Opioides / Opioids

Septiembre 3, 2017. No. 2800

Riesgo comparativo de delirio con diferentes opioides. Una revisión sistemática The Comparative Risk of Delirium with Different Opioids: A Systematic Review. Swart LM1, van der Zanden V2, Spies PE3, de Rooij SE2,4, van Munster BC3,4. Author information Abstract Drugs Aging. 2017 Jun;34(6):437-443. doi: 10.1007/s40266-017-0455-9. OBJECTIVE: There is substantial evidence that the use of opioids increases the risk of adverse outcomes such as delirium, but whether this risk differs between the various opioids remains controversial. In this systematic review, we evaluate and discuss possible differences in the risk of delirium from the use of various types of opioids in older patients. METHODS: We performed a search in MEDLINE by combining search terms on delirium and opioids. A specific search filter for use in geriatric medicine was used. Quality was scored according to the quality assessment for cohort studies of the Dutch Cochrane Institute. RESULTS: Six studies were included, all performed in surgical departments and all observational. No study was rated high quality, one was rated moderate quality, and five were rated low quality. Information about dose, route, and timing of administration of the opioid was frequently missing. Pain and other important risk factors of delirium were often not taken into account. Use of tramadol or meperidine was associated with an increased risk of delirium, whereas the use of morphine, fentanyl, oxycodone, and codeine were not, when compared with no opioid. Meperidine was also associated with an increased risk of delirium compared with other opioids, whereas tramadol was not. The risk of delirium appeared to be lower with hydromorphone or fentanyl, compared with other opioids. Numbers used for comparisons were small. CONCLUSION: Some data suggest that meperidine may lead to a higher perioperative risk for delirium; however, high-quality studies that compare different opioids are lacking. Further comparative research is needed. PDF Tendencias de la prevalencia y la incidencia de diagnósticos de las alteraciones por  uso de opiáceos recetados en el Reino Unido. Prevalence and Incidence Trends for Diagnosed Prescription Opioid Use Disorders in the United Kingdom. Cooper AJM1, Willis J2, Fuller J2, Benecke H3, Leighton-Scott J2, Andersohn F4,5, Kim J6, Maier C7, Knaggs RD8,9. Author information Pain Ther. 2017 Jun;6(1):73-84. doi: 10.1007/s40122-017-0070-9. Epub 2017 Apr 27. Abstract INTRODUCTION: The prevalence of prescription opioid use disorders in the US has increased markedly in parallel with increases in opioid prescribing. Whilst an increase in opioid prescribing has also occurred in the UK, it remains unknown if there have been concurrent increases in opioid use disorders. The aim of this study was to examine national trends in the prevalence and incidence of physician-diagnosed opioid use disorders in the UK. METHODS: In a retrospective electronic health care database analysis using data from the UK Clinical Practice Research Datalink (CPRD), we identified persons receiving a first opioid prescription between January 1, 2008 and December 31, 2012. Persons with an opioid use disorder were identified by Read codes assigned by patients' physicians within 6 months following an opioid prescription. We calculated prevalence and incidence rates by dividing the analysis population by the total number of patients exposed (prevalence) or the total patient-years of exposure (incidence) using the 'exact' Clopper-Pearson Binomial method. RESULTS: Our analysis included 714,699 person-years of prescription opioid exposure. The 5-year period prevalence of opioid use disorders was 4.61 (95% CI 4.28-4.96) per 10,000 individuals, or 0.05%. The incidence rate of opioid use disorders was of 6.51 (95% CI 5.93-7.13) patients per 10,000 patient-years exposed. When examined by study year, there was no clear suggestion of a changing trend over time. When stratified by opioid drug, trends in the incidence rate during the study were either stable (i.e., codeine and tramadol), increasing (i.e., morphine) or decreasing (i.e., dihydrocodeine). CONCLUSIONS: Our study demonstrates that despite the marked increase in overall opioid prescribing in the UK in the past decade, there has not been an increase in the incidence of physician-diagnosed opioid use disorders. KEYWORDS: Abuse; Clinical Practice Research Datalink (CPRD); Dependence; Incidence; Misuse; Opioid use disorders; Opioids; Prescription; Prevalence; UK PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo California Society of Anesthesiologists Reuniones / Events Informacion / Information

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