Rotation of narcotics

The purpose of this study was to investigate deltoid compartment pressures during arthroscopic rotator cuff repair using modern pressure pumps to achieve visualization. Twelve patients undergoing arthroscopic rotator cuff repairs were monitored for deltoid compartment pressure changes intraoperatively. Pre-, intra-, and postoperative intramuscular pressures were recorded. All patients demonstrated varying degrees of swelling due to fluid extravasation. Swelling was qualified as mild, moderate, or severe by clinical assessment and quantified objectively using a pressure monitor to record deltoid compartment pressures...

BACKGROUND: Arthroscopic rotator cuff repair has a high rate of patient satisfaction. However, multiple studies have shown significant rates of anatomic failure. Biological augmentation would seem to be a reasonable technique to improve clinical outcomes and healing rates. PURPOSE: To represent a prospective, double-blinded, randomized study to assess the use of platelet-rich fibrin matrix (PRFM) in rotator cuff surgery. STUDY DESIGN: Randomized controlled trial; level of evidence, 1...

Brachial neuritis following vaccination is an uncommon but clinically important presentation of severe shoulder and arm pain associated with globally reduced range of movement. It may be confused with the more common diagnoses of rotator cuff pathology, adhesive capsulitis (frozen shoulder), shoulder arthritis or cervical spondylosis. We present a case of acute brachial neuritis, which posed a clinical diagnostic challenge to emergency, acute medical and rheumatology clinicians.

CONTEXT: Continuous processing is becoming popular in the pharmaceutical industry for its cost and quality advantages. OBJECTIVE: This study evaluated the mechanical properties, uniformity of dosage units and drug release from the tablets prepared by continuous direct compression process. MATERIALS AND METHODS: The tablet formulations consisted of acetaminophen (3-30% (w/w)) pre-blended with 0.25% (w/w) colloidal silicon dioxide, microcrystalline cellulose (69-96% (w/w)) and magnesium stearate (1% (w/w))...

OBJECTIVE: Solventless dry powder coating methods have many advantages compared to solvent-based methods: they are more economical, simpler, safer, more environmentally friendly and easier to scale up. The purpose of this study was to investigate a highly effective dry powder coating method using the mechanofusion system, a mechanochemical treatment equipped with high compressive and shearing force. MATERIALS AND METHODS: Acetaminophen (AAP) and carnauba wax (CW) were selected as core particles of the model drug and coating material, respectively...

BACKGROUND: The benefits of subacromial local anesthetic infusion are controversial. The aim of this study was to evaluate the efficacy of subacromial bupivacaine infusion after arthroscopic acromionplasty and rotator cuff procedures. METHODS: Ninety patients with subacromial impingement disease scheduled for elective shoulder arthroscopy were enrolled in this randomized, prospective and placebo-controlled study. The patients received subacromially either 5.0 mg/ml bupivacaine or 9...

One explanation for diminished opioid analgesic efficacy is opioid-induced hyperalgesia (OIH). We report a case of OIH in an infant with gastroschisis, requiring multiple surgical interventions and prolonged sedation for ventilation. This is the first report of OIH in an infant. On day 41 of life after nine separate surgical interventions, the patient's pain scores increased and remained elevated, despite increasing opioid administration. The patient also developed hyperalgesia, allodynia, and photophobia and became extremely irritable upon handling...

An adjuvant (or co-analgesic) is a drug that in its pharmacological characteristic is not necessarily primarily identified as an analgesic in nature but that has been found in clinical practice to have either an independent analgesic effect or additive analgesic properties when used with opioids. The therapeutic role of adjuvant analgesics (AAs) is to increase the therapeutic index of opioids by a dose-sparing effect, add a unique analgesic action in opioid-resistant pain, or reduce opioid side effects. A notable difference between opioids and AAs is that unlike opioids some AAs are associated with permanent organ toxicity, for example, nonsteroidal anti-inflammatory drugs (NSAIDs) and renal failure...

Theoretical studies of the potential energy surface and bound states were performed for the N(2)O dimer. A four-dimensional intermolecular potential energy surface (PES) was constructed at the CCSD(T) level with aug-cc-pVTZ basis set supplemented with bond functions. Three co-planar local minima were found on this surface. They correspond to a nonpolar isomer with slipped-antiparallel planar structure and two equivalent polar isomers with slipped-parallel planar structures. The nonpolar isomer is energetically more stable than the polar ones by 162 cm(-1)...

BACKGROUND: Recent evidence suggests an anti-nociceptive effect of botulinum toxin. OBJECTIVES: To compare the efficacy and safety of botulinum toxin in comparison to placebo or other treatment options for shoulder pain. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), Ovid MEDLINE, CINAHL (via EBSCOhost), Ovid SPORTDiscus, EMBASE and Science Citation Index. SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing botulinum toxin with placebo or active treatment in people with shoulder pain were included...

PURPOSE: The aim of the study was to determine the effect of low-dose gabapentin on postoperative pain management in patients undergoing arthroscopic rotator cuff repair. METHODS: This randomized, double-blinded, placebo-controlled study included 46 patients. The patients were divided into 2 groups according to the drug administered 2 hours before surgery, either 300 mg of gabapentin or placebo. The primary outcome measure was the visual analog scale (VAS) score at 2, 6, 12, and 24 hours postoperatively...

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We synthesized novel 15-16 nornaltrexone derivatives 9, 11 and 22 to examine the importance of the cavity in the Beckett-Casy model, which was proposed to interact with the 15-16 ethylene moiety in the morphine structure. All the synthesized compounds showed lower affinities for the opioid receptor than did the naltrexone (10). The binding affinities of 14-OH derivatives 11, in which the rotation of the 9-17 bond would be restricted by an intramolecular hydrogen bond, was improved compared to the corresponding 14-H derivatives 9...

The objective of the present investigation was to prepare novel solid dispersions (SDs) of poorly water-soluble drugs with special microstructural characteristics using electrospinning process. With the hydrophilic polymer polyvinylpyrrolidone as the filament-forming polymer and acetaminophen (APAP) as the poorly water-soluble drug model, SDs having a continuous web structure, and in the form of non-woven nanofiber membranes, were successfully prepared. The electrospun nanofiber-based SDs were compared with those prepared from three traditional SD processes such as freeze-drying, vacuum drying, and heating drying...

This paper describes the design of a medication dispenser developed for narcotic rehabilitation programs. The dispenser holds up to four doses of medication and operates under remote supervision. A direct-into-mouth dispensing mechanism is a feature of the device. The mechanical dispenser mechanism includes a rotating barrel, medication tubes and dispensing slider unit. The electronic design involves a microprocessor PIC18F4550, stepper-motors, sensing devices a LabVIEW-based computer interface for remote supervisory control and monitoring...

Pediatric palliative care (PPC) is provided to children experiencing life-limiting diseases (LLD) or life-threatening diseases (LTD). Sixty to 90% of children with LLD/LTD undergoing PPC receive opioids at the end of life. Analgesia is often insufficient. Reasons include a lack of knowledge concerning opioid prescribing and adjustment of opioid dose to changing requirements. The choice of first-line opioid is based on scientific evidence, pain pathophysiology, and available administration modes. Doses are calculated on a bodyweight basis up to a maximum absolute starting dose...

BACKGROUND: Patients with frozen shoulder who fail conservative therapy need surgical treatment and aggressive post-operative rehabilitation. OBJECTIVE: To evaluate the effect of continuous cervical epidural analgesia on pain scores and range of motion of the shoulder joint in patients undergoing surgery for treatment of refractory frozen shoulder. METHODS: Twenty-one patients with refractory frozen shoulder who had failed conservative treatment and undergone surgical procedure (manipulation under anesthesia or capsular release) were identified and the data were collected retrospectively...

Several barriers exist to the routine use of continuous interscalene block (CISB) for postoperative analgesia following rotator cuff repair There is a perception that the technique is feasible only for single operators exposed to a high volume case load. The aim of this retrospective review was to compare the three commonly employed analgesic techniques following rotator cuff repair in a multi-provider setting. The techniques studied were CISB, combined single injection interscalene block with postoperative intermittent intra-articular local anaesthetic infiltration (SSISB/IA) and intermittent intra-articular only local anaesthetic infiltration (IA)...

PURPOSE/OBJECTIVES: To describe the most common side effects associated with the use of opioid treatment in patients with moderate to severe cancer pain; to discuss research findings specific to the use of opioids for cancer pain in long-term cancer survivors. DATA SOURCES: Published research, articles from a literature review, and U. S. statistics. DATA SYNTHESIS: Side effects associated with opioid use are a major contributor to patient reluctance to follow treatment plans for cancer pain...

PURPOSE/OBJECTIVES: To review strategies to optimize the management of chronic pain in patients with cancer, with an emphasis on the role of opioid analgesics. DATA SOURCES: Published research, articles from a literature review, and U. S. statistics. DATA SYNTHESIS: Treatment for cancer pain remains suboptimal. With the therapies currently available, as much as 90% of cancer pain can be controlled. Opioid analgesics are an important component of pain management in patients with cancer...