Psychoactive Plant Database - Neuroactive Phytochemical Collection

1. Acta Orthop. 2024 Nov 7;95:625-632. doi: 10.2340/17453674.2024.42182.

Measurement of acute postoperative pain intensity in orthopedic trials: a 
qualitative concept elicitation study.

Bjørnholdt KT(1), Andersen CWG(2).

Author information:
(1)Department of Orthopedic Surgery, Horsens Regional Hospital, Denmark. 
karebo@rm.dk.
(2)Department of Orthopedic Surgery, Svendborg Hospital, Denmark.

BACKGROUND AND PURPOSE: Pain intensity is an important outcome in clinical 
trials of surgery because pain relief is important to patients. Currently, 
recommended scales are the numeric rating scale 0-10 and visual analogue scale. 
However, these scales allow for considerable influence of individual 
imagination, previous experience, and coping skills, limiting proficiency in 
comparative clinical trials. We aimed to explore postoperative expressions of 
"how much it hurts"-the first step to improve pain intensity measurement.
METHODS: This was a qualitative study using inductive content analysis: words 
and visual cues describing pain intensity were collected from (i) existing pain 
intensity measures by search of COSMIN, PubMed, and Google, (ii) patient 
interviews recorded and transcribed word-for-word, (iii) clinician interviews 
transcribed likewise, and (iv) 100 patient telephone interviews with notes 
taken. After familiarization, the collected expressions were labelled 
inductively in categories and assembled in tables (case and theme-based 
matrices).
RESULTS: Descriptors fell into 12 categories: intensity (slight/strong), 
evaluative (negligible/unbearable), cognitive impact (distracting/can be 
ignored), activity impact (limits some/all activity), sleep impact (can/cannot 
sleep), examples (like stubbing a toe), physical signs (crying/writhing), 
associated symptoms (nauseating/tiring), treatment (ice helps/need morphine), 
affective (annoying/dreadful), discriminative (aching/piercing), and general 
recovery (hindering recovery/functional interference). Many visual cues were 
also identified. Literature and recorded interviews gave rise to the categories, 
and telephone interviews found saturation, providing no further categories.
CONCLUSION: Pain intensity is expressed by terms that fall into 12 categories 
and by a variety of graphic elements. This advances development of a 
patient-reported outcome measure of pain intensity for orthopedic trials.

DOI: 10.2340/17453674.2024.42182
PMID: 39508169 [Indexed for MEDLINE]


2. Acta Anaesthesiol Scand. 2025 Jan;69(1):e14545. doi: 10.1111/aas.14545.

Effect of intraoperative methadone in robot-assisted cystectomy on postoperative 
opioid requirements: A randomized clinical trial.

Uhrbrand CG(1)(2), Obad DS(1), Jensen BT(3), Jensen JB(2)(3), Friesgaard KD(4), 
Nikolajsen L(1)(2).

Author information:
(1)Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, 
Aarhus, Denmark.
(2)Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
(3)Department of Urology, Aarhus University Hospital, Aarhus, Denmark.
(4)Department of Anaesthesiology and Intensive Care, Regional Hospital Horsens, 
Horsens, Denmark.

BACKGROUND: Postoperative pain management is a challenge after robot-assisted 
cystectomy (RAC). Methadone has a long duration of action, and we therefore 
hypothesized that a single dose of intraoperative methadone would reduce 
postoperative opioid requirements and pain intensity in bladder cancer patients 
undergoing RAC.
METHODS: We conducted a blinded randomized controlled clinical trial from July 
2020 to August 2023. Patients scheduled to undergo RAC because of bladder cancer 
were randomized to receive intraoperative methadone (0.15 mg/kg-1) or morphine 
(0.15 mg kg-1) 1 h before endotracheal extubation. The primary outcome was 
opioid requirements after 24 h. Secondary outcomes were opioid requirements 
after 3 h, pain intensity at rest and during coughing, postoperative nausea and 
vomiting (PONV), sedation, hypoxemia, hypoventilation, time spent in the 
post-anesthetic care unit, and patient satisfaction.
RESULTS: A total of 114 patients were randomized. Data from 99 patients (14 
females, 85 males; mean age 69.8 ± 8.9 years) were available for analysis; 52 
received methadone and 47 received morphine. Opioid consumption was similar 
between the methadone group and morphine group at 3 h (median, mg, 45 (IQR 30 to 
75) vs. 45 (IQR 15 to 82.5) p = .97) and at 24 h (median, mg, 125 (IQR 75 to 
198.5) versus 105 (IQR 72 to 157.5), p = .29). Pain intensity was significantly 
lower in the morphine group at 48 h compared with the methadone group. Patient 
satisfaction at 24 h was increased in the methadone group compared with the 
morphine group (median, (IQR), NRS; 9 (IQR 7 to 10) versus 7 (IQR 4 to 9), 
p = .020). There were no differences between treatment groups in terms of time 
spent in the post-anesthetic care unit and the occurrence of opioid-related side 
effects.
CONCLUSION: A single dose of intraoperative methadone does not reduce 
postoperative opioid requirements compared with a single dose of morphine in 
bladder cancer patients undergoing RAC.

© 2024 The Author(s). Acta Anaesthesiologica Scandinavica published by John 
Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.

DOI: 10.1111/aas.14545
PMID: 39508073 [Indexed for MEDLINE]


3. Cureus. 2024 Oct 6;16(10):e70963. doi: 10.7759/cureus.70963. eCollection 2024 
Oct.

Comparative Analysis of the Postoperative Analgesic Effects of Caudal Epidural 
Injection of Ropivacaine Combined With Fentanyl Versus Ropivacaine Alone in 
Lumbosacral Spine Surgeries: A Randomized Double-Blinded Study.

Rajwade S(1), Dubey R(1), Khetarpal M(1), Ramchandani S(1), Panda CK(1), Kumar 
M(2), Kalbande JV(2).

Author information:
(1)Anaesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, 
IND.
(2)Anesthesiology and Critical Care, All India Institute of Medical Sciences, 
Raipur, Raipur, IND.

INTRODUCTION: A single injection of local anesthetic as a caudal epidural block 
provides pain relief for 2-4 hours. This duration can be extended by adding 
adjuvants such as opioids (morphine, fentanyl, buprenorphine, tramadol), 
ketamine, α2 agonists (dexmedetomidine, clonidine), and adrenaline. Caudal 
analgesia also reduces the need for intravenous opioids during and after 
surgery, which helps avoid the systemic side effects of opioids. Additionally, 
adjuncts such as opioids synergistically augment the analgesic properties of 
caudal epidural anesthetics without escalating motor block. Combining local 
anesthetics and opioids also reduces the dose-related adverse effects of each 
drug.  Materials and method: Fifty-six ASA (American Society of 
Anesthesiologists) grade I and II patients undergoing lumbosacral spine 
surgeries were randomized into two groups. The RF group (n=28) received a single 
caudal epidural injection of 20 ml of 0.2% ropivacaine with 50 micrograms of 
fentanyl, while the R group (n=28) received 20 ml of 0.2% ropivacaine alone. 
Postoperatively, patients were monitored for pain levels, heart rate (HR), 
non-invasive blood pressure (NIBP), mean arterial pressure (MAP), and visual 
analog scale (VAS) scores. The time until the first rescue analgesia request and 
the total amount of rescue analgesia administered were also recorded.
RESULTS: The two groups were comparable in terms of age, weight, height, and 
body mass index (BMI). In the R group, the VAS score was at least 1.82 at 2 
hours and at most 5.96 at 6 hours, then decreased to 2.25 at 24 hours. In the RF 
group, the VAS score was at least 1.68 at 2 hours and at most 5.87 at 4 hours, 
then decreased to 2.29 at 24 hours. In the RF group, the time until the first 
rescue pain relief was needed was significantly longer compared to the R group 
(in RF, the mean value was 7.30 hours, and in R, 6.68 hours, p <.0001).
CONCLUSIONS:  The study shows that adding 50 micrograms of fentanyl to 20 ml of 
0.2% ropivacaine for ultrasound-guided caudal block in patients undergoing 
lumbosacral spine surgeries results in longer analgesia duration and reduced VAS 
scores over the postoperative 24 hours.

Copyright © 2024, Rajwade et al.

DOI: 10.7759/cureus.70963
PMCID: PMC11538397
PMID: 39507136

Conflict of interest statement: Human subjects: Consent was obtained or waived 
by all participants in this study. Institutional Ethics committee, AIIMS Raipur 
issued approval AIIMSRPR/IEC/2020/681. Research Proposal No. 
AIIMSRPR/IEC/2020/681 is approved by the IEC AIIMS Raipur. Animal subjects: All 
authors have confirmed that this study did not involve animal subjects or 
tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure 
form, all authors declare the following: Payment/services info: All authors have 
declared that no financial support was received from any organization for the 
submitted work. Financial relationships: All authors have declared that they 
have no financial relationships at present or within the previous three years 
with any organizations that might have an interest in the submitted work. Other 
relationships: All authors have declared that there are no other relationships 
or activities that could appear to have influenced the submitted work.


4. Surg Infect (Larchmt). 2024 Nov 6. doi: 10.1089/sur.2024.100. Online ahead of 
print.

Impact of an Acute Care Surgery Clinical Pathway on Patient Outcomes in Acute 
Appendicitis.

Islam N(1), Thakkar G(2), Ferguson C(2), Kennedy K(3), Bennett N(4), Oyetunji 
T(2)(5), Fesmire A(2)(6), Gazzetta J(2)(6), Arce D(2)(6), Neblock-Beirne 
T(2)(6), Nix S(2)(6), Benedict LAO(2)(6).

Author information:
(1)Saba School of Medicine, Devens, Massachusetts, USA.
(2)Department of Surgery, University of Missouri-Kansas City School of Medicine, 
Kansas City, Missouri, USA.
(3)Cardiovascular Research Center, St. Luke's Hospital of Kansas City, Kansas 
City, Missouri, USA.
(4)Antimicrobial and Diagnostic Advisement Program, Saint Luke's Health System, 
Kansas City, Missouri, USA.
(5)Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA.
(6)Department of Trauma Surgery, St. Luke's Hospital of Kansas City, Kansas 
City, Missouri, USA.

Objectives: Acute care surgery (ACS) encompasses surgical critical care, 
emergency general surgery, and the surgical management of trauma. Following ACS 
implementation at our institution, we developed a perioperative clinical pathway 
for acute appendicitis (AA) to improve efficiency and standardize post-operative 
care. The purpose of our study is to assess patient outcomes utilizing our ACS 
clinical pathway for patients with AA. Methods: This is a retrospective cohort 
study involving patients admitted to our tertiary care facility with AA who 
underwent appendectomy. Patients were classified by pre-implementation (January 
1, 2016-July 31, 2018) and post-implementation (August 1, 2018-December 31, 
2020) of our ACS clinical pathway. The primary outcome was hospital length of 
stay (LOS). Statistical analysis was performed using SAS with a p-value <0.05 
determined as significant. Results: Of the 492 patients included, 225 were in 
the pre- and 267 were in the post-implementation cohorts. Hospital LOS was 
substantially decreased in the post-implementation cohort (31.2 vs. 50.4 h, p < 
0.001). The post-implementation group had a substantial decrease in computed 
tomography (CT) to operating room (OR) start time (6.81 vs. 11.4 h, p < 0.001), 
CT to antibiotic agents' administration (2.20 vs. 3.37 h, p < 0.001), inpatient 
opioid utilization (125 morphine equivalents [ME] vs. 172 ME, p < 0.001), and 
discharge antibiotic agents' prescription rates (23.6% vs. 30.7%, p = 0.077). 
Recovery unit discharges (20 vs. 9%, p < 0.001) were increased in the 
post-implementation cohort. Conclusion: Our ACS clinical pathway for AA resulted 
in earlier surgical intervention, enhanced opioid and antimicrobial stewardship, 
and gains in surgical care efficiencies.

DOI: 10.1089/sur.2024.100
PMID: 39506928


5. Am J Med Qual. 2024 Nov 7. doi: 10.1097/JMQ.0000000000000209. Online ahead of 
print.

Expanding Naloxone Coprescribing at a Regional VA Medical Center.

Zhang J(1), Zhang K(1), Phillips J(1), Sauer MC(1), Van Dorin S(1), Watson P(1), 
Zabel L(1), Peters E(2), De Sloover Koch Y(2), Kuperman EF(1), Soltys MD(1)(2).

Author information:
(1)Department of Internal Medicine, University of Iowa Carver College of 
Medicine, Iowa City, IA.
(2)Iowa City VA Health Care System, Iowa City, IA.

Veterans are disproportionately affected by chronic pain and are more likely to 
be prescribed opioids. As a means of risk mitigation, the Centers for Disease 
Control and Prevention and Department of Defense recommend naloxone for patients 
on opioids with risk factors, including use of ≥50 morphine milligram 
equivalents daily, concurrent benzodiazepine/sedative use, and pulmonary or 
liver disease. An interprofessional quality improvement team consisting of 6 
residents, a pharmacist, a nurse educator, and a faculty mentor was formed to 
increase naloxone coprescriptions at a regional VA medical center Continuity of 
Care Clinic. Primary intervention identified eligible patients via the VA 
Primary Care Almanac's Opioid Therapy Risk Report and alerted providers by email 
and secure messaging. Naloxone coprescription rates increased from 42% initially 
in June 2022 to 82% by June 2023 (29/69 to 41/50 patients, P < 0.0001). This 
project demonstrates that notifying providers of high-risk patients can 
significantly increase naloxone coprescriptions.

Copyright © 2024 the American College of Medical Quality.

DOI: 10.1097/JMQ.0000000000000209
PMID: 39506239