morphine sulphate / Generic mfg. - LARVOL DELTA

Efficacy of Ultrasound-Guided PENG Block for Acute Pain Relief in Adult Hip Fracture Patients: A Double-Blind Randomized Trial. (PubMed, Acad Emerg Med) - "In adult ED patients with hip fractures, ultrasound-guided PENG block significantly reduced pain scores and opioid requirements compared with sham, with no significant adverse events reported. PENG block may be an effective, opioid-sparing analgesic strategy for acute hip fractures in the ED."

Clinical • Journal • Anesthesia • Musculoskeletal Diseases • Orthopedics • Pain

Mechanistic insights into opioid-induced pulmonary edema: receptor specificity and sodium transport. (PubMed, Ir J Med Sci) - "Opioid-induced AFC impairment involves receptor-specific alterations in alveolar fluid regulation, with the DOR playing a dominant inhibitory role, suggesting its involvement in the development of pulmonary edema."

Journal • Acute Respiratory Distress Syndrome • Addiction (Opioid and Alcohol) • Anesthesia • Cardiovascular • Pain • Respiratory Diseases

Trace determination of morphine and codeine in whole blood samples using pH-switchable hydrophobic deep eutectic solvents based liquid phase microextraction followed by HPLC-UV. (PubMed, J Sep Sci) - "The results showed that both morphine and codeine were detected in the blood sample of the addicted person. The relative recoveries of real blood samples which have been spiked with different levels of morphine and codeine were 91.8-107.0%."

Journal

Hemoglobin SC disease: Clinical analysis from the Georgia comprehensive sickle cell center at grady memorial hospital, Atlanta, Georgia. (ASH 2025) - "Objective: Evaluate clinical manifestations, treatment response, and complications in adults with HbSC, with focus on hydroxyurea (HU) effects and age-related complications...Variables included demographics, comorbidities, steady-state laboratory values, morphine milliequivalent/day (MME/day) use and SCD-related hospitalization/acute visits... Our study demostrates that patients with HbSC disease have significant healthcare utilization and chronic opioid use. They also demonstrated distinct age-related complication patterns including early onset-retinopathy within the first 3 decades of life and late onset SNHL occurring beyond the 4 th decade of life. There was a strong association between ACS and VTE risk which is likely reflective of a more severe HbSC phenotype increasing VTE risk."

Clinical • Cardiovascular • Chronic Kidney Disease • Diabetes • Genetic Disorders • Hematological Disorders • Hypertension • Mental Retardation • Metabolic Disorders • Nephrology • Obesity • Otorhinolaryngology • Pulmonary Arterial Hypertension • Pulmonary Disease • Renal Disease • Respiratory Diseases • Retinal Disorders • Sickle Cell Disease • Venous Thromboembolism

IV diphenhydramine is not associated with poor outcomes among hospitalized people with sickle cell disease. (ASH 2025) - "Opioid exposure was standardized to oral morphine milligram equivalents per day (MME/day), calculated for the entire admission or, among patients who developed ACS, prior to the diagnosis. Despite some indication in the published literature of the opposite, use of IV diphenhydramine was not associated with acute chest syndrome in patients with sickle cell disease. However, the incidence of acute chest syndrome was associated with higher MME/day."

Clinical • Cough • Genetic Disorders • Hematological Disorders • Pruritus • Respiratory Diseases • Sickle Cell Disease

Impact of chronic pain on acute pain trajectories in sickle cell disease: Insights from the sickle cell disease treatment with arginine therapy (STArT) randomized controlled trial (ASH 2025) - P3 | "Unadjusted models were examined, as were models adjusted for total opioid received in IV morphine milligram equivalent/kilogram body weight... About half of children and young adults hospitalized with SCD VOE have CP. Children and young adults with CP, compared to those without CP, experience a smaller magnitude of change in pain score and a slower decline in pain during hospitalization. These findings should be considered in the study design and selection of study outcomes for future SCD acute pain clinical trials."

Clinical • Asthma • Genetic Disorders • Hematological Disorders • Immunology • Pain • Respiratory Diseases • Sickle Cell Disease

Avascular necrosis of the femoral head in children and adolescents with sickle cell disease presenting with HIP PAIN (ASH 2025) - P | "However, no differences werefound in hemoglobin levels (9.4 g/dL vs. 9.7 g/dL, p=0.29), hemoglobin F (9.6% vs. 8.2%, p=0.39), vitamin D(20.0 vs. 25.5 ng/mL, p=0.097), hydroxyurea use (82.5% vs. 72.3%, p=0.22), or chronic transfusions (35.1%vs. 36.2%, p=0.91)...There was a statisticallynonsignificant increase in opioid utilization 1 year after CD with a mean increase of 3.5 morphinemilligram equivalents/day (MME/d) (CI: -5.1, 12.1; p=0.41) and a statistically nonsignificant decrease inopioid utilization 1 year after THA of -2.36 MME/d (CI: -20.65, 0.11; p=0.055) AVNFH is more common among males; age appears to be a risk factor, though the smallsample size limits conclusions... AVNFH is more common among males; age appears to be a risk factor, though the smallsample size limits conclusions. Patients tend to have higher WBC and RDW levels. MPV was found to belower in our cohort, contrary to reports in the literature."

Clinical • Genetic Disorders • Hematological Disorders • Orthopedics • Pain • Sickle Cell Disease

Correlation between outpatient opioid dosage and hospital visits in sickle cell disease patients (ASH 2025) - "For the year prior to their visit, the dailyaverage amount of prescribed outpatient morphine milligram equivalents (MME), number of visits to anemergency department (ED) and inpatient admissions, and total days in hospital were calculated.Prescription information was collected from the Georgia Prescription Drug Monitoring Program...Multiple studies have already shown opioids have poor efficacyfor chronic pain, indicating that better chronic pain management strategies than outpatient opioids arelikely needed. Further studies will be needed to better determine the balance between pain control inSCD and prevention of overprescribing of opioids."

Clinical • Genetic Disorders • Hematological Disorders • Inflammation • Sickle Cell Disease

Subtotal versus total splenectomy in children with sickle cell disease: Clinical outcomes and splenic function assessed by pocked red blood cell count (ASH 2025) - "Early postoperativemorbidity was higher in the subtotal splenectomy group, with longer intensive care unit stays (3 [1.5–3]vs. 1 [1–1] days, p=0.04), more frequent fever (47 vs. 7%, p<0.001), and prolonged morphine use (3 [2–4]vs. 1 [1–1] days, p=0.01)...Compared with total splenectomy, subtotal splenectomy in children with SCD is associated with anincreased incidence of early inflammatory and vaso-occlusive events, but it appears to allow partial andpossibly long-lasting preservation of splenic function, which may be particularly beneficial for thispopulation. These findings support individualized surgical decision-making, balancing the benefits ofpreserving splenic function with the risk of early postoperative complications. Pocked RBC quantificationappears to be a promising tool for assessing splenic function in patients with SCD."

Clinical • Clinical data • Genetic Disorders • Hematological Disorders • Sickle Cell Disease

Healthcare utilization in patients with sickle cell disease on buprenorphine for chronic pain (ASH 2025) - "The studywas performed at the University of Chicago Medical Center and included patients aged 18 years andolder with a confirmed diagnosis of SCD (HbSS, HbSC, or HbSbeta0).Patients with acute-on-chronic pain were offered BUP if they were admitted for at least 7 days on IVopioids and unable to wean despite offering Ketamine or Lidocaine, or if they had at least 2 admissions inthe last 30 days. Patients on chronic opioid therapy with methadone or a prior diagnosis of opioid usedisorder were excluded from the study...Concurrent opioidutilization was assessed through prescription records, documenting daily morphine milligram equivalents(MME) for breakthrough opioid therapy.Primary outcomes included admission (Adm) rates and average length of stay (LOS) per admission,captured from inpatient encounter records...Otherfactors, such as access to outpatient care, psychosocial support, or disease-modifying therapies likehydroxyurea, may also have influenced outcomes.This study..."

Clinical • HEOR • Genetic Disorders • Hematological Disorders • Pain • Sickle Cell Disease • Substance Abuse

Sickle cell disease treatment with arginine therapy (STArT) – results of a phase-3 randomized controlled trial (ASH 2025) - P3 | "Secondary outcomes included TPO, defined as total IV morphine equivalents in mg/kgfrom study drug delivery to last parenteral opioid) and patient reported outcomes (PROMIS) atadmission, discharge, and 7-12 days post-discharge...Mean age ±standard deviation (SD) was 14±4 years, 51% were male, 71% had Hb-SS,76% on hydroxyurea, and 41% had chronic pain (SCD-pain ≥15 days/month for the last 6 months).Demographics were similar across study arms... All phase-3 RCTs for SCD-VOE to date have failed to meet their primary outcomes afterpromising phase-2 RCTs. The PECARN STArT trial is the latest addition to this list, stopped early for futilityto achieve the primary outcome of TCR. There were no safety concerns."

Clinical • P3 data • Genetic Disorders • Hematological Disorders • Inflammation • Sickle Cell Disease

Efficacy of a virtual reality headset for managing severe pain during sickle cell vaso-occlusive crisis: A single-center study in adults. (ASH 2025) - "Patients were included if the pain intensity was ≥ 5 on a numerical rating scale (NRS,from 0 (no pain) to 10 cm (intolerable pain), validated in adults), despite treatment with intravenous (IV)morphine administered by patient-controlled analgesia... A 20-minute VR session significantly reduces pain and anxiety for at least 1 hour, withexcellent tolerance, in adult patients with SCD hospitalized with severe pain despite IV treatment withmorphine. To the best of our knowledge, the only study (also open-label) on the effect of VR on acutepain in SCD has been conducted by Agrawal et al. in 2019 in 30 pediatric and young adult patients(median age 16 [13,3; 20] years), showing a similar reduction in pain1."

Clinical • Addiction (Opioid and Alcohol) • Genetic Disorders • Hematological Malignancies • Mood Disorders • Pain • Psychiatry • Sickle Cell Disease

Hemoglobin S beta thalessemia plus: Clinical analysis from the Georgia comprehensive sickle cell center at grady memorial hospital, Atlanta, Georgia. (ASH 2025) - "Comorbidities, acute healthcare visits, hospitalizations and opioidutilization patterns (morphine milligram equivalents per day, MME/day) were assessed...Chronic opioid use was seen in 30.1% of patients (median dose of 62MME/day [IQR 30-162] in the opioid utilizers).Hydroxyurea (HU) was utilized in 18.7% of patients (mean dose 13.6±5.7 mg/kg)... Patients with HbSβ+ have significant disease burden with high healthcare utilization andopioid use despite the "mild" designation. Psychiatric comorbidities, chronic pain and AVN appeared tobe the major independent predictors of high acute healthcare utilization and opioid use. Thisunderscores the importance of dedicated, comprehensive care and investigational therapeuticapproaches rather than being dismissed as having "milder" disease."

Clinical • Addiction (Opioid and Alcohol) • Anemia • Beta-Thalassemia • Cardiovascular • Chronic Kidney Disease • CNS Disorders • Diabetes • Genetic Disorders • Hematological Disorders • Hypertension • Mental Retardation • Metabolic Disorders • Nephrology • Psychiatry • Pulmonary Arterial Hypertension • Pulmonary Disease • Renal Disease • Respiratory Diseases • Retinal Disorders • Sickle Cell Disease

Examining the utility of RBC transfusions in uncomplicated vaso-occlusive episodes (ASH 2025) - "Opioid exposure was standardized to oral morphine milliequivalents (MME)...Betweenthe transfusion and non-transfusion groups, there were no significant differences in total opioid usethroughout hospitalization (p=0.16), rates of ICU admission (p=0.17), or mortality (p=0.64). Transfusedpatients had longer LOS (p<0.01).In uncomplicated VOE, RBC transfusions are associated with a reduction in pain scores and longerlengths of stay but not with opioid use, ICU admissions, or mortality."

Genetic Disorders • Hematological Disorders • Sickle Cell Disease

Presumed Envenoming by the Striped Eel-Tailed Catfish Plotosus lineatus in the Mascarene Islands: Experience of the Marseille Poison Control Center and the Indian Ocean Toxicovigilance Department. (PubMed, Wilderness Environ Med) - "The main treatment involved the use of analgesics (ie, paracetamol, tramadol, or morphine), exposure to hot water or alternating cycle of exposure to hot and cold sources, and local anesthetics. For 10 patients (33%) for whom information was available, there was full recovery within 24 h in most cases (after 7 d in 1 patient) without sequelae.ConclusionThese findings show that stings by P lineatus may occur in the Mascarene Islands and that fishermen are the most likely to be stung because of handling P lineatus."

Journal • Anesthesia • Musculoskeletal Pain • Pain

Delivery of Intrathecal Morphine Through Baclofen Pump for Perioperative Analgesia. (PubMed, J Am Acad Orthop Surg Glob Res Rev) - "We demonstrate that baclofen pumps can be used to deliver intrathecal morphine for effective perioperative analgesia with minimal risk of complications such as respiratory depression, pruritis, and nausea/vomiting. We also highlight steps which must be taken to ensure safety when using this technique."

Journal • CNS Disorders • Depression • Pain • Pruritus • Psychiatry

Adductor Canal Block Preserves Quadriceps Function Despite Transient Sensory Deficits Following Total Knee Arthroplasty: A Randomized Controlled Trial. (PubMed, J Am Acad Orthop Surg Glob Res Rev) - "ACB preserves quadriceps strength while effectively managing pain after TKA, although temporary sensory deficits should be anticipated during early mobility."

Clinical • Journal • Orthopedics • Pain

Independent Factors Associated With Opioid Refills After Inpatient Otolaryngology-Head and Neck Surgery. (PubMed, JAMA Otolaryngol Head Neck Surg) - "From 2017 to 2023, despite a substantial reduction in the total oral morphine equivalents (OME) of discharge opioid prescriptions after OHNS procedures, opioid refill rates remained unchanged...Other factors associated with increased odds of refills at various time points included preoperative use of opioids, benzodiazepines, and cannabis; higher postsurgical pain levels; receiving a prior refill; and receiving an opioid prescription despite not using any inpatient opioids during the last 24 hours of hospitalization. This cohort study identified independent perioperative risk factors for opioid refills after inpatient OHNS procedures and proposes an evidence-based strategy to reduce refill risk."

Journal • Addiction (Opioid and Alcohol) • Otorhinolaryngology • Pain

Prevalence and Patterns of Off-Label Transmucosal Immediate-Release Fentanyl Use in French General Practice: A Mixed-Methods Study Based on a Voluntary Online Survey. (PubMed, Pain Ther) - "This study confirms widespread off-label TIRF use in well-defined clinical situations. While many GPs report positive outcomes, important concerns remain, including limited training, difficulty with dose titration, and the risk of use disorder. Targeted education and clearer prescribing guidelines could help ensure a safer and more appropriate use of TIRF in GPs practice."

Journal • Otorhinolaryngology • Pain • Rheumatology

Pain management guidelines reduce opioids in post-operative and mechanically ventilated neonates. (PubMed, Pain) - "We retrospectively analyzed the cumulative opioid exposure dose (expressed in morphine equivalents) in neonates admitted to our intensive care unit who underwent surgery and/or were invasively ventilated for greater than 24 hours, comparing data from 18 months pre-implementation and 16 months postimplementation of pain guidelines...There was no increase preguideline and postguideline in mortality (18%, 12%, P = 0.6), rates of intubation (85%, 75%, P = 0.12), median duration of peripheral intravenous access (4 [2-6], 4 [2-6] days, P = 0.4), or median duration of total-parenteral nutrition (7 [3-14] days, 7.5 [4-16] days, P = 0.8). Evidence-based guidelines reduced cumulative opioid exposure in mechanically ventilated and postoperative neonates by 55% without adverse effects on pain and increased documentation of pain assessments by 44%."

Journal • Anesthesia • Critical care • Pain

Efficacy and safety of celiac plexus radiotherapy in Pancreatic cancer-related pain management: a systematic review and meta-analysis. (PubMed, Ann Med Surg (Lond)) - "Celiac plexus radiotherapy appears effective in reducing cancer-related pain at 3- and 6-week post-procedure with minimal impact on morphine use. It demonstrates a favorable safety profile, making it a promising option for managing advanced cancer pain."

Journal • Retrospective data • Fatigue • Oncology • Pain • Pancreatic Cancer • Solid Tumor

Single-Shot Subcutaneous Lidocaine Infiltration at Closure Is Associated with Reduced Early Pain and Opioid Requirement After Single-Incision Laparoscopic Totally Extraperitoneal Hernia Repair. (PubMed, J Clin Med) - "Lidocaine was also associated with significantly lower odds of requiring rescue analgesia on POD 0 (OR = 0.12; 95% CI: 0.03-0.46; p = 0.002), fewer rescue doses during hospitalization (β = -1.11; 95% CI: -1.62 to -0.49; p < 0.001), and a lower morphine-equivalent dose (β = -5.14; 95% CI: -7.79 to -2.49; p < 0.001)... Single-shot subcutaneous lidocaine infiltration in SILTEP hernia repair is a simple, low-risk intervention that was associated with reduced immediate postoperative pain and opioid use without increasing complications. However, the effect was short-lived with no sustained benefit beyond the first postoperative day."

Journal • Anesthesia • Gastroenterology • Pain

Comparison of thoracic epidural anesthesia with an erector spinae plane infusion for post-esophagectomy analgesia: a pragmatic retrospective cohort study. (PubMed, J Thorac Dis) - "Secondary outcomes were average pain, and opioid use in morphine milligram equivalents (MME)...The average reported pain over 72 h was significantly greater in the ESP group and exceeded the clinical important threshold of 0.5, and opioid analgesia consumption exceeded the minimally clinically important threshold of 10 MME/day. ESP analgesia may represent an alternative to TEA and reduce catheter-related side effects; however, it likely offers somewhat reduced analgesia requiring greater opioid supplementation."

Journal • Retrospective data • Anesthesia • Pain

Protocol for a Single-Arm Pilot Clinical Trial: Developing and Evaluating a Machine Learning Opioid Prediction & Risk-Stratification E-Platform (DEMONSTRATE). (PubMed, J Clin Med) - "We will evaluate effectiveness by comparing pre- and post-implementation outcomes using a composite patient-level measure defined by the presence of any of the following 6 favorable indicators: (1) evidence of naloxone access; (2) absence of opioid overdose diagnoses and naloxone administration; (3) absence of emergency department (ED) visits or hospitalizations due to opioid overdose or opioid use disorder (OUD); (4) absence of overlapping opioid and benzodiazepine use within a 7-day window; (5) absence of opioid use ≥50 morphine milligram equivalent daily average; (6) receipt of referrals to non-pharmacological pain management...Usability and acceptability will be assessed using a 12-item questionnaire for PCPs and semi-structured interviews. Expected The trial will provide insights into real-world ML-driven CDS implementation and inform future strategies to reduce opioid-related harm."

Journal • Addiction (Opioid and Alcohol) • CNS Disorders • Oncology • Pain • Substance Abuse

Outpatient opioid use after minimally invasive surgery for lung cancer: a Surveillance, Epidemiology, and End Results-Medicare cohort study. (PubMed, J Thorac Dis) - "Outcomes included any opioid, abuse-potential (schedule II/III), and high-dose (≥50 morphine milligram equivalents/day) opioid fill, assessed across immediate (0-42 days), short-term (43-90 days), and long-term (91-180 days) periods...There was no difference in long-term opioid fills, except among adjuvant therapy subgroup where RAS was associated with less likely fill for any opioid (OR =0.70; P=0.047) and abuse-potential opioids (OR =0.58; P=0.007). RAS was associated with reduced short-term opioid use compared to VATS after NSCLC resection."

Journal • Medicare • Reimbursement • US reimbursement • Lung Cancer • Non Small Cell Lung Cancer • Oncology • Pain • Solid Tumor