![]() ![]() The medical team’s continuous education on extravasation is essential. They should regularly check the extravasation kit, assess patients’ sensory changes, tingling or burning, and always pay attention to patients’ words. For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. At the first sign of extravasation, nursing intervention with following steps is recommended: stop administration of IV fluids immediately, disconnect the IV tube from the cannula, aspirate any remaining drug from the cannula, administer drug-specific antidote, and notify the physician. Management of extravasation includes nursing intervention and thermal application. Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. 2021 373:n1032.The purpose of these practice guidelines is to offer and share strategies for preventing extravasation and measures for handling drugs known to cause tissue necrosis, which may occur even with the most skilled experts at intravenous (IV) injection. Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials. Wang L, Hong PJ, May C, Rehman Y, Oparin Y, Hong CJ, et al. Opioid-sparing effects of medical cannabis or cannabinoids for chronic pain: a systematic review and meta-analysis of randomised and observational studies. Noori A, Miroshnychenko A, Shergill Y, Ashoorion V, Rehman Y, Couban RJ, et al. Opioid-sparing effect of cannabinoids: a systematic review and meta-analysis. Nielsen S, Sabioni P, Trigo JM, Ware MA, Betz-Stablein BD, Murnion B, et al. Effects of opioid/cannabinoid mixtures on impulsivity and memory in rhesus monkeys. Effects of cannabidiol on morphine conditioned place preference in mice. Markos JR, Harris HM, Gul W, ElSohly MA, Sufka KJ. Consistent with laboratory studies on healthy adults, the present study shows minimal benefit of combining dronabinol (10 mg) and hydromorphone (4 mg) for analgesia and improving physical functioning in adults with KOA. Only hydromorphone impaired cognitive performance. No serious adverse events were reported hydromorphone produced more mild adverse events than placebo, but hydromorphone + dronabinol produced more moderate adverse events than both placebo and hydromorphone alone. ![]() While subjective drug effects and some HAP ratings were increased in the combined drug condition, these were not significantly increased over the dronabinol alone condition. Little enhancement of hydromorphone analgesia by dronabinol was observed on evoked pain indices. ![]() No significant analgesic effects were observed for clinical pain severity or physical functioning across all drug conditions. Clinical and experimentally-induced pain, physical and cognitive function, subjective drug effects, HAP, adverse events, and pharmacokinetics were evaluated. Participants received (1) placebo-placebo, (2) hydromorphone (4 mg)-placebo (3) dronabinol (10 mg)-placebo, and (4) hydromorphone (4 mg)-dronabinol (10 mg). Participants (N = 37 65% women mean age = 62) diagnosed with knee osteoarthritis of ≥3/10 average pain intensity were included. ![]() This was a within-subject, double-blind, randomized, placebo-controlled study. The present study aimed to evaluate the combined analgesic and drug effects of oral opioid (hydromorphone) and delta-9-tetrahydrocannabinol (dronabinol), as well as their effects on physical and cognitive functioning, and human abuse potential (HAP) outcomes among individuals with knee osteoarthritis (KOA). No studies to date have evaluated this combination in patients with chronic pain. The potential synergistic effects of combining cannabinoids and opioids for analgesia has received considerable attention. ![]()
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