Effect of Perioperative Systemic α2 Agonists on Postoperative Morphine Consumption and Pain Intensity

Blaudszun, G.; Lysakowski, Christopher; Elia, Nadia; Tramèr, Martin R.

doi:10.1097/aln.0b013e31825681cb

Cited by 443 publications

(177 citation statements)

References 46 publications

Supporting

Mentioning

160

Contrasting

Unclassified

Order By: Relevance

“…6). In this respect it is interesting that such agents were tried with some success in addiction (Kleber, 2003), pain (Blaudszun et al, 2012) and impaired impulse control conditions (Arnsten and Pliszka, 2011) that are quite ubiquitous in suicide attempters (Keilp et al, 2012). …”

Section: Therapeutic Considerationsmentioning

confidence: 99%

Pain and suicidality: Insights from reward and addiction neuroscience

Elman

Borsook

Volkow

2013

Progress in Neurobiology

176

131

View full text Add to dashboard Cite

Suicidality is exceedingly prevalent in pain patients. Although the pathophysiology of this link remains unclear, it may be potentially related to the partial congruence of physical and emotional pain systems. The latter system’s role in suicide is also conspicuous during setbacks and losses sustained in the context of social attachments. Here we propose a model based on the neural pathways mediating reward and anti-reward (i.e., allostatic adjustment to recurrent activation of the reward circuitry); both are relevant etiologic factors in pain, suicide and social attachments. A comprehensive literature search on neurobiology of pain and suicidality was performed. The collected articles were critically reviewed and relevant data were extracted and summarized within four key areas: (1) physical and emotional pain, (2) emotional pain and social attachments, (3) pain-and suicide-related alterations of the reward and anti-reward circuits as compared to addiction, which is the premier probe for dysfunction of these circuits and (4) mechanistically informed treatments of co-occurring pain and suicidality. Pain-, stress- and analgesic drugs-induced opponent and proponent states of the mesolimbic dopaminergic pathways may render reward and anti-reward systems vulnerable to sensitization, cross-sensitization and aberrant learning of contents and contexts associated with suicidal acts and behaviors. These findings suggest that pain patients exhibit alterations in the brain circuits mediating reward (depressed function) and anti-reward (sensitized function) that may affect their proclivity for suicide and support pain and suicidality classification among other “reward deficiency syndromes” and a new proposal for “enhanced anti-reward syndromes”. We suggest that interventions aimed at restoring the balance between the reward and anti-reward networks in patients with chronic pain may help decreasing their suicide risk.

show abstract

Section: Therapeutic Considerationsmentioning

confidence: 99%

Pain and suicidality: Insights from reward and addiction neuroscience

Elman

Borsook

Volkow

2013

Progress in Neurobiology

176

131

View full text Add to dashboard Cite

show abstract

“…Clonidine reduces the BP mainly when large doses are used. Bradycardia and hypotension were reported with higher doses (300 mcg) [7]. …”

Section: Discussionmentioning

confidence: 99%

“…The authors of a review concluded that clonidine promotes a reduction of postoperative pain [7]. This led us to conduct the study with the aim of assessing the effect of clonidine on the intraoperative analgesia, sedation, and intraocular pressure in patients subjected to cataract extraction under topical anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Effects of Preoperative Intravenous Clonidine in Patients Undergoing Cataract Surgery: A Double-Blind, Randomized Trial

Santiago

Issy

Sakata

2014

Journal of Ophthalmology

View full text Add to dashboard Cite

Objectives. The aim of this study was to assess the effects of clonidine on intraoperative analgesia, sedation, intraocular and blood pressure, arrhythmia, and ischemia. Methods. Forty patients undergoing cataract surgery were allocated into two groups. They were monitored with Holter machine, the pupil was dilated, and 30 minutes later, 20 patients received clonidine (4 µg/kg), while the other 20 patients were given a 0.9% saline intravenously. Twenty minutes later, 2% lidocaine gel was applied. There were assessed intraoperative analgesia, intraocular pressure, blood pressure, heart rate, and the occurrence of arrhythmias and myocardial ischemia. Results. Pain intensity was lower in G1 during the phacoemulsification, irrigation, aspiration, and intraocular lens implantation. The HR and BP were lower with clonidine. The IOP was lower with clonidine after 15 minutes and at the end of the surgery. Sedation was higher with clonidine. The incidence of arrhythmia was lower at the end of surgery with clonidine. The incidence of myocardial ischemia did not differ between the groups. Conclusions. Clonidine (4 µg/kg) before a phacoemulsification reduced the intensity of pain during cataract surgery. It also induced sedation, reduction of BP, HR, and incidence of arrhythmia at the end of the surgery, and did not alter myocardial ischemia. This trial is registered with Clinicaltrials.gov NCT01677351.

show abstract

“…Se puede administrar por vía oral, transdérmica o intravenosa para modular el dolor posquirúrgico. Un metanálisis de 19 ECA (1156 pacientes) para examinar la clonidina y la dexmedetomidina en el contexto postoperatorio concluyó que la clonidina proporciona un efecto ahorrador de opioides durante 24 horas pero en menor grado que la dexmedetomidina (16). Desde 2012, un número limitado de ensayos ha investigado la clonidina para el dolor postoperatorio y ha encontrado resultados similares (17).…”

Section: Clonidinaunclassified