Pharmacogenomics of buprenorphine - a narrative review.

Buprenorphine, a semi-synthetic opioid, is used to treat Opioid Use Disorder (OUD) and as an analgesic. Buprenorphine's benefits over other opioids include longer duration of action, lower abuse potential, and a ceiling effect to serious adverse effects such as respiratory depression. This is a literature review of gene variants affecting the pharmacokinetics and pharmacodynamics of buprenorphine from databases, such as PubMed.

Investigating Urinary Complications in Young Infant Surgical Patients with Indwelling Epidural Catheters: A Retrospective Cohort Study.

Background/objectives: Continuous epidural analgesia (CEA) is commonly used to manage postoperative pain in young infants. However, it can impair bladder function, leading to postoperative urinary retention (POUR) and necessitating Foley catheter placement, which carries a risk of urinary tract infection (UTI). Limited research exists on the frequency of POUR and UTIs and factors influencing optimal Foley catheter management in this population.

Auriculotherapy for Prolonged Postoperative Pain Management Following Rotator Cuff Surgery: A Randomized, Placebo-Controlled Study.

Introduction: Pain after rotator cuff surgery is prolonged. This has led to the need for opioids and the risk of developing opioid use disorder. This study was designed to investigate the role that active auriculotherapy treatment (AT) may play in reducing opioid consumption following rotator cuff surgery.

Intraoperative Methadone Versus Non-Methadone Analgesia in Pediatric Cardiac Surgery: A Retrospective Cohort Study.

Introduction: Methadone is an opioid-sparing opioid and it is increasingly used in children undergoing surgery due to its beneficial effects on postoperative pain scores, decreased opioid requirements, and fewer adverse effects compared to other opioids. Intraoperative methadone is not well studied in pediatric cardiac surgery. We hypothesized that intraoperative methadone-based analgesia would provide comparable effectiveness in pain management to non-methadone-based analgesia, including caudal morphine, following pediatric cardiac surgery.

Prenatal opioid exposure alters pain perception and increases long-term health risks in infants with neonatal opioid withdrawal syndrome.

Background: Opioids are often prescribed for pain relief, yet they pose risks such as addiction, dependence, and overdose. Pregnant women have unique vulnerabilities to opioids and infants born to opioid-exposed mothers could develop neonatal opioid withdrawal syndrome (NOWS). The study of opioid-induced epigenetic changes in chronic pain is in its early stages.

Pregnant maternal brain dorsal anterior cingulate cortex choline/creatine ratios on 1H-MR spectroscopy in opioid exposure.

There is growing interest in understanding the effects of opioid use on the brain, yet the effects of opioid use on the pregnant maternal brain are still relatively unknown. Pregnant women with opioid exposure during pregnancy are at high risk for adverse neurological and neuropsychiatric outcomes. Much of what is currently known about the impact of opioids on the maternal brain is mainly derived from studies in animal models; however, species-specific opioid pathways and other socio-environmental factors complicate the interpretation of results.

Predicting Postoperative Delirium Using Intraoperative Neuromonitoring in Patients Undergoing Craniotomy for Aneurysm Clipping Surgery.

Introduction: Postoperative delirium (POD) that is associated with intracranial surgeries can have several adverse outcomes, including a high rate of morbidity and mortality. The use of intraoperative neurophysiological monitoring (IONM) via somatosensory evoked potentials (SSEP) and electroencephalography (EEG) provides continuous information regarding cerebral blood flow (CBF) during aneurysm clipping. In this study, we hypothesize that CBF changes during aneurysm clipping increase the risk of POD.

Intraoperative neuromonitoring as an independent predictor for postoperative delirium in ICU following aneurysm clipping.

Objectives: This study aims to evaluate the diagnostic accuracy of significant intraoperative neurophysiological monitoring (IONM) changes as an independent predictor of postoperative delirium (POD) in patients undergoing aneurysm clipping.

Methods: IONM and clinical data from 273 patients who underwent craniotomy for aneurysm clipping from 2019 until 2021 were retrospectively reviewed. Significant IONM changes and POD were respectively evaluated based on visual review of data and clinical documentation.

Intraoperative Methadone in Adult Cardiac Surgical Patients and Risks for Postoperative QTc Prolongation.

Objectives: To evaluate the effect of intraoperative intravenous methadone within a standardized enhanced recovery after cardiac surgery pathway on the perioperative corrected QT interval (QTc).

Design: Retrospective cohort study.

Setting: Cardiac surgical patients from a tertiary academic medical institution.

Role of Intraoperative Neurophysiological Monitoring in Predicting Postoperative Delirium in Patients Undergoing Carotid Endarterectomy Surgeries.

Introduction: This study aimed to evaluate the diagnostic utility of electroencephalography (EEG) and somatosensory evoked potentials (SSEP) as modalities of intraoperative neurophysiological monitoring (IONM) in predicting postoperative delirium (POD) in patients who underwent carotid endarterectomy (CEA) surgery.

Methods: A total cohort of 425 patients was included in this study. Medical record data were reviewed retrospectively and their documented significant IONM data were analyzed and integrated into the study for each patient.

Intravenous Methadone versus Intrathecal Morphine as Part of an Enhanced Recovery After Cardiac Surgery Protocol on Postoperative Pain and Outcomes: A Retrospective Cohort Study.

Objectives: Evaluate the effect of intravenous (IV) methadone versus intrathecal morphine (ITM) within an Enhanced Recovery After Cardiac Surgery (ERACS) pathway on postoperative pain and outcomes (length of hospital stay and postoperative complications) after cardiac surgery.

Design: Retrospective cohort study.

Setting: Two tertiary academic medical institutions within the same health system.

Nanotechnology for Pain Management.

: In the context of the current opioid crisis, non-pharmacologic approaches to pain management have been considered important alternatives to the use of opioids or analgesics. Advancements in nano and quantum technology have led to the development of several nanotransporters, including nanoparticles, micelles, quantum dots, liposomes, nanofibers, and nano-scaffolds. These modes of nanotransporters have led to the development of new drug formulations.

Gaining Insight into Teenagers' Experiences of Pain after Laparoscopic Surgeries: A Prospective Study.

There is an anecdotal impression that teenage patients report exaggerated postoperative pain scores that do not correlate with their actual level of pain. Nurse and parental perception of teenagers' pain can be complemented by knowledge of patient pain behavior, catastrophizing thoughts about pain, anxiety, and mood level. Two hundred and two patients completed the study-56.

Opioid use disorder in pediatric populations: considerations for perioperative pain management and precision opioid analgesia.

Introduction: Opioids are commonly used for perioperative analgesia, yet children still suffer high rates of severe post-surgical pain and opioid-related adverse effects. Persistent and severe acute surgical pain greatly increases the child's chances of chronic surgical pain, long-term opioid use, and opioid use disorder.

Areas Covered: Enhanced recovery after surgery (ERAS) protocols are often inadequate in treating a child's severe surgical pain.

Utilizing Peripheral Nerve Blocks for Pain Management in Pediatric Patients during Embolization and Sclerotherapy for Vascular Malformations.

Vascular anomalies are a diverse group of abnormal blood vessel developments that can occur at birth or shortly afterward. Embolization and sclerotherapy have been utilized as a treatment option for these malformations but may cause moderate-to-severe pain. This study aims to evaluate the utilization of peripheral nerve blocks in opioid consumption, pain scores, and length of stay.

Placental cytochrome P450 methylomes in infants exposed to prenatal opioids: exploring the effects of neonatal opioid withdrawal syndrome on health horizons.

Neonatal opioid withdrawal syndrome (NOWS), arises due to increased opioid use during pregnancy. Cytochrome P450 (CYP) enzymes play a pivotal role in metabolizing a wide range of substances in the human body, including opioids, other drugs, toxins, and endogenous compounds. The association between CYP gene methylation and opioid effects is unexplored and it could offer promising insights.

Multicenter Population Pharmacokinetics of Fentanyl in Neonatal Surgical Patients Using Dried Blood Spot Specimen Collection Demonstrates Maturation of Elimination Clearance.

Background: Fentanyl is widely used for analgesia and sedation in neonates, but pharmacokinetic (PK) analysis in this population has been limited by the relatively large sample volumes required for plasma-based assays.

Methods: In this multicenter observational study of fentanyl kinetics in neonates up to 42 weeks of postmenstrual age (PMA) who received fentanyl boluses and continuous infusions, dried blood spots were used for small-volume sampling. A population PK analysis was used to describe fentanyl disposition in term and preterm neonates.

Reduction in postoperative opioid requirement associated with use of the NSS-2 Bridge device, a disposable auriculo-nerve field stimulator, and factors affecting the response in cancer patients undergoing abdominal surgical procedures.

Objective: Determine the effect on opioid use after surgery with use of the NSS-2 Bridge device (NBD) as a field nerve stimulator of the nerves innervating the ear for 5 days.

Methods: This was a prospective, randomized, double-blind, placebo-controlled trial investigating the effectiveness of the NBD in reducing opioid (expressed as oral morphine equivalent; OME, mg) requirement in subjects undergoing abdominal surgery for cancer. A total of 53 subjects randomly assigned to receive either an active NBD (NBD group) or placebo NBD (placebo group) were included in the analysis.

Role of the NeuroCuple™ Device for the Postoperative Pain Management of Patients Undergoing Unilateral Primary Total Knee and Hip Arthroplasty: A Pilot Prospective, Randomized, Open-Label Study.

Background: The potential effectiveness of the non-pharmacological and nanotechnology-based NeuroCuple™ device in reducing postoperative surgical pain and opioid consumption remains unknown.

Methods: This randomized controlled open-label study was conducted in patients undergoing a primary unilateral total knee or total hip arthroplasty. In the recovery room, patients were randomized to receive either standard of care (control group) or standard of care plus two NeuroCuple™ devices.

Role of Intraoperative Neuromonitoring to Predict Postoperative Delirium in Cardiovascular Surgery.

Objective: Postoperative delirium (POD) can occur in up to 50% of older patients undergoing cardiovascular surgery, resulting in hospitalization and significant morbidity and mortality. This study aimed to determine whether intraoperative neurophysiologic monitoring (IONM) modalities can be used to predict delirium in patients undergoing cardiovascular surgery.

Design: Adult patients undergoing cardiovascular surgery with IONM between 2019 and 2021 were reviewed retrospectively.

Short-acting versus long-acting opioids for pediatric postoperative pain management.

Introduction: Opioids are potent analgesics commonly used to manage children's moderate to severe perioperative pain in children. A wide range of short and long-acting opioids are used to treat surgical pain and will be reviewed in this article.

Areas Covered: Both short- and long-acting opioids contain unique therapeutic benefits and adverse effects; however, due to the side effect profile and safety concerns, lack of familiarity, and evidence with long-acting opioids to treat surgical pain, shorter-acting opioids have traditionally been used in children.

Development and Validation of a Machine Learning Model to Identify Patients Before Surgery at High Risk for Postoperative Adverse Events.

Importance: Identifying patients at high risk of adverse outcomes prior to surgery may allow for interventions associated with improved postoperative outcomes; however, few tools exist for automated prediction.

Objective: To evaluate the accuracy of an automated machine-learning model in the identification of patients at high risk of adverse outcomes from surgery using only data in the electronic health record.

Design, Setting, And Participants: This prognostic study was conducted among 1 477 561 patients undergoing surgery at 20 community and tertiary care hospitals in the University of Pittsburgh Medical Center (UPMC) health network.

Isha yoga practices, vegan diet, and participation in Samyama meditation retreat: impact on the gut microbiome & metabolome - a non-randomized trial.

Background: Growing evidence suggests a role for gut bacteria and their metabolites in host-signaling responses along the gut-brain axis which may impact mental health. Meditation is increasingly utilized to combat stress, anxiety, and depression symptoms. However, its impact on the microbiome remains unclear.

Effects of oxycodone pharmacogenetics on postoperative analgesia and related clinical outcomes in children: a pilot prospective study.

Variability in the pharmacokinetics and pharmacodynamics of oxycodone in children undergoing surgery could be due to genetic polymorphisms. The authors studied the association between clinical outcomes and pharmacogenes in children undergoing major surgery. A total of 89 children (35 undergoing pectus excavatum repair and 54 undergoing spinal fusion) were recruited.