Dersleri yüzünden oldukça stresli bir ruh haline sikiş hikayeleri bürünüp özel matematik dersinden önce rahatlayabilmek için amatör pornolar kendisini yatak odasına kapatan genç adam telefonundan porno resimleri açtığı porno filmini keyifle seyir ederek yatağını mobil porno okşar ruh dinlendirici olduğunu iddia ettikleri özel sex resim bir masaj salonunda çalışan genç masör hem sağlık hem de huzur sikiş için gelip masaj yaptıracak olan kadını gördüğünde porn nutku tutulur tüm gün boyu seksi lezbiyenleri sikiş dikizleyerek onları en savunmasız anlarında fotoğraflayan azılı erkek lavaboya geçerek fotoğraflara bakıp koca yarağını keyifle okşamaya başlar
Efficacy of Hyaluronidase Preceding Subcutaneous Opioid Infusions for the Treatment of Pain among Hospice Patients | OMICS International | Abstract
ISSN: 2165-7386

Journal of Palliative Care & Medicine
Open Access

Our Group organises 3000+ Global Conferenceseries Events every year across USA, Europe & Asia with support from 1000 more scientific Societies and Publishes 700+ Open Access Journals which contains over 50000 eminent personalities, reputed scientists as editorial board members.

Open Access Journals gaining more Readers and Citations
700 Journals and 15,000,000 Readers Each Journal is getting 25,000+ Readers

This Readership is 10 times more when compared to other Subscription Journals (Source: Google Analytics)

Research Article

Efficacy of Hyaluronidase Preceding Subcutaneous Opioid Infusions for the Treatment of Pain among Hospice Patients

Ronald S. Schonwetter1*, Sehwan Kim1, Mary J. Quinn1, Dee Boehm1, Dipesh Patel2, Cathy Emmett1, Beverly Douglas3, Teresa Kirkland3, Stephen Leedy4, Deidra Woods3 and Anna K. Westmoreland5

1Chapters Health System, Inc., Temple Terrace, Florida, USA

2Chapters Health Pharmacy, LLC, Tampa, Florida, USA

3LifePath Hospice Inc., Tampa, Florida, USA

4Tidewell Hospice, Sarasota, Florida, USA

5Legacy Meridian Park Medical Center, Tualatin, Oregon, USA

*Corresponding Author:
Dr. Ronald S. Schonwetter
Chapters Health System, Inc.,
12973 Telecom Parkway Suite 100
Temple Terrace, FL 33637, USA
Tel: (813) 871-8001
Fax: (813) 383-5044
E-mail: [email protected]

Received date December 07, 2011; Accepted date January 18, 2012; Published date January 26, 2012

Citation: Schonwetter RS, Kim S, Quinn MJ, Boehm D, Patel D, et al. (2012) Efficacy of Hyaluronidase Preceding Subcutaneous Opioid Infusions for the Treatment of Pain among Hospice Patients. J Palliative Care Med 2:105. doi:10.4172/2165-7386.1000105

Copyright: ©2012 Schonwetter RS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Background: Morphine or hydromorphone are often administered by the subcutaneous (SC) route when oral and/or venous access is difficult to achieve or higher doses of opiates are needed. Human recombinant hyaluronidase is believed to increase the permeability of SC connective tissues by degrading hyaluronan and increasing the dispersion and absorption of coadministered molecules.

Objectives:To determine whether hyaluronidase coadministered with SC morphine or hydromorphone to hospice patients results in 1) faster reduction in pain level; 2) self-perceived pain relief, 3) improved pain-related distress, 4) reduction in the frequency of opiate bolus attempts utilized, and 5) more favorable outcomes on these measures over an eight-hour period.

Methods:This double blind, randomized, placebo-controlled study compared patients given SC hyaluronidase (n=25) and those receiving normal saline (n=29) both immediately prior to SC infusions with morphine or hydromorphone.

Results:Hyaluronidase was found to facilitate reduced pain level (p=0.059) and augmented pain relief (p=0.047) during the first 15 minutes following co-infusion of hyaluronidase when compared to patients in the control group who received usual pain control medication involving SC morphine or hydromorphone. In subsequent periods of observation up to eight hours, the intensity of pain level and the magnitude of pain relief realized showed no difference between the groups. There were no differences between the groups in pain-related distress (p≥0.657) and in the frequency of nfusion bolus attempts during the entire period under observation (p=0.173).

Conclusion: Hyaluronidase may be an effective adjunct during the first 15 minutes of drug administration in reducing pain intensity and enhancing pain relief when administered at the onset of a subcutaneous opioid infusion among hospice patients.


Google Scholar citation report
Citations : 1733

Journal of Palliative Care & Medicine received 1733 citations as per Google Scholar report

Journal of Palliative Care & Medicine peer review process verified at publons
Indexed In
  • Index Copernicus
  • Google Scholar
  • Open J Gate
  • Genamics JournalSeek
  • China National Knowledge Infrastructure (CNKI)
  • Electronic Journals Library
  • RefSeek
  • Hamdard University
  • OCLC- WorldCat
  • Virtual Library of Biology (vifabio)
  • Publons
  • Geneva Foundation for Medical Education and Research
  • Euro Pub
Share This Page