Scholars@Duke
Brian Ginsberg

Brian Ginsberg

Associate Professor Emeritus of Anesthesiology
Anesthesiology, Regional
ginsb001@mc.duke.edu
Box 3094 Med Ctr, Durham, NC 27710
201 Trent Drive, 4314 Duke South, Orange Zone, Durham, NC 27710

Selected Publications

PCA safety data review after clinical decision support and smart pump technology implementation.

Journal Article J Patient Saf · June 2013 INTRODUCTION: Medication errors account for 20% of medical errors in the United States with the largest risk at prescribing and administration. Analgesics or opioids are frequently used medications that can be associated with patient harm when prescribed o ... Full text Link to item Cite

Meperidine

Chapter · January 1, 2010 Generic Name: meperidine, pithidine, pethanol.Trade Name: Demerol™.Class of Drug: opioid analgesic (Schedule II).Manufacturers: Abbott Laboratories, Hospital Products Division, Abbott Park, IL 60064; Sanofi-Aventis U.S. LLC, 55 Corporate Drive, Bridgewater ... Full text Cite

Acute pain management

Book · January 1, 2009 This textbook is written as a comprehensive overview of acute pain management. It is designed to guide clinicians through an impressive array of different options available to them and to patients. In the last decade there has been a flurry of interest in ... Full text Cite

Where in the world is ASRA AcutePOP?

Journal Article Reg Anesth Pain Med · 2009 Progress continues on American Society of Regional Anesthesia (ASRA) AcutePOP. Highlights include selection of data fields and creation of definitions for complications jointly accepted by clinical registries for ASRA, American Society of Anesthesiologists ... Full text Link to item Cite

Announcing the Official Formation of ASRA AcutePOP (Acute Postoperative Pain) Initiative

Journal Article Regional Anesthesia and Pain Medicine · January 1, 2007 Full text Cite

DepoDur extended-release epidural morphine: reshaping postoperative care. What perioperative nurses need to know.

Journal Article Orthop Nurs · 2007 Epidural morphine as a single bolus dose has demonstrated analgesia that lasts up to 24 hours. Recent advances in drug delivery mechanisms have resulted in a formulation of morphine, DepoDur, which is a lipid-encapsulated extended-release epidural morphine ... Full text Link to item Cite

Acute post-surgical pain management: a critical appraisal of current practice, December 2-4, 2005.

Journal Article Reg Anesth Pain Med · 2006 The Acute Pain Summit 2005 was convened to critically examine the perceptions of physicians about current methods used to control postoperative pain and to compare those perceptions with the available scientific evidence. Clinicians with expertise in treat ... Full text Link to item Cite

Evidence-based oral transmucosal fentanyl citrate (OTFC) dosing guidelines.

Journal Article Pain Med · 2005 OBJECTIVE: To review the evidence for dosing and efficacy of oral transmucosal fentanyl citrate in the management of pain and produce dosing guidelines. DESIGN: The scientific literature pertaining to oral transmucosal fentanyl citrate was reviewed, focusi ... Full text Link to item Cite

Conversion to oral controlled-release oxycodone from intravenous opioid analgesic in the postoperative setting.

Journal Article Pain Med · March 2003 OBJECTIVE: This study assessed conversion factors utilized by physicians to transfer postoperative patients from intravenous opioids to oral controlled-release (CR) oxycodone and the subsequent analgesic effectiveness. DESIGN: This was a multicenter, open- ... Full text Link to item Cite

Prediction of tracheal tube size in children using multiple variables.

Journal Article Paediatr Anaesth · July 2002 BACKGROUND: Tracheal tube (TT) size selection in children is important to avoid complications. Formulae utilizing age and physical characteristics to predict appropriate tube size are not entirely predictive. METHODS: Using an automated anaesthesia record ... Full text Link to item Cite

Patient-specific factors affecting patient-controlled analgesia dosing.

Journal Article J Pain Palliat Care Pharmacother · 2002 A study was conducted to evaluate the effect of characteristics patients' gender, age, weight, height, and body surface area, as well as the concurrent or recent use of opioids, ethanol and tobacco, on opioid dose requirements during administration of pati ... Full text Link to item Cite

Meperidine: a critical review.

Journal Article Am J Ther · 2002 Meperidine was initially synthesized as an anticholinergic agent but was soon discovered to have analgesic properties. Although meperidine's anticholinergic effects were demonstrated in vivo, the anticholinergic effects on the biliary and renal tracts have ... Full text Link to item Cite

Pharmacokinetics of remifentanil in anesthetized pediatric patients undergoing elective surgery or diagnostic procedures.

Journal Article Anesth Analg · December 2001 UNLABELLED: Remifentanil hydrochloride is an ultra-short-acting opioid that undergoes rapid metabolism by tissue and plasma esterases. We aimed to characterize the pharmacokinetics and determine the hemodynamic profile of remifentanil after a single-bolus ... Full text Link to item Cite

Pain management in knee surgery.

Journal Article Orthop Nurs · 2001 Thus Jefferson says, "The art of life is the art of avoiding pain." How can we possibly avoid pain either physical or psychological throughout our life span? Perhaps it is more realistic to do our best to minimize pain or manage it effectively. Managing pa ... Full text Link to item Cite

Intramuscular rapacuronium in infants and children: a comparative multicenter study to confirm the efficacy and safety of the age-related tracheal intubating doses of intramuscular rapacuronium (ORG 9487) in two groups of pediatric subjects.

Journal Article Anesthesiology · January 2001 BACKGROUND: This multicenter, assessor, blinded, randomized study was conducted to confirm and extend a pilot study in which intramuscular rapacuronium was given to infants and children to confirm efficacy and to evaluate tracheal intubating conditions. ME ... Full text Link to item Cite

Thromboelastography as a perioperative measure of anticoagulation resulting from low molecular weight heparin: a comparison with anti-Xa concentrations.

Journal Article Anesth Analg · November 2000 UNLABELLED: Low molecular weight heparin (LMWH) is commonly used to prevent postoperative thromboembolism. Currently, there is no convenient test to measure the degree of anticoagulation from LMWH. This prospective study examines the relationship of thromb ... Full text Link to item Cite

Changes in the auditory evoked potentials and the bispectral index following propofol or propofol and alfentanil.

Journal Article Anesthesiology · May 2000 BACKGROUND: Midlatency auditory evoked potentials (MLAEP) show graded changes with increasing doses of hypnotics but little change with opioids. The effect of their combination on the MLAEP was evaluated. Also, the bispectral index (BIS) was compared with ... Full text Link to item Cite

Neuromuscular effects of rapacuronium in pediatric patients during nitrous oxide-halothane anesthesia: comparison with mivacurium.

Journal Article Can J Anaesth · February 2000 PURPOSE: To describe neuromuscular effects of rapacuronium in pediatric patients during N2O-halothane anesthesia and compare them with mivacurium in children. METHODS: 103 pediatric patients, seven days -12 yr, received rapacuronium or mivacurium during N2 ... Full text Link to item Cite

Assessment of the relative clinical utility of sufentanil and morphine administered by patient controlled analgesia pumps following abdominal hysterectomy

Journal Article Journal of Pharmaceutical Care in Pain and Symptom Control · January 1, 2000 The objective of this study was to compare clinical efficacy of two opioid analgesics postoperatively using Patient Controlled Analgesia (PCA). It was a randomized, double-blind study involving 43 women undergoing elective abdominal hysterectomy. Each pati ... Full text Cite

Duke pain initiative takes proactive role for patient relief: An interview with Brian Ginsberg M.D

Journal Article Disease Management · January 1, 2000 Dr. Brian Ginsberg is an associate professor at Duke University Medical Center Durham North Carolina where he is director of the Acute Pain Service and co-chairperson of the Duke Pain Initiative. He is board certified with the American Board of Anesthesiol ... Full text Cite

Duration and recovery profile of cisatracurium after succinylcholine during propofol or isoflurane anesthesia.

Journal Article J Clin Anesth · December 1999 STUDY OBJECTIVE: To determine the duration and recovery profile of maintenance doses of cisatracurium besylate following succinylcholine, and during propofol or isoflurane anesthesia. DESIGN: Randomized, open-label study. SETTING: Operating suite of a univ ... Full text Link to item Cite

Intramuscular rocuronium in infants and children: a multicenter study to evaluate tracheal intubating conditions, onset, and duration of action.

Journal Article Anesthesiology · September 1999 BACKGROUND: This multicenter, assessor-blinded, randomized study was done to confirm and extend a pilot study showing that intramuscular rocuronium can provide adequate tracheal intubating conditions in infants (2.5 min) and children (3 min) during halotha ... Full text Link to item Cite

The relative potency of oral transmucosal fentanyl citrate compared with intravenous morphine in the treatment of moderate to severe postoperative pain.

Journal Article Anesth Analg · September 1999 UNLABELLED: Pharmacokinetic studies have shown that oral transmucosal absorption of fentanyl is relatively rapid compared with gastrointestinal absorption, and it results in increased bioavailability. We designed this study to establish the relative potenc ... Full text Link to item Cite

Anesthesia-based pain services improve the quality of postoperative pain management.

Journal Article Pain · March 1999 Anesthesia-based pain services are facilitating improvements in the quality of care of surgical patients by developing and directing institution-wide perioperative analgesia programs that include interdisciplinary collaborations. However, the impact of ane ... Full text Link to item Cite

Onset and recovery of neuromuscular blockade after two doses of rocuronium in children.

Journal Article J Clin Anesth · December 1998 STUDY OBJECTIVE: To determine if 450 micrograms/kg (1.5 times the ED95) of rocuronium would result in a comparable onset with a shorter duration of action when compared with 600 micrograms/kg (2 times the ED95). DESIGN: Randomized, single-blind study. SETT ... Full text Link to item Cite

The effect of the interaction of propofol and alfentanil on recall, loss of consciousness, and the Bispectral Index.

Journal Article Anesth Analg · October 1998 UNLABELLED: The Bispectral Index (BIS) correlates well with the level of consciousness with single anesthetic drugs. We studied the effect of the interaction of propofol with alfentanil on propofol concentration and BIS associated with 50% probability of l ... Full text Link to item Cite

Paediatric preoperative teaching: effects at induction and postoperatively.

Journal Article Paediatr Anaesth · 1998 In a randomized controlled trial at Duke University and University of North Carolina Hospitals, 143 two to six year old children undergoing elective ambulatory surgery were randomized into a control group who received routine preoperative teaching or an in ... Full text Link to item Cite

Oral transmucosal fentanyl citrate as an anaesthetic premedication when dosed to an opioid effect vs total opioid consumption.

Journal Article Paediatr Anaesth · 1998 Thirty min prior to anaesthetic induction for surgery, children aged 4-12 years old were given a 10 micrograms.kg-1 oral transmucosal fentanyl citrate (OTFC) and were instructed to suck the OTFC until pruritus appeared (Group 2) or until the entire dose wa ... Full text Link to item Cite

Opioid-sparing effects of a low-dose infusion of naloxone in patient-administered morphine sulfate.

Journal Article Anesthesiology · November 1997 BACKGROUND: A naloxone infusion is effective in reducing epidural and intrathecal opioid-related side effects. The use of naloxone infusion concomitant with intravenous morphine patient-controlled analgesia (PCA) has not been evaluated, probably because of ... Full text Link to item Cite

Determination of plasma concentrations of propofol associated with 50% reduction in postoperative nausea.

Journal Article Anesthesiology · October 1997 BACKGROUND: Subhypnotic doses of propofol possess direct antiemetic properties. The authors sought to determine the plasma concentration of propofol needed to effectively manage postoperative nausea and vomiting. METHODS: Patients aged 18-70 yr who were cl ... Full text Link to item Cite

Drug interactions: volatile anesthetics and opioids.

Journal Article J Clin Anesth · September 1997 Multiple drugs are used to provide anesthesia. Volatile anesthetics are commonly combined with opioids. Several studies have demonstrated that small doses of opioid (i.e., within the analgesic range) result in a marked reduction in minimum alveolar concent ... Full text Link to item Cite

Monitoring practices following epidural analgesics for pain management: a follow-up survey.

Journal Article J Pain Symptom Manage · July 1997 Indwelling epidural catheters are commonly used in pain management. There is much literature on the risks and benefits of this therapy, but there is no consensus on a standard, cost-effective method of monitoring these patients, nor on the types of analges ... Full text Link to item Cite

Using an anesthesia information management system as a cost containment tool. Description and validation.

Journal Article Anesthesiology · May 1997 BACKGROUND: Medical informatics provide a new way to evaluate the practice of medicine. Anesthesia automated record keepers have introduced anesthesiologists to computerized medical records. To derive useful information from the stored data requires progra ... Full text Link to item Cite

How to manage drug interactions.

Journal Article Eur J Anaesthesiol Suppl · May 1997 Multiple drugs are used to provide anaesthesia. On average, four to six drugs are used during anaesthesia and, therefore, drug interactions are common. These interactions are primarily either pharmacokinetic or pharmacodynamic. Due to the relatively short ... Full text Link to item Cite

The successful implementation of pharmaceutical practice guidelines. Analysis of associated outcomes and cost savings. SWiPE Group. Systematic Withdrawal of Perioperative Expenses.

Journal Article Anesthesiology · May 1997 BACKGROUND: Although approximately 2,000 medical practice guidelines have been proposed, few have been successfully implemented and sustained. We hypothesized that we could develop and institute practice guidelines to promote more appropriate use of costly ... Full text Link to item Cite

Pharmacokinetic model-driven infusion of fentanyl in children.

Journal Article Anesthesiology · December 1996 BACKGROUND: This study determined the accuracy of previously defined adult fentanyl pharmacokinetics in children having surgery; from this population, the pharmacokinetics of fentanyl were characterized in children when administered via a computerized assi ... Full text Link to item Cite

Double-blind, randomized comparison of ondansetron and intraoperative propofol to prevent postoperative nausea and vomiting.

Journal Article Anesthesiology · November 1996 BACKGROUND: Breast surgery is associated with a high incidence of postoperative nausea and vomiting. Propofol and prophylactic administration of ondansetron are associated with a lower incidence of postoperative nausea and vomiting. To date no comparison o ... Full text Link to item Cite

Intravenous ondansetron in established postoperative emesis in children. S3A-381 Study Group.

Journal Article Anesthesiology · August 1996 BACKGROUND: In pediatric postsurgical patients, postoperative vomiting is a common occurrence that can delay recovery and result in unplanned hospital admissions after outpatient surgery. This randomized, double-blind, placebo-controlled, multicenter study ... Full text Link to item Cite

Patient-controlled analgesia for conscious sedation during endoscopic retrograde cholangiopancreatography: a randomized controlled trial.

Journal Article Gastrointest Endosc · May 1996 BACKGROUND: Adequate comfort is essential to patients undergoing invasive procedures. This study was designed to evaluate whether patient-controlled analgesia could improve sedation for ERCP. METHODS: Patients were randomized to receive standard sedation ( ... Full text Link to item Cite

Patient controlled analgesia used to assess the efficacy and potency of a new opioid

Journal Article Pain Research and Management · January 1, 1996 Patient controlled analgesia (PCA) is widely used for the management of postoperative pain. PCA also permits a comparison to be made among analgesics in the clinical setting because it limits the variability introduced by third parties. Use of PCA to estab ... Full text Cite

The influence of lockout intervals and drug selection on patient-controlled analgesia following gynecological surgery.

Journal Article Pain · July 1995 This study systematically compared 2 opioids, morphine (MOR) and fentanyl (FEN), and 2 lockout intervals, long (L) and short (S) in patients utilizing patient-controlled analgesia (PCA). Seventy-eight women undergoing gynecological surgery were randomly as ... Full text Link to item Cite

A survey on the clinical use of epidural catheters for acute pain management.

Journal Article J Pain Symptom Manage · July 1994 Indwelling epidural catheters are commonly used to provide analgesia in the postoperative setting. In an attempt to determine how epidurals are used in clinical practice, a survey was conducted at the 1992 annual meeting of the American Society of Pain Man ... Full text Link to item Cite

Epidural analgesia after lumbar laminectomy

Journal Article Regional Anesthesia · January 1, 1994 Cite

Narcotic agonists and antagonists

Journal Article Anesthesiology Clinics of North America · January 1, 1994 Several new fentanyl derivatives are currently under evaluation in clinical trials and will eventually be available for clinical use. This article reviews new concepts in opioid pharmacokinetics and discusses several of these new opioids. Novel routes of o ... Cite

Evaluation of flumazenil for reversing the effects of midazolam-induced conscious sedation or general anesthesia.

Journal Article South Med J · November 1993 To evaluate the effectiveness of flumazenil in reversing midazolam-induced conscious sedation and general anesthesia, we gave either flumazenil or placebo to 55 patients in a double-blind manner after surgery. Whether surgery was done under conscious sedat ... Full text Link to item Cite

The esophageal temperature gradient in anesthetized children.

Journal Article J Clin Monit · April 1993 OBJECTIVE: Our objective was to study the effect of the temperature of the anesthetic gas mixture (AGM) on esophageal temperature measurements made in children whose tracheas had been intubated for anesthesia. We also sought to establish the optimal site f ... Full text Link to item Cite

Anaesthetic death of a child with a cold.

Journal Article Anaesthesia · February 1993 Full text Link to item Cite

Anaesthesia and the Kearns‐Sayre syndrome

Journal Article Pediatric Anesthesia · January 1, 1993 A six‐month‐old infant presented for anaesthesia with, unbeknown to us, some of the manifestations of the Kearns‐Sayre Syndrome. This syndrome is one of the clinical presentations in patients with mitochondral myopathy. The anaesthetic related events and a ... Full text Cite

More on epidural fentanyl analgesia.

Journal Article Anesth Analg · November 1992 Full text Link to item Cite

Patient controlled analgesia: the relation of psychological factors to pain and analgesic use in adolescents with postoperative pain.

Journal Article Clin J Pain · September 1992 OBJECTIVE: To examine the relationship of psychological variables to pain and patient-controlled analgesia (PCA) use in adolescents undergoing orthopedic surgeries. DESIGN: Cohort. PATIENTS: Fifty adolescents and their parents. MAIN OUTCOME MEASURES: Visua ... Link to item Cite

Limb tourniquets and central temperature in anesthetized children.

Journal Article Anesth Analg · April 1992 We have observed an association between the use of tourniquets for limb surgery and a progressive increase in body temperature in pediatric patients. Consequently, we evaluated the effect of leg tourniquet(s) on intraoperative nasopharyngeal temperature in ... Full text Link to item Cite

Use of patient-controlled analgesia to compare the efficacy of epidural to intravenous fentanyl administration.

Journal Article Anesth Analg · March 1992 Fentanyl, unlike morphine, is highly lipophilic and rapidly diffuses out of the epidural space. Respiratory depression is, therefore, unlikely when fentanyl is given epidurally. However, much of fentanyl's analgesic effect is mediated by systemic rather th ... Full text Link to item Cite

Acute pain management

Journal Article Problems in Urology · January 1, 1992 The management of postoperative pain has made incredible advances during the course of the last decade. A number of newer methods of pain control are available now for routine clinical use. In this chapter the scientific basis; clinical application; and po ... Cite

Clinical responses to ORG 9426 during isoflurane anesthesia.

Journal Article Anesth Analg · February 1991 To determine average dose requirements and pharmacodynamic characteristics before general clinical use, the dose-response curve, onset time, and recovery time for the neuromuscular relaxant ORG 9426 were determined in 72 adult patients given doses of 120, ... Full text Link to item Cite

Pharmacokinetic model-driven infusion of fentanyl: assessment of accuracy.

Journal Article Anesthesiology · December 1990 Computer-assisted continuous infusion (CACI) is a pharmacokinetic model-driven infusion device that enables physicians to administer intravenous (iv) drugs in a quantitative fashion, specifying a theoretical blood or plasma concentration. This study evalua ... Full text Link to item Cite

Patient-controlled analgesia in postoperative pain: the relation of psychological factors to pain and analgesic use.

Journal Article Clin J Pain · June 1990 The surgical experience is often characterized by fear, stress, and pain. Whenever an individual has to confront a painful or stressful event such as surgery, the individual's opportunity to control some aspect of the situation may actually influence the d ... Full text Link to item Cite

Onset and duration of neuromuscular blockade following high-dose vecuronium administration.

Journal Article Anesthesiology · August 1989 To determine the onset time and duration of high doses of vecuronium, 40 ASA Physical Status 1 and 2 patients were randomly assigned to receive either 100, 200, 300, or 400 micrograms/kg of vecuronium bromide for muscle relaxation during elective general s ... Full text Link to item Cite

Anesthesia for caesarean section.

Journal Article S Afr Med J · April 2, 1983 Link to item Cite