Opioids and Cardiac Arrhythmia: A Literature Review

Behzadi, Mina; Joukar, Siyavash; Beik, Ahmad

doi:10.1159/000492616

Cited by 123 publications

(99 citation statements)

References 125 publications

(142 reference statements)

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“…Opium contains 80 different alkaloids, such as morphine and codeine. Morphine is a μ receptor agonist responsible for cardiovascular complications, including histamine release, and results in bradycardia, vasodilation, hypotension, and decreased cardiac output [94]. It has also been demonstrated that increased contractile response due to the stimulation of rat cardiac betaadrenergic receptors is reversed through delta receptor agonism [95].…”

Section: Potential Mechanismmentioning

confidence: 99%

The effects of opium on the cardiovascular system: a review of side effects, uses, and potential mechanisms

Nakhaee

Ghasemi

Karimzadeh

et al. 2020

Subst Abuse Treat Prev Policy

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Background: In Iran, as in many other Asian and Middle Eastern countries, some believe that opium has beneficial effects on cardiovascular system. Dependent patients suppose that opium has positive effects on cardiovascular function and can prevent or improve cardiovascular diseases; however, only few comprehensive studies evaluating such effects have been performed. Objectives: In this study, we sought to clarify the effect of opium on cardiovascular problems by incorporating the previous findings and the current information on the issue and to explain the possible mechanisms of this effect. Methods: The available human studies published up to October 30, 2019, were searched in different databases. Case-control, cohort, and cross-sectional studies were retrieved. Papers published in English or those with an English abstract were included. The risk of bias for each included study was assessed based on the Newcastle-Ottawa Scale (NOS). We then categorized the effects of opium on cardiovascular problems along with its probable underlying mechanisms of action. Results: In this study, most of the published articles suggested the adverse effects of opium on the cardiovascular system, including atherosclerosis, myocardial infarction, arrhythmia, low ejection fraction, and cardiovascular mortality; however, some articles reported the beneficial or impartial effects of opium on the cardiovascular system. In this article, we have categorized all the effects of opium on cardiovascular system; also, the proposed mechanisms of action of opium in each of the above-mentioned disorders are summarized. Conclusion: Although the available evidences were incoherent, it was mostly suggested that opium use does not protect against or improve cardiovascular problems.

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Section: Potential Mechanismmentioning

confidence: 99%

The effects of opium on the cardiovascular system: a review of side effects, uses, and potential mechanisms

Nakhaee

Ghasemi

Karimzadeh

et al. 2020

Subst Abuse Treat Prev Policy

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“…13,[17][18][19] The association between opioids and cardiovascular (CVD) outcomes has not been widely reported and results have been mixed. 2,16,24,25 In a recent study among those ages ‡45 years using subgroups of opioids, no significant association was evident between opioid medication use and coronary artery disease. 25 A 2007 review summarizing the use of tramadol for management of chronic pain indicated that tramadol had no known associations with CVD adverse effects, gastrointestinal bleeding, or renal toxicity in contrast to contraindications associated with chronic NSAIDs.…”

Section: Introductionmentioning

confidence: 97%

Safety Events Associated with Tramadol Use Among Older Adults with Osteoarthritis

Wang

Schaeffer

Slindee

et al. 2021

Population Health Management

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Tramadol is a low-level opioid increasingly recommended to treat moderate-to-severe acute and chronic pain. Although characterized as having fewer opioid-related adverse events, the longer term safety of tramadol use among older adults has not been thoroughly documented. Thus, the primary objective was to examine the risk of safety events associated with chronic tramadol use compared to other chronic opioid use or no opioids among older adults with osteoarthritis. Safety events considered included: ‡3 emergency room (ER) visits, falls/hip fractures, cardiovascular (CVD) hospitalization, composite safety event hospitalization, and all-cause mortality. The study population included older adults ages ‡65 years diagnosed with osteoarthritis and classified into new or continuing tramadol use, new or continuing other opioid use, or nonuse. Inclusion criteria included: 6-month pre period and up to 33 months post period. Tramadol, other opioid, and no opioid users were 1:1 propensity-matched providing study populations of 25,899 within each category; 72% were new chronic opioid users. Multiple logistic regression or Cox proportional hazard ratios were used to document risk. Generally, tramadol users had fewer adverse event risks compared to other opioid users but higher risks than nonusers. New users of tramadol or other opioids had higher risks than continuing users. Tramadol use was associated with increased risk of multiple ER utilizations, falls/fractures, CVD hospitalizations, safety event hospitalizations, and mortality (new users only) compared to nonuse. Thus, although tramadol use may be appropriately recommended within a pain management strategy for older adults with osteoarthritis, careful monitoring for adverse safety events is warranted.

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“…There are many side effects of opioids 41 and one of the most common effects on the cardiovascular system is prolongation of the QT interval which can lead to torsade de pointes (TDP), kind of the ventricular tachyarrhythmia that can provokes sudden death. 42,43 The other side effects on the cardiovascular system are bradycardia, histamine release, and rhythm disturbance. Mechanism of action of prolongation of QT interval is associated with prolonged cardiac repolarisation that is initiated by rapid outflow of potassium (K+), through the cardiac rapid-rectifying K+ channel.…”

Section: Resultsmentioning

confidence: 99%

Multimodal neural block analgesia versus morphine analgesia after elective knee surgery

Lončar-Stojiljković¹

2019

Scripta Medica

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Background: Total knee arthroplasty has become a standard for treatment of endstage knee osteoarthritis. Due to intense and complex knee innervation, there is a need to improve the anaesthetic/analgesic approach to such operations. The aim of this randomised clinical trial was to compare the analgesic efficacy of the classical regimen and two of those based on the nerve blocks. Methods: A total of 60 patients was included and subjected to elective total knee arthroplasty under the general balanced anaesthesia. They were randomised to receive postoperatively (1) only morphine 5-10 mg q6h and paracetamol 1 g q6h (MP), (2) femoral nerve block (FNB) or (3) fascia iliac compartment nerve block (FICNB). Nerve blocks were produced by a single administration of 30-40 ml of bupivacaine 0.5%. Pain intensity, duration of neural block and additional consumption of analgesics were recorded postoperatively. Results: There were no demographic differences among the three groups of patients. Pain intensity was significantly lower in the two nerve block groups than in the MP group. The same two groups also demanded significantly less analgesics postoperatively than the MP group. Cardiovascular control was significantly better in the nerve block groups. There were no significant differences between the FNB and FIC-NB groups of patients regarding any of the studied parameters. Conclusion: In comparison with the classical MP analgesia, use of FNB or FICNB after the elective total knee arthroplasty results in lower pain scores, lower systolic blood pressure and less consumption of analgesics in the immediate postoperative course.

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Opioids and Cardiac Arrhythmia: A Literature Review

Cited by 123 publications

References 125 publications

The effects of opium on the cardiovascular system: a review of side effects, uses, and potential mechanisms

The effects of opium on the cardiovascular system: a review of side effects, uses, and potential mechanisms

Safety Events Associated with Tramadol Use Among Older Adults with Osteoarthritis

Multimodal neural block analgesia versus morphine analgesia after elective knee surgery

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