcotic analgesics. Women in the wound analgesia group were able to earlier activating: they could walk after 5.6±0.2 hours, compared to 6.1± 0.2 hours with TAP-block and 8.8± 0.4 hours with analgesia with systemic analgesics.Conclusion. Continuous analgesia of postoperative wound is a safe and effective method that allows achieving adequate postoperative analgesia, avoiding using narcotic analgesics and reducing the consumption of non-narcotic systemic analgesics.

Post operative pain assessment and pain management among patients undergoing cranioplasty

Pain assessment and pain management is the most crucial job of critical care nurses. Pain assessment and its management in patients undergoing cranioplasty, especially those with communication barriers, continue to present challenges to nurses in the critical care areas. The present study was undertaken to assess the level of post-operative pain suffered by patients after cranioplasty, to identify the activities that increases/relieve pain and to find out association between pain score of patients and selected variables. This study has used the following tools, a self-prepared validated questionnaire and Wong Bakers Faces pain scale. As per the findings, the post-operative pain was mild to moderate and decreased from first to third postoperative day. Patients Pain relief was adequate with the combination therapy of pain medications like non-narcotic analgesics and non-steroidal anti-inflammatory drugs. The study revealed that there was no significant difference between the pain perception and age or gender of the patient. It is found that the activities that increased pain were surgical dressing removal and patient’s position changing. Critical care nursing staff should focus on assessing and managing post-operative pain to improve quality of nursing care in order to improve the comfort of cranioplasty patients.

MP80-04 NON-NARCOTIC REGIMEN CENTERED ON PREOPERATIVE ERECTOR SPINAE PLANE (ESP) BLOCKS FOR ROBOT-ASSISTED RADICAL PROSTATECTOMY DRASTICALLY REDUCES ADMINISTERED POSTOP MORPHINE EQUIVALENTS

You have accessJournal of UrologyCME1 Apr 2023MP80-04 NON-NARCOTIC REGIMEN CENTERED ON PREOPERATIVE ERECTOR SPINAE PLANE (ESP) BLOCKS FOR ROBOT-ASSISTED RADICAL PROSTATECTOMY DRASTICALLY REDUCES ADMINISTERED POSTOP MORPHINE EQUIVALENTS Aaron Saxton, Deaton Jones, Adam Visca, Kaitlyn Mitchell, Danielle Lindenmuth, Christopher Wanderling, Austin Lee, and Thomas P. Frye Aaron SaxtonAaron Saxton More articles by this author , Deaton JonesDeaton Jones More articles by this author , Adam ViscaAdam Visca More articles by this author , Kaitlyn MitchellKaitlyn Mitchell More articles by this author , Danielle LindenmuthDanielle Lindenmuth More articles by this author , Christopher WanderlingChristopher Wanderling More articles by this author , Austin LeeAustin Lee More articles by this author , and Thomas P. FryeThomas P. Frye More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot-assisted radical prostatectomy (RARP) is associated with improved postoperative pain control and reduced opioid requirements compared with open surgery. Recent literature has shown a decreased need for narcotic use in the post-operative period. However, there is still question over the optimal pain regimen. Our study evaluates a non-narcotic regimen for patients undergoing RARP that centers on preoperative erector spinae plane (ESP) blocks. METHODS: In association with the Department of Anesthesiology, a non-narcotic analgesic pathway was created for patients undergoing RARPs. The pathway was centered on an ESP block and replacing narcotics with multi-modal analgesia post-operatively. After IRB approval, a retrospective cohort of patients who received narcotics post-operatively and no ESP block pre-operatively was compared to a prospective cohort of patients who underwent the non-narcotic pathway. Narcotics were available for patients in the non-narcotic group if their pain was not controlled. Patients were excluded from the non-narcotic group if NSAIDs were contraindicated, if they were taking narcotics, or if they underwent a concomitant procedure at the time of RARP. Nursing pain scores were recorded for each patient, as well as post-operative morphine equivalents received, if narcotic was prescribed for home, the amount of morphine equivalents prescribed for home, and the need for any narcotic refills. RESULTS: 163 patients were in the narcotic group compared to 131 in the non-narcotic group. There was a statistically significant difference in average post-operative pain scores between the narcotic and non-narcotic groups (3.5 vs. 2.4, p<0.001) and a statistically significant difference in postoperative morphine equivalents delivered (49.4 vs. 7.4, p<0.001). In addition, only 17 patients in the non-narcotic group were discharged with a narcotic prescription for home, compared to 161 in the narcotic cohort (13.0% vs, 98.8%, p<0.001). The average length of stay was lower in the non-narcotic group (1.1 vs 1.3, p<0.001). No adverse patient events resulted from the block. CONCLUSIONS: A non-narcotic analgesic pathway centered on pre-operative ESP blocks decreased both post-operative pain scores and post-operative morphine equivalents received in patients who underwent RARP, providing an additional modality to aid in optimal, non-narcotic analgesia. Source of Funding: N/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1152 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Saxton More articles by this author Deaton Jones More articles by this author Adam Visca More articles by this author Kaitlyn Mitchell More articles by this author Danielle Lindenmuth More articles by this author Christopher Wanderling More articles by this author Austin Lee More articles by this author Thomas P. Frye More articles by this author Expand All Advertisement PDF downloadLoading ...

The use of centrally acting analgesics in the postoperative analgesia in patients with the consequences of a severe mine-explosive injury of the lower extremities

In this article, the authors discuss the place of modern analgesics of central action (nefopam hydrochloride) in the analgesia of patients with explosive injuries of the lower extremities. Currently, there is no information in global practice regarding the use of centrally acting analgesics for analgesia in patients with combat trauma. An example was the analgesia of patients in the p/o period with a severe explosive injury of the lower extremities. Attention is drawn to the need for effective analgesia for patients with a combo injury not only in the acute period. A feature of the treatment of such patients is the need for major restorative and reconstructive surgical interventions, which in turn are accompanied by a pronounced pain syndrome. In our experience, the addition of non-narcotic analgesics of central action (nefopam hydrochloride) to the scheme of multimodal analgesia is appropriate to improve analgesia in this category of patients. The addition of nefopam hydrochloride to a multimodal analgesia regimen at 20 mg IV every 6 hours was effective in the treatment of severe acute postoperative pain.

The Effect of Concomitant Usage of Analgesics on Immune Checkpoint Inhibitor-related Interstitial Lung Disease.

Interstitial lung disease (ILD) is a serious adverse event (AE) associated with the use of immune checkpoint inhibitors (ICIs). However, the risk factors for developing ICI-related ILD remain poorly understood. Therefore, this study investigated the effect of concomitant analgesics on developing ICI-related ILD using the Japanese Adverse Drug Event Report (JADER) database. All the reported AE data were downloaded from the Pharmaceuticals and Medical Devices Agency website, and the JADER data between January 2014 and March 2021 were analysed. The relationship between ICI-related ILD and concomitant use of analgesics was assessed using reporting odds ratio (ROR) and 95% confidence interval. We investigated whether the effect of developing ILD varied according to the type of analgesics used during ICI treatment. Positive signals for ICI-related ILD development were detected for the concomitant use of the narcotic analgesics codeine, fentanyl and oxycodone, but not with morphine. In contrast, there were no positive signals for the concomitant use of the non-narcotic analgesics celecoxib, acetaminophen, loxoprofen and tramadol. An increased ROR for ICI-related ILD in cases with concomitant use of narcotic analgesics was observed in a multivariate logistic analysis adjusted by sex and age. These results suggest that the concomitant use of narcotic analgesics is involved in the development of ICI-related ILD.

Effect of Fast-Track Surgery under ERAS protocol in Laparoscopic Hysterectomy: A Randomized Controlled Trial

Background & Objective: Fast-track surgery (FTS) consists of different pathways to decrease surgical complications and improve outcomes and patient satisfaction. FTS in an elective gynecologic laparoscopic surgery has not been well assessed. No consensus guidelines have been developed for gynecologic laparoscopic surgeries. The purpose of this study is to evaluate enhanced recovery after surgery (ERAS) for total laparoscopic hysterectomy.Materials & Methods: 260 patients underwent for laparoscopic hysterectomy surgery. All patients were divided into two groups as follows: one group received traditional laparoscopic hysterectomy surgery and the intervention group was treated under ERAS protocol. ERAS protocol includes not receiving preoperative mechanical bowel preparation and laxatives as well as fasting 6 h and not drinking liquids 2h before surgery. The patients were allowed to resume the ordinary diet 6h post-operation. Ondansetron 4 mg were prescribed after surgery for nausea and vomiting, pain was controlled with non-narcotic analgesics diclofenac suppository 100 mg/q12 h and paracetamol 1000 mg/q6 h until discharge. Urinary catheter was removed whenever possible and early ambulation occurred 6h after the surgery.Results: A total of 260 patients were studied. Regarding the length of hospitalization, significant differences were shown between the groups (P<0.001). Return to daily functions was occurred earlier in the fast-track surgery group than another group. Complications and VAS pain scores showed no significant differences between the groups.Conclusion: Our results show that ERAS surgery has fewer side effects and better outcomes which make it more suitable for patients undergoing laparoscopic hysterectomy.

40 Pre-operative non-narcotic analgesia decreases the use of postoperative narcotics

40 Pre-operative non-narcotic analgesia decreases the use of postoperative narcotics

ANESTHESIA OR SEDATION OF NEWBORNS IN INTENSIVE CARE: HOW TO DETERMINE THE OPTIMAL WAY?

During their stay in the intensive care unit, newborns are subjected to an enormous number of painful procedures and operations. Poorly treated pain during the newborn period can lead to negative remote effects such as cognitive dysfunction, the formation of chronic pain. Therefore, every day reanimatologists accept the challenge to evaluate the pain adequately and to choose right analgesia tactics. The literature review represents the analysis of 87 literary sources over the past 10 years. This article covers the results of multicenter studies and clinical recommendations. It has been determined that optimal treatment of pain and anxiety in newborns requires a multimodal approach, always including non-medication strategies and directed primarily to analgesia. Placing on the chest and breastfeeding, sucking reflex, «skin to skin» contact, «kangaroo» care, swaddling – all these aspects of childcare are effective to reduce physiological and behavioural response to pain in invasive procedures, and also have sedative effect. Every manipulation requires a mandatory analgesic. The choice of the method of anesthesia depends on the invasiveness of the procedure, gestational age and the severity of the condition of the child. It is advisable to combine various non-medication analgesic methods for mild pain, to add medication methods for moderate and severe pain to achieve better therapeutic effect. Neonates who are on prolonged ventilation cannot avoid sedation. However, sedation can be achieved by a combination of non-medication methods and sedatives. In order to prevent tachyphylaxis, analgesics should be rotated, and combinations of opiates with non-narcotic analgesics and adjuvant analgesics should be used. The multimodal approach to pain treatment has the benefits of reducing the dosage of any single drug and mitigating the overall risk of side effects. Acetaminophen, fentanyl or morphine in combination with midazolam are the safest medicines for use in newborns, despite the side effects.

CREATION OF ANTI-INFLAMMATORY PHARMACEUTICAL COMPOSITIONS (review)

The review article summarizes the date of literature and our own research on the creation of more effective and safe domestic combined drugs with a pronounced anti-inflammatory and analgesic effects. Untimely treatment of inflammatory processes often leads to long-term disability and even disability, so today there is an active search for new effective and safe domestic combination drugs with pronounced anti-inflammatory and analgesic effects. The constant search for innovative drugs causes a significant number of diseases, pathological conditions for which treatment with existing drugs is not effective or causes addiction and a large number of side effects. Because of, inflammatory processes can be accompanied by severe pain, spasms, increased convulsive activity of the brain, other disorders of the body, so non-narcotic analgesics and nonsteroidal anti-inflammatory drugs are combined with other drugs that can cause complementary effects or potentiate each other's effects. Caffeine is a useful adjuvant of nonsteroidal anti-inflammatory drugs of various chemical structures in terms of anti-inflammatory and analgesic effects. The review article presents a literature review of the current state of treatment of inflammation and pain, conducting research to expand the therapeutic capabilities of known pharmaceuticals, the creation of pharmaceutical compositions of nonsteroidal anti-inflammatory drugs with caffeine.

Prescribing Narcotics for Pain: Reconsider the Fifth Vital Sign.

Prescribing Narcotics for Pain: Reconsider the Fifth Vital Sign.

Impact of individual and treatment characteristics on wearable sensor-based digital biomarkers of opioid use

Opioid use disorder is one of the most pressing public health problems of our time. Mobile health tools, including wearable sensors, have great potential in this space, but have been underutilized. Of specific interest are digital biomarkers, or end-user generated physiologic or behavioral measurements that correlate with health or pathology. The current manuscript describes a longitudinal, observational study of adult patients receiving opioid analgesics for acute painful conditions. Participants in the study are monitored with a wrist-worn E4 sensor, during which time physiologic parameters (heart rate/variability, electrodermal activity, skin temperature, and accelerometry) are collected continuously. Opioid use events are recorded via electronic medical record and self-report. Three-hundred thirty-nine discreet dose opioid events from 36 participant are analyzed among 2070 h of sensor data. Fifty-one features are extracted from the data and initially compared pre- and post-opioid administration, and subsequently are used to generate machine learning models. Model performance is compared based on individual and treatment characteristics. The best performing machine learning model to detect opioid administration is a Channel-Temporal Attention-Temporal Convolutional Network (CTA-TCN) model using raw data from the wearable sensor. History of intravenous drug use is associated with better model performance, while middle age, and co-administration of non-narcotic analgesia or sedative drugs are associated with worse model performance. These characteristics may be candidate input features for future opioid detection model iterations. Once mature, this technology could provide clinicians with actionable data on opioid use patterns in real-world settings, and predictive analytics for early identification of opioid use disorder risk.