As some references suggested that tobacco smoking behavior increases the risk of persistent pain and poorer recovery, but some demonstrated that nicotine decreased pain sensitivity. Both contrary conclusions make clinicians confused on how to manage the patients with tobacco smoking habit. This study conducted a retrospective way to evaluate the relationship between acute postoperative pain management and tobacco smoking behavior. This study included 511 Patients underwent general surgery were assigned to smokers or non-smokers. Site of surgery, type and duration of anesthesia were extracted from the anesthetic record. Information regarded each patient's gender, age, preoperative weight, past medical history, postoperative course, all non-opiate sedatives and opiate analgesics used in the first 72 hours were collected and recorded. Morphine administered via a patient-controlled analgesia (PCA) device was the preferred method of analgesia for these patients. Anesthesia was standardized. Exclusion criteria included the patients underwent major thoracic cardiovascular surgery, the patients with significant lung lesion, the patients with conscious disturbance, and the patients with allergic history to morphine. The results showed that of the sense of pain, the smoking group in the second day the pain scores significantly higher than non-smoking group (p<0.001), indicated that smoking patients were had more pain than non-smoking patients after surgery. And of the analgesic drug effects, the smoking group in the second and third day analgesic doses and the total analgesic doses were significantly higher than non-smoking group (p<0.023), showed that smoking patients significantly used more analgesic than non-smoking group after surgery. Smoking was associated with pain indeed existence.

Background: Unmitigated immunization pain in infants has the potential to impact long-term health outcomes. Teaching parents in the prenatal period may increase utilization of pain management (PM) strategies in clinical practice. Objective: To assess the efficaciousness of teaching parents in the prenatal environment and its impact on the number of analgesic PM strategies utilized during the 2-month immunization appointment. Methods: This partially blinded cluster randomized controlled trial enrolled mothers from prenatal classes at Mount Sinai Hospital. Classes were randomized to receive a presentation on either immunization PM or general immunization information. Results: One hundred and ninety-seven mothers from 28 classes participated in this study. There was a statistically significant increase (p<0.01) in the use of one or more analgesic interventions in the group that received a presentation on immunization PM compared to those who received general immunization information. Conclusions: Prenatal classes are a suitable environment to educate parents about immunization PM.

Background: Unmitigated immunization pain in infants has the potential to impact long-term health outcomes. Teaching parents in the prenatal period may increase utilization of pain management (PM) strategies in clinical practice. Objective: To assess the efficaciousness of teaching parents in the prenatal environment and its impact on the number of analgesic PM strategies utilized during the 2-month immunization appointment. Methods: This partially blinded cluster randomized controlled trial enrolled mothers from prenatal classes at Mount Sinai Hospital. Classes were randomized to receive a presentation on either immunization PM or general immunization information. Results: One hundred and ninety-seven mothers from 28 classes participated in this study. There was a statistically significant increase (p<0.01) in the use of one or more analgesic interventions in the group that received a presentation on immunization PM compared to those who received general immunization information. Conclusions: Prenatal classes are a suitable environment to educate parents about immunization PM.

In the United States, prescription opioids have been a major problem that contributed to the opioid crisis in the country. As dentists prescribe analgesics routinely for dental pain management, further investigation into opioid and non-opioid prescription patterns by dentists on a national level is needed. This research project aimed to examine 1) the trends in opioid and non-opioid analgesic prescriptions by dentists in the US,2) to examine the racial-ethnic disparities in receiving an opioid and non-opioid prescription from a dental professional, 3) the effect of federal Rescheduling of hydrocodone combination on opioid prescription patterns by dentists in a school setting. Data on analgesic prescriptions by dentists were obtained using medical panel survey MEPS (1996- 2015), and Boston University Henry M. Goldman School of Dental Medicine clinical repository (2010 -2019). On average about 31,206 individuals of all ages were interviewed for MEPS each year. The trend in analgesics prescription was reported weighted numbers and proportions of total and dental analgesics prescriptions were reported. Kendall tau correlation test was used to examine trends in the rate of opioid prescriptions per 100 persons over survey years. Racial differences were examined using MEPS data (2002-2015) on dental analgesic prescriptions, dental care utilization, patients’ race, and other demographic information. The outcome was analgesic prescription received. The main independent variable was the patients’ race/ethnicity. Covariates included in the analysis were gender, age, marital status, income, geographical region, and survey year. Using BUSDM data (2010-2019) we examined 12,807 patients who received an opioid prescription from a dentist. The primary outcome variables were opioid prescriptions and opioid morphine milligram equivalent (MME). The primary predictor used is the date of opioid prescription (Time before and after the intervention). To assess the effect of hydrocodone medication reclassification on the outcome variables we used an interrupted time series (ITS) analysis with a segmented regression model. Our results showed a decrease in the proportion of dental opioids out of total opioids from 9.76% in 1996 to 4.5% in 2015. Kendall tau correlation indicated an increase in prescribing rate over the years in total opioids but not in dental opioids. Racial differences were found in opioid prescriptions by dentists with whites having a lower risk of receiving an opioid analgesic compared to other racial minorities. The effect of federal rescheduling of hydrocodone combination on opioid prescription patterns by dentists showed specifically a reduction in non-hydrocodone opioids prescribing rate by morphine milligram equivalent (MME). In conclusion dentists’ contribution to the increase in prescription opioids in the United States seem to be limited compared to other health care professionals. Nevertheless, racial differences were found in whites when compared to other racial minorities. Efforts to curb the use of opioids should be encouraged even more so with evidence supporting the effectiveness of non-opioids analgesics in control of dental pain. / 2022-12-09T00:00:00Z

No / Cryptolepine is the major alkaloid of the West African shrub, Cryptolepis sanguinolenta. Cryptolepine has been shown to inhibit nitric oxide production, and DNA binding of Nuclear Factor-kappa B following inflammatory stimuli in vitro. In order to validate the anti-inflammatory property of this compound in vivo, we investigated its effects on a number of animal models of inflammation. Cryptolepine (10¿40 mg/kg i.p.) produced significant dose-dependent inhibition of the carrageenan-induced rat paw oedema, and carrageenaninduced pleurisy in rats. These effects were compared with those of the non-steroidal anti-inflammatory drug indomethacin (10 mg/kg). At doses of 10¿40 mg/kg i.p., cryptolepine inhibited lipopolysaccharide (LPS)-induced microvascular permeability in mice in a dose-related fashion. Oral administration of up to 40 mg/kg of the compound for four consecutive days did not induce gastric lesion formation in rats. Analgesic activity was also exhibited by cryptolepine through a dose-related (10¿40 mg/kg i.p.) inhibition of writhing induced by i.p. administration of acetic acid in mice. The results of this study reveal that cryptolepine possesses in vivo anti-inflammatory activity.Copyright © 2009 John Wiley & Sons, Ltd.

Opioid medications are medicine's best weapon against severe intractable pain, but prolonged use of these medications can be complicated by side effects like tolerance and mental clouding which, themselves, can be disabling. The present study examined the independent and combined effects of inflammatory pain and opioid medication on spatial memory for a well learned task in Sprague-Dawley rats. The Hargreaves method was used to verify the pain state of the animals after complete Freund's adjuvant injection and morphine treatment. Whereas pain had little effect on spatial memory, morphine had profound detrimental effects that persisted beyond the analgesic effectiveness of the drug. However, morphine-induced cognitive deficits were absent when morphine was provided to animals in chronic pain. Also, analgesic tolerance was significantly attenuated in these animals. Taken together, these results suggest that chronic pain activates a neural mechanism that antagonizes the unwanted effects of opioids.

Objetivou-se comparar os efeitos de duas doses de nalbufina em relação ao tramadol após infusão contínua de fentanil durante cirurgia de osteotomia de nivelamento de platô tibial. Realizou-se estudo clínico encoberto com 28 cães (idade 5,6±1,2 anos e peso 34,7±4,2 kg), pré-medicadas com acepromazina (0,03 mg/kg, IM), induzidas com propofol (4 mg/kg, IV), mantidas com isofluorano (EtISO 1,3 V%) e fentanil (bólus de 3 &micro;g/kg, seguido por 0,3 &micro;g/kg/min, IV), randomizados ao final da cirurgia nos grupos: NAL 0,1: 0,1 mg/kg de nalbufina (n=9), NAL0,3: 0,3 mg/kg de nalbufina (n=9) ou TRA: 3 mg/kg de tramadol, (n=10). Avaliou-se os parâmetros fisiológicos, escores de sedação e de dor (Colorado, Glasgow e VAS) a cada 30 minutos após a administração dos tratamentos, por seis horas ou até o resgate (tramadol 4 mg/kg e dipirona 30 mg/kg, quando VAS &ge; 4, Glasgow &ge; 5 e/ ou Colorado &ge; 2). Coletas de sangue para mensuração para gasometria arterial foram realizadas. Avaliou-se ainda os tempos de extubação (TE), recuperação da respiração espontânea (TRE) e decúbito esternal (TDE). Os tempos de recuperação foram avaliados por meio de ANOVA, com pós-teste de Tukey, enquanto as escalas foram avaliadas pelos testes de Friedman e Kruskal-Wallis, seguidos por pós-teste de Dunn quando necessário, com nível de significância de 95%. Os animais que receberam tramadol apresentaram maior grau de sedação em todos os momentos avaliados (p < 0,05), além de maior TE, TRE e TDE que NAL0,1 e NAL0,3 (p<0,001). Quando comparado ao momento basal, o grupo TRA apresentou redução significativa do pH do HCO3 e elevação da PaCO2 em T 30. Na comparação entre grupos, o grupo TRA apresentou menor pH em T30 quando comparado a NAL 0,1 e NAL 0,3. Na escala de avaliação de dor de Glasgow, Colorado e na EAV, o grupo NAL 0,1 apresentou média &#177;DP significativamente mais alta do que NAL 0,3 (p<0,05) e TRA (p<0,001) em T60, T120 e T180. O tempo para administração do resgate foi de 133&#177;50 minutos no grupo NAL0,1, 220&#177;30 minutos no NAL0,3 e 360 minutos no grupo TRA. Com os dados obtidos conclui-se que a administração de nalbufina reduz o tempo de recuperação anestésica, necessitando, porém, de resgate analgésico mais precocemente que o tramadol / The aim of this study was to compare the effects of two nalbuphine doses versus tramadol after fentanyl continuous infusion during tibial plateau leveling osteotomy surgery. A clinical study with 28 dogs (5.6&#177;1.2 years old and 34.7&#177;4.2 kg), pre-medicated with acepromazine (0.03 mg/kg, IM), followed by propofol induction (4 mg/kg, IV), isoflurane (EtISO 1.3 V%) and fentanyl (bolus of 3 &micro;g/kg, following 0,3 &micro;g/kg/min, IV) maintenance; were randomized distributed in the following groups: NAL0.1: 0.1 mg/kg of nalbuphine (n=9), NAL0.3: 0.3 mg/kg of nalbuphine (n=9) or TRA: 3 mg/kg of tramadol (n=10). Physiological parameters, sedation and pain scale (Colorado, Glasgow and VAS) were evaluated every 30 minutes after treatment administration, during six hours, or until rescue medication (tramadol 4 mg/kg and dipyrone 30 mg/kg, when VAS &ge; 4, Glasgow &ge; 5 and/or Colorado &ge; 2). Arterial blood gas sampling were collected. Furthermore, time of extubation (TE), spontaneous respiration recovery (TRE) and sternal decubitus (TDE) were registered. Recovery periods were analyzed using ANOVA, followed by Tukey test, while the pain scales were evaluated using Friedman and Kruskal-Wallis, followed by Dunn&#39;s test, when necessary, with significance level of 95%. Animals that received tramadol exhibited higher sedation score in all evaluated moments (p < 0.05), and also higher TE, TRE and TDE than NAL0.1 and NAL0.3 (p<0.001). TRA group showed significate pH of HCO3 reduction when comparing to baseline and PaCO2 elevation in T30. When comparing between groups, TRA showed significate smaller pH in T30 than NAL0.1 e NAL0.3. Considering Glasgow, Colorado and EAV pain scale, NAL0.1 group produced average &#177;SD significant higher than NAL0.3 (p<0.05) and TRA (p<0.001) in T60, T120 and T180.Rescue pain medication time was 133&#177;50 minutes in NAL0.1 group, 220&#177;30 minutes in NAL0.3 group and 360 minutes in TRA group. The results of this investigation shows that nalbuphine administration decreases anesthesia recovery time, requiring, however, early rescue pain medication than tramadol

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 4 uppsatser.

Objetivou-se comparar os efeitos de duas doses de nalbufina em relação ao tramadol após infusão contínua de fentanil durante cirurgia de osteotomia de nivelamento de platô tibial. Realizou-se estudo clínico encoberto com 28 cães (idade 5,6±1,2 anos e peso 34,7±4,2 kg), pré-medicadas com acepromazina (0,03 mg/kg, IM), induzidas com propofol (4 mg/kg, IV), mantidas com isofluorano (EtISO 1,3 V%) e fentanil (bólus de 3 &micro;g/kg, seguido por 0,3 &micro;g/kg/min, IV), randomizados ao final da cirurgia nos grupos: NAL 0,1: 0,1 mg/kg de nalbufina (n=9), NAL0,3: 0,3 mg/kg de nalbufina (n=9) ou TRA: 3 mg/kg de tramadol, (n=10). Avaliou-se os parâmetros fisiológicos, escores de sedação e de dor (Colorado, Glasgow e VAS) a cada 30 minutos após a administração dos tratamentos, por seis horas ou até o resgate (tramadol 4 mg/kg e dipirona 30 mg/kg, quando VAS &ge; 4, Glasgow &ge; 5 e/ ou Colorado &ge; 2). Coletas de sangue para mensuração para gasometria arterial foram realizadas. Avaliou-se ainda os tempos de extubação (TE), recuperação da respiração espontânea (TRE) e decúbito esternal (TDE). Os tempos de recuperação foram avaliados por meio de ANOVA, com pós-teste de Tukey, enquanto as escalas foram avaliadas pelos testes de Friedman e Kruskal-Wallis, seguidos por pós-teste de Dunn quando necessário, com nível de significância de 95%. Os animais que receberam tramadol apresentaram maior grau de sedação em todos os momentos avaliados (p < 0,05), além de maior TE, TRE e TDE que NAL0,1 e NAL0,3 (p<0,001). Quando comparado ao momento basal, o grupo TRA apresentou redução significativa do pH do HCO3 e elevação da PaCO2 em T 30. Na comparação entre grupos, o grupo TRA apresentou menor pH em T30 quando comparado a NAL 0,1 e NAL 0,3. Na escala de avaliação de dor de Glasgow, Colorado e na EAV, o grupo NAL 0,1 apresentou média &#177;DP significativamente mais alta do que NAL 0,3 (p<0,05) e TRA (p<0,001) em T60, T120 e T180. O tempo para administração do resgate foi de 133&#177;50 minutos no grupo NAL0,1, 220&#177;30 minutos no NAL0,3 e 360 minutos no grupo TRA. Com os dados obtidos conclui-se que a administração de nalbufina reduz o tempo de recuperação anestésica, necessitando, porém, de resgate analgésico mais precocemente que o tramadol / The aim of this study was to compare the effects of two nalbuphine doses versus tramadol after fentanyl continuous infusion during tibial plateau leveling osteotomy surgery. A clinical study with 28 dogs (5.6&#177;1.2 years old and 34.7&#177;4.2 kg), pre-medicated with acepromazine (0.03 mg/kg, IM), followed by propofol induction (4 mg/kg, IV), isoflurane (EtISO 1.3 V%) and fentanyl (bolus of 3 &micro;g/kg, following 0,3 &micro;g/kg/min, IV) maintenance; were randomized distributed in the following groups: NAL0.1: 0.1 mg/kg of nalbuphine (n=9), NAL0.3: 0.3 mg/kg of nalbuphine (n=9) or TRA: 3 mg/kg of tramadol (n=10). Physiological parameters, sedation and pain scale (Colorado, Glasgow and VAS) were evaluated every 30 minutes after treatment administration, during six hours, or until rescue medication (tramadol 4 mg/kg and dipyrone 30 mg/kg, when VAS &ge; 4, Glasgow &ge; 5 and/or Colorado &ge; 2). Arterial blood gas sampling were collected. Furthermore, time of extubation (TE), spontaneous respiration recovery (TRE) and sternal decubitus (TDE) were registered. Recovery periods were analyzed using ANOVA, followed by Tukey test, while the pain scales were evaluated using Friedman and Kruskal-Wallis, followed by Dunn&#39;s test, when necessary, with significance level of 95%. Animals that received tramadol exhibited higher sedation score in all evaluated moments (p < 0.05), and also higher TE, TRE and TDE than NAL0.1 and NAL0.3 (p<0.001). TRA group showed significate pH of HCO3 reduction when comparing to baseline and PaCO2 elevation in T30. When comparing between groups, TRA showed significate smaller pH in T30 than NAL0.1 e NAL0.3. Considering Glasgow, Colorado and EAV pain scale, NAL0.1 group produced average &#177;SD significant higher than NAL0.3 (p<0.05) and TRA (p<0.001) in T60, T120 and T180.Rescue pain medication time was 133&#177;50 minutes in NAL0.1 group, 220&#177;30 minutes in NAL0.3 group and 360 minutes in TRA group. The results of this investigation shows that nalbuphine administration decreases anesthesia recovery time, requiring, however, early rescue pain medication than tramadol

During myocardial ischemia, the cranial cervical spinal cord (C1-C2) modulates the central processing of the cardiac nociceptive signal. This study was done to determine 1) whether C2 SCS-induced release of an analgesic neuropeptide in the dorsal horn of the thoracic (T4) spinal cord; 2) if one of the sources of this analgesic peptide was cervical propriospinal neurons, and 3) if chemical inactivation of C2 neurons altered local T4 substance P (SP) release during concurrent C2 SCS and cardiac ischemia. Ischemia was induced by intermittent occlusion of the left anterior descending coronary artery (CoAO) in urethane-anesthetized Sprague-Dawley rats. Release of dynorphin A (1-13), (DYN) and SP was determined using antibody-coated microprobes inserted into T4. SCS alone induced DYN release from laminae I-V in T4, and this release was maintained during CoAO. C2 injection of the excitotoxin, ibotenic acid, prior to SCS, inhibited T4 DYN release during SCS and ischemia; it also reversed the inhibition of SP release from T4 dorsal laminae during C2 SCS and CoAO. Injection of the κ-opioid antagonist, nor-binaltorphimine, into T4 also allowed an increased SP release during SCS and CoAO. CoAO increased the number of Fos-positive neurons in T4 dorsal horns but not in the intermediolateral columns (IML), while SCS (either alone or during CoAO) minimized this dorsal horn response to CoAO alone, while inducing T4 IML neuronal recruitment. These results suggest that activation of cervical propriospinal pathways induces DYN release in the thoracic spinal cord, thereby modulating nociceptive signals from the ischemic heart.