Anesthesiology and Pain Medicine最新文献

{"title":"Comparison of Analgesic Effects of Ketorolac Plus Apotel to Meperidine in Patients Undergoing Right Thoracotomy: A Double-Blind Randomized Clinical Trial.","authors":"Mohammad Salehi Aliabad, Shima Sheybani, Hassan Mehrad-Majd, Alireza Sharifian Attar","doi":"10.5812/aapm-136822","DOIUrl":"10.5812/aapm-136822","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain management using nonsteroidal anti-inflammatory drugs with no narcotic-attributed adverse effects, such as respiratory depression, nausea, and vomiting, is still the subject of extensive research. However, concerns about bleeding and nephrotoxicity have limited routine use.</p><p><strong>Objectives: </strong>The present trial aimed to compare the effects of ketorolac/apotel and meperidine on postoperative pain relief in patients undergoing thoracotomy.</p><p><strong>Methods: </strong>This randomized controlled trial enrolled 122 patients who were candidates for right thoracotomy. The patients were randomly divided into two groups that received ketorolac (30 mg)/apotel (1 g) or meperidine (0.5 - 1 mg/kg) at the beginning of recovery, respectively. This study assessed the Numeric Rating Scale pain score immediately and 30 and 60 minutes after the surgery in the recovery room, blood pressure, oxygen saturation (SpO₂), sweating, and pulse rate.</p><p><strong>Results: </strong>The average pain score at recovery time was significantly lower in the ketorolac/apotel group (2.06 ± 1.40) than in the meperidine group (2.76 ± 1.61) (P = 0.011). In contrast to the ketorolac/apotel group, an increasing trend was observed in pain scores in the meperidine group throughout the time sequence (P < 0.05). However, a slight non-significant increase was also observed in the ketorolac/apotel group. No statistical differences were observed in blood pressure (P = 0.826), SpO₂ (P = 0.826), and pulse rate (P = 0.811) between the two study groups.</p><p><strong>Conclusions: </strong>This study provides support that the combination of ketorolac/apotel offers a slightly superior analgesic effect for patients undergoing thoracotomy, compared to meperidine. Pain management is crucial during recovery, and the current study's findings suggest that administering ketorolac/apotel provides effective analgesia during recovery after thoracic surgery.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":" ","pages":"e136822"},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10664621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48652270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Efficacy and Safety of a Single-Dose Tranexamic Acid in Reducing Blood Loss During Cytoreductive Surgery Followed by Hyperthermic Intraperitoneal Chemotherapy: A Randomized Comparative Pilot Study.","authors":"Ehab Hanafy Shaker, Ahmed Mohamed Soliman, Ahmed Fahmy Hussein, Ehab Samy Fayek, Mai Mohamed Elrawas","doi":"10.5812/aapm-136578","DOIUrl":"10.5812/aapm-136578","url":null,"abstract":"<p><strong>Background: </strong>Hyperthermic intraperitoneal chemotherapy (HIPEC), following cytoreductive surgery (CRS), is a lengthy procedure, usually associated with considerable bleeding due to the extensive nature of surgery. Various techniques have been used to decrease blood transfusion requirements.</p><p><strong>Objectives: </strong>This study aimed to evaluate the possible advantage of a single dose of tranexamic acid (TA) in such surgeries.</p><p><strong>Methods: </strong>In this randomized comparative pilot study, 60 patients scheduled to undergo CRS followed by HIPEC were randomly assigned to 2 equal groups: group 1 (TA group) that received 10 mg/kg of TA in 100 mL of 0.9% NaCl over 20 minutes after the induction of anesthesia and before surgical incision, and group 2 (control group) that received a placebo of 100 mL of 0.9% NaCl during the same time interval. The primary endpoint was the blood loss volume. The secondary endpoints were the number of patients requiring transfusion and the occurrence of any postoperative thrombotic events 30 days after surgery. Serum creatinine levels were measured before the operation and on postoperative days 1, 3, and 5. Intraoperative and first 24 hours urine outputs were also recorded. The levels of hemoglobin (Hb) were measured before the operation, immediately after the operation, and 5 days postoperatively.</p><p><strong>Results: </strong>Compared to the control group, the TA group exhibited lower intraoperative blood loss, as well as lower blood loss on postoperative day 1 and in total blood loss (P = 0.006, 0.035, and 0.001, respectively). However, the blood loss on the remaining postoperative days was comparable between both groups. Intraoperative blood transfusion requirements were lower in the TA group (P = 0.032) than in the control group. The total number of units of blood and plasma transfused was also lower in the TA group both intra and postoperatively (0.007, 0.40, and 0.032, 0.008, respectively) than in the control group. Hemoglobin levels, serum creatinine levels, and urine outputs during the first 24 hours postoperatively were comparable between the 2 groups. The thromboembolic events within 30 days were also comparable between the 2 groups.</p><p><strong>Conclusions: </strong>Administering a single dose of TA between the induction of anesthesia and the surgical incision may reduce blood loss and transfusion rates in CRS followed by HIPEC without causing significant adverse effects. It is a promising approach in surgeries where massive blood loss is expected shortly after anesthesia induction. This can minimize the drawbacks of repeated blood transfusions during and after the operation without causing significant adverse effects. Besides reducing the need for repeated blood transfusions, it would also reduce the costs of blood/blood products and the risks of transfusion.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":" ","pages":"e136578"},"PeriodicalIF":0.0,"publicationDate":"2023-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10664172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44448814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erector Spinae Plane Block for the Treatment of Intractable Pain in a Patient with Pancoast Tumor: A Case Report.","authors":"Poupak Rahimzadeh, Ali Ahani, Ali Antar, Seyedeh Fatemeh Morsali, Faegheh Zojaji, Gholamali Dikafraz Shokooh","doi":"10.5812/aapm-135829","DOIUrl":"10.5812/aapm-135829","url":null,"abstract":"<p><strong>Introduction: </strong>The erector spinae plane (ESP) block is a regional anesthetic technique that involves injecting a local anesthetic below the erector spinae muscle in an interfascial plane.</p><p><strong>Case presentation: </strong>We report a case of a 66-year-old man with cervicothoracic junction pain caused by an advanced Pancoast tumor. The administration of ESP block at the T2-T3 level led to pain relief of more than 50% in this patient after two sessions.</p><p><strong>Conclusions: </strong>Therefore, the application of this method of regional analgesia is both convenient and safe and reduces opioid consumption. Further studies are needed to evaluate the safety and effectiveness of continuous blocks in outpatient settings.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":" ","pages":"e135829"},"PeriodicalIF":0.0,"publicationDate":"2023-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10664171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41411927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refractory Complex Regional Pain Syndrome: A Case Report and Review of Literature.","authors":"Mahmood-Reza Alebouyeh, Seyedeh Fatemeh Morsali, Faegheh Zojaji, Seyed Ali Ebrahimi, Ali Ahani, Ali Antar","doi":"10.5812/aapm-135286","DOIUrl":"10.5812/aapm-135286","url":null,"abstract":"<p><strong>Introduction: </strong>Complex regional pain syndrome (CRPS) is characterized by extreme pain in a limb disproportional to the clinical history or physical findings accompanied by the signs of autonomic dysfunction. The pathophysiology of CRPS is obscure, making it challenging to treat. Treatment options include medications, physical therapy, and psychological support. In some cases, surgery or other minimally-invasive procedures such as nerve blocks may be recommended, while several novel treatments, such as ozone therapy, lack sufficient clinical evidence.</p><p><strong>Case presentation: </strong>A 40-year-old man with CRPS was referred to our clinic with pain in his right arm and left lower leg. The patient had a history of trauma to the ulnar nerve and had undergone a sural to ulnar nerve autograft surgery. After the surgery, the patient's symptoms began, primarily in the right arm. Despite receiving conventional drugs, multiple nerve blocks, and lidocaine patches, the patient's symptoms persisted. In addition, we tried medical ozone for 14 sessions along with ketamine infusion, but these treatments were also ineffective.</p><p><strong>Conclusions: </strong>We emphasize the importance of studying and developing more effective treatments for CRPS and suggest that further randomized clinical trials are needed to determine whether ozone therapy is effective for patients with severe, intractable CRPS symptoms.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":" ","pages":"e135286"},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10676669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47144800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epigenetic and Anesthesia: Challenges and Opportunities.","authors":"Fatemeh Roodneshin","doi":"10.5812/aapm-136907","DOIUrl":"10.5812/aapm-136907","url":null,"abstract":"<jats:p />","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":" ","pages":"e136907"},"PeriodicalIF":0.0,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10664618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48591258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung Ultrasound Abnormalities in Patients Without Pulmonary Pathology Prior to Surgery.","authors":"Susana Gonzalez Suarez, Macarena Aznar de Legarra, Antonio Barbara Ferreras, Melissa Caicedo Toro, Eva Maria Pelaez de la Fuente, Juan Blazquez Martin, Sandra Martin Iglesias, Ximena Eliana Monsalve Ortiz","doi":"10.5812/aapm-137900","DOIUrl":"10.5812/aapm-137900","url":null,"abstract":"<p><strong>Background: </strong>The occurrence of lung ultrasound abnormalities in patients without lung disease remains uncertain, while patients with respiratory disease often exhibit such abnormalities.</p><p><strong>Objectives: </strong>The primary aim was to identify pathological ultrasonographic pulmonary findings and their correlation with baseline diseases and static lung compliance in patients without any pre-existing respiratory conditions.</p><p><strong>Methods: </strong>This prospective observational study enrolled a series of surgical patients with no history of pulmonary pathology (n = 104). Baseline diseases and patients' physical status classification, based on the American Society of Anesthesiologists (ASA), were documented by reviewing medical records. Prior to surgery, a lung ultrasound was performed to assess pulmonary changes. During surgery with general anesthesia, static lung compliance was measured. The Spearman correlation coefficient was employed to determine the correlation between the two variables.</p><p><strong>Results: </strong>Twenty-four patients (23.07%) exhibited 1 - 2 B-lines in certain lung fields. Seven patients (6.7%) had an ultrasound B-line score > 0 (indicating ≥ 3 B-lines). Among these patients, the average number of lung fields with ≥ 3 B-lines was 3.71 ± 2.43. Patients with systemic diseases (ASA ≥ 2) displayed a higher number of B-lines compared to ASA I patients (P-value = 0.039). Pleural irregularities were found in 10 patients (9.6%), while atelectasis and pleural effusion were observed in five (4.8%) and four (3.8%) patients, respectively. The mean lung compliance value was 56.78 ± 15.33. No correlation was observed between the total score of the B-lines and lung compliance (Spearman's correlation: rho = -0.028, P-value = 0.812).</p><p><strong>Conclusions: </strong>Patients without pulmonary pathology may exhibit ultrasound pulmonary abnormalities, which tend to increase with higher ASA scores and do not appear to have a correlation with static lung compliance.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":" ","pages":"e137900"},"PeriodicalIF":0.0,"publicationDate":"2023-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10664153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44562607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Study of the Effectiveness of Vapocoolant Spray Versus EMLA Cream in Reducing Pain During Intravenous Cannulation in the Adult Population.","authors":"Sisla Nazer, Sonal Bhat, Ranjan Ramakrishna, Sunil Baikadi Vasudevarao","doi":"10.5812/aapm-136404","DOIUrl":"10.5812/aapm-136404","url":null,"abstract":"<p><strong>Background: </strong>Intravenous cannulation is a prerequisite before any major or minor surgical procedures.</p><p><strong>Objectives: </strong>The rationale of the study was to compare the effectiveness of eutectic mixtures of local anesthetics (EMLA) cream and vapocoolant spray for pain reduction during intravenous (I.V.) cannulation.</p><p><strong>Methods: </strong>This observational prospective cohort study was done on 140 patients requiring I.V. cannulation prior to elective procedure who were divided into two groups, including group E: EMLA (eutectic mixtures of local anesthetics) cream and group V: Vapocoolant spray (ethyl chloride). Visual Analogue Scale (VAS) score, hemodynamic variables, and cost analysis were studied between the two groups. Statistical analyses were done using Mann-Whitney U test, unpaired <i>t</i>-test, Fisher's exact test, and chi-square test were used to identify variation in pain scores between the two groups. Post hoc analysis was done at different time points by the Bonferroni test. P-value < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>It was observed that the groups were comparable in terms of age, sex, and American Society of Anesthesiologists (ASA) physical status. A highly significant difference was observed between the two groups in terms of VAS scores for pain. There was also a significant difference in terms of heart rate and movement of hands during cannulation between the two groups. No changes were observed in the other hemodynamic parameters. Vapocoolant spray was also more cost-effective compared to EMLA cream with an occlusive dressing.</p><p><strong>Conclusions: </strong>Vapocoolant spray was a better tool compared to EMLA cream for intravenous cannulation, especially in emergency settings.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":" ","pages":"e136404"},"PeriodicalIF":0.0,"publicationDate":"2023-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10664170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45930498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Veno-venous Extracorporeal Membrane Oxygenation: Anesthetic Considerations in Clinical Practice.","authors":"Kimberly L Skidmore, Alireza Rajabi, Angela Nguyen, Farnad Imani, Alan D Kaye","doi":"10.5812/aapm-136524","DOIUrl":"10.5812/aapm-136524","url":null,"abstract":"<p><strong>Context: </strong>After the COVID-19 pandemic, multiple reviews have documented the success of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Patients who experience hypoxemia but have normal contractility may be switched to veno-venous-ECMO (VV-ECMO).</p><p><strong>Purpose: </strong>In this review, we present three protocols for anesthesiologists. Firstly, transesophageal echocardiography (TEE) aids in cannulation and weaning off inotropes and fluids. Our main objective is to assist in patient selection for the Avalon Elite single catheter, which is inserted into the right internal jugular vein and terminates in the right atrium. Secondly, we propose appropriate anticoagulant doses. We outline day-to-day monitoring protocols to prevent heparin-induced thrombocytopenia (HIT) or resistance. Once the effects of neuromuscular paralysis subside, sedation should be reduced. Therefore, we describe techniques that may prevent delirium from progressing into permanent cognitive decline.</p><p><strong>Methods: </strong>We conducted a PubMed search using the keywords VV-ECMO, TEE, Avalon Elite (Maquet, Germany), and quetiapine. We combined these findings with interviews conducted with nurses and anesthesiologists from two academic ECMO centers, focusing on anticoagulation and sedation.</p><p><strong>Results: </strong>Our qualitative evidence synthesis reveals how TEE confirms cannulation while avoiding right atrial rupture or low flows. Additionally, we discovered that typically, after initial heparinization, activated partial thromboplastin time (PTT) is drawn every 1 to 2 hours or every 6 to 8 hours once stable. Daily thromboelastograms, along with platelet counts and antithrombin III levels, may detect HIT or resistance, respectively. These side effects can be prevented by discontinuing heparin on day two and initiating argatroban at a dose of 1 μg/kg/min while maintaining PTT between 61 - 80 seconds. The argatroban dose is adjusted by 10 - 20% if PTT is between 40 - 60 or 80 - 90 seconds. Perfusionists assist in establishing protocols following manufacturer guidelines. Lastly, we describe the replacement of narcotics and benzodiazepines with dexmedetomidine at a dose of 0.5 to 1 μg/kg/hour, limited by bradycardia, and the use of quetiapine starting at 25 mg per day and gradually increasing up to 200 mg twice a day, limited by prolonged QT interval.</p><p><strong>Conclusions: </strong>The limitation of this review is that it necessarily covers a broad range of ECMO decisions faced by an anesthesiologist. However, its main advantage lies in the identification of straightforward argatroban protocols through interviews, as well as the discovery, via PubMed, of the usefulness of TEE in determining cannula position and contractility estimates for transitioning from VA-ECMO to VV-ECMO. Additionally, we emphasize the benefits in terms of morbidity and mortality of a seldom-discussed sedation supplement, quetiapine, to dexmedetomidine.</","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":" ","pages":"e136524"},"PeriodicalIF":0.0,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10664155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41670907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Orthopedic Pains in Children and Adolescents: A Systematic Review and Meta-analysis.","authors":"Hosein Karimiyarandi, Majid Khalilizad","doi":"10.5812/aapm-136616","DOIUrl":"10.5812/aapm-136616","url":null,"abstract":"<p><strong>Context: </strong>Musculoskeletal disorders are among the main causes of death and disability and can impose high costs on individuals and countries. Considering the importance of pain, the present meta-analysis study aimed to investigate the prevalence of orthopedic pains in Iranian children and adolescents.</p><p><strong>Methods: </strong>The present study was reported in line with PRISMA. The searching process was carried out using keywords, including adolescents, pain, youth, school-age children, shoulder pain, neck pain, shoulder, and neck, AND/OR operators for the articles published during 2000 and 2022 in Scopus, Embase, PubMed, Scientific Information Database, Magiran, International Statistical Institute, and Islamic World Science Citation Center databases. This study reviewed the articles that reported the prevalence of orthopedic pains (i.e., wrists/hands, shoulders, elbows, and knees) among the 5-18-year age group in Iran and extracted their results. Two researchers conducted the search quite independently and extracted the necessary data using a researcher-made checklist. The collected data were analyzed using Comprehensive Meta-Analysis software (CMA3).</p><p><strong>Results: </strong>Initially, 418 articles were identified, and 14 articles were entered into the systematic review stage. The prevalence rates of pains related to wrists/hands, shoulders, elbows, and knees were 6.6 (95% confidence interval [CI]: 3.2 - 13.0), 26.9 (95% CI: 17.0 - 39.7), 2.9 (95% CI: 1.3 - 6.3), and 6.6 (95% CI: 3.0 - 14.2), respectively.</p><p><strong>Conclusions: </strong>The prevalence of shoulder and knee pains in individuals under 18 years in Iran was high. Therefore, it is necessary to make necessary interventions and take preventive measures.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":" ","pages":"e136616"},"PeriodicalIF":0.0,"publicationDate":"2023-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10676658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48035878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Serum Cortisol Levels and Response to Cosyntropin Test in Methadone-treated Opium Addicts.","authors":"Faegheh Zojaji, Alireza Khalesi, Afsane Bahrami, Seyed Ali Ebrahimi, Mahmoud Ganjifard","doi":"10.5812/aapm-135206","DOIUrl":"10.5812/aapm-135206","url":null,"abstract":"<p><strong>Background: </strong>Opium has been used for thousands of years for medical and analgesic purposes, and its misuse has also increased in recent years. Methadone, a synthetic opioid, has been used as an analgesic and to help patients quit opium addiction. However, some evidence suggests that long-term use of opioids can affect the hypothalamic-pituitary-adrenal axis.</p><p><strong>Objectives: </strong>We aimed to evaluate the serum cortisol level and response to the cosyntropin stimulation test in opium addicts on methadone treatment.</p><p><strong>Methods: </strong>The study was conducted in November 2019 at Imam Reza Hospital Rehab Center, Birjand, Iran. Thirty-eight methadone-treated opium addicts participated in the study. A blood sample was initially obtained, then 250 µg intramuscular cosyntropin was injected. After 30 and 60 minutes, two other blood samples were obtained. The data were analyzed using SPSS.</p><p><strong>Results: </strong>There was a significant difference between serum cortisol levels and the normal value in methadone users (9.46 ± 5.42 vs. 14 µg/dL) (P < 0.001). The mean response to the cosyntropin stimulation test in methadone users was 9.34 ± 8.11 µg/dL. Also, 55% of the participants had adrenal insufficiency.</p><p><strong>Conclusions: </strong>Serum cortisol levels significantly differed from normal values in methadone-treated patients. Therefore, we recommend measuring serum cortisol levels in methadone-treated patients before major medical procedures to consider the stress doses of corticosteroids.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":" ","pages":"e135206"},"PeriodicalIF":0.0,"publicationDate":"2023-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10788091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43832794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}