The impact of caudally administrated tramadol on immune response and analgesic efficacy for pediatric patients: a comparative randomized clinical trial

Sayed, Jehan Ahmed; Elshafy, Sayed Kaoud Abd; Kamel, Emad Zarief; Riad, Mohamed Amir F.; Mahmoud, Amal; Khalaf, Ghada Shalaby

doi:10.3344/kjp.2018.31.3.206

Cited by 12 publications

(9 citation statements)

References 30 publications

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“…However, both groups began to recover gradually from 12 h after surgery, but the recovery rate of immune function in patients with dezocine was faster within 48 h after surgery. The variation tendencies of NK cells and T lymphocyte subsets were basically consistent with the results of previous studies (25,26).…”

Section: Discussionsupporting

confidence: 92%

Effects of dezocine and sufentanyl for postoperative analgesia on activity of NK, CD4+ and CD8+ cells in patients with breast cancer

2019

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The effects of dezocine and sufentanyl on the activity of natural killer (NK), CD4 + and CD8 + cells in patients with breast cancer undergoing postoperative analgesia after radical mastectomy were compared. The clinical data of 76 female patients undergoing radical mastectomy in the Fudan University Shanghai Cancer Center from January 2015 to October 2017 were analyzed retrospectively. Forty-two patients treated with dezocine were group D and 34 patients with sufentanyl were group S. Visual analogue scale (VAS) was used to evaluate the analgesic effect at 3, 12, 24, 48 h after surgery. There was no significant difference in VAS score, NK cells, CD4 + cells, and CD8 + cell vitality at 3 h postoperatively between the two groups (P>0.05), and VAS score at 12, 24 and 48 h postoperatively in the S group was significantly lower than that in group D (P<0.05). The activity of NK cells and CD4 + cells at 3, 12, 24 and 48 h after surgery in group D was significantly higher than that in group S, and the difference was statistically significant (P<0.05). The activity of CD8 + cells at 3, 12, 24 and 48 h after surgery in group D was significantly lower than that in group S, and the difference was statistically significant (P<0.05). The analgesic effect of dezocine was slightly worse than that of sufentanyl, but it was more beneficial to the recovery of early postoperative immune function.

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Section: Discussionsupporting

confidence: 92%

Effects of dezocine and sufentanyl for postoperative analgesia on activity of NK, CD4+ and CD8+ cells in patients with breast cancer

2019

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“…A study has shown that dexmetomide can effectively maintain the homeostasis of cellular immune function in patients undergoing radical mastectomy, can effectively improve the recovery of patients and reduce inflammation (15). Another study has reported that dexmetomide can effectively reduce the release of inflammatory factors in patients undergoing radical resection of gastric cancer and can reduce the decrease of CD3 + and CD4 + cells to improve the impairment of immune function (16). These studies have shown that drug PCIA has a positive effect on the immune function of the body.…”

Section: Discussionmentioning

confidence: 95%

Clinical effect and safety evaluation of hydromorphone combined with sufentanil in patient‑controlled intravenous analgesia for patients with hepatocellular cancer and its effect on serum immune factors

et al. 2020

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The present study aimed to explore the clinical efficacy and safety of hydromorphone combined with sufentanil in patient-controlled intravenous analgesia (PCIA) for patients with hepatocellular carcinoma (HCC) and its effect on serum immune factors in serum. Data from 385 patients with HCC, admitted to the Hunan Provincial People's Hospital (Changsha, China) from February 2015 to September 2018, were retrospectively analyzed. Laparoscopic hepatectomy was performed in all patients. A total of 180 patients who received PCIA were treated with sufentanil (control group), and 205 patients who received PCIA were treated with hydromorphone and sufentanil (study group). PCIA was used after hepatocellular cancer operation. In the control group, the analgesic pump was filled with sufentanil (2 µg/kg) and tropisetron (5 mg), whereas in the study group, the analgesic pump was filled with sufentanil (2 µg/kg), tropisetron (5 mg) and hydromorphone (5 mg). Both groups of drugs were diluted into 100 ml with normal saline and the loading dose was 5 ml; the continuous dose was 2 ml/h and the single PCIA amount was 2 ml. The visual analogue scale (VAS) and numeric sedation scale (NSS) scores at 12 and 24 h after operation, as well as and satisfaction score at 24 h after operation, were recorded. The levels of CD3 + , CD4 + , CD8 + lymphocytes and NK cells in the peripheral blood of patients were detected by flow cytometry. The postoperative hospitalization time, first flatulence time, first defecation time and first ambulation time, as well as the adverse reactions, were recorded. The results revealed that the satisfaction score of the patients at 24 h after operation was significantly higher in the study group than that in the control group (P<0.05). Additionally, there were no serious adverse reactions in either group. In conclusion, PCIA with hydromorphone and sufentanil can provide safe and effective analgesia, may improve the levels of immune factors and enhance the recovery ability of the patients.

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“…In accordance, histopathological examination of different tissues, such as lung, heart and brain, after H & E staining, showed that tramadol was associated with less inflammatory cell infiltrates than tapentadol [ 55 ]. In this sense, considering tramadol analgesic potency and lower immunosuppressive effects, it was suggested as a better alternative for pain treatment than classical opioids, since it may have an immune enhancing effect and, thus, be especially considered in conditions where immunosuppression is contraindicated [ 80 , 85 , 86 , 87 ].…”

Section: Discussionmentioning

confidence: 99%

Repeated Administration of Clinically Relevant Doses of the Prescription Opioids Tramadol and Tapentadol Causes Lung, Cardiac, and Brain Toxicity in Wistar Rats

et al. 2021

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Tramadol and tapentadol, two structurally related synthetic opioid analgesics, are widely prescribed due to the enhanced therapeutic profiles resulting from the synergistic combination between μ-opioid receptor (MOR) activation and monoamine reuptake inhibition. However, the number of adverse reactions has been growing along with their increasing use and misuse. The potential toxicological mechanisms for these drugs are not completely understood, especially for tapentadol, owing to its shorter market history. Therefore, in the present study, we aimed to comparatively assess the putative lung, cardiac, and brain cortex toxicological damage elicited by the repeated exposure to therapeutic doses of both prescription opioids. To this purpose, male Wistar rats were intraperitoneally injected with single daily doses of 10, 25, and 50 mg/kg tramadol or tapentadol, corresponding to a standard analgesic dose, an intermediate dose, and the maximum recommended daily dose, respectively, for 14 consecutive days. Such treatment was found to lead mainly to lipid peroxidation and inflammation in lung and brain cortex tissues, as shown through augmented thiobarbituric acid reactive substances (TBARS), as well as to increased serum inflammation biomarkers, such as C reactive protein (CRP) and tumor necrosis factor-α (TNF-α). Cardiomyocyte integrity was also shown to be affected, since both opioids incremented serum lactate dehydrogenase (LDH) and α-hydroxybutyrate dehydrogenase (α-HBDH) activities, while tapentadol was associated with increased serum creatine kinase muscle brain (CK-MB) isoform activity. In turn, the analysis of metabolic parameters in brain cortex tissue revealed increased lactate concentration upon exposure to both drugs, as well as augmented LDH and creatine kinase (CK) activities following tapentadol treatment. In addition, pneumo- and cardiotoxicity biomarkers were quantified at the gene level, while neurotoxicity biomarkers were quantified both at the gene and protein levels; changes in their expression correlate with the oxidative stress, inflammatory, metabolic, and histopathological changes that were detected. Hematoxylin and eosin (H & E) staining revealed several histopathological alterations, including alveolar collapse and destruction in lung sections, inflammatory infiltrates, altered cardiomyocytes and loss of striation in heart sections, degenerated neurons, and accumulation of glial and microglial cells in brain cortex sections. In turn, Masson’s trichrome staining confirmed fibrous tissue deposition in cardiac tissue. Taken as a whole, these results show that the repeated administration of both prescription opioids extends the dose range for which toxicological injury is observed to lower therapeutic doses. They also reinforce previous assumptions that tramadol and tapentadol are not devoid of toxicological risk even at clinical doses.

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The impact of caudally administrated tramadol on immune response and analgesic efficacy for pediatric patients: a comparative randomized clinical trial

Cited by 12 publications

References 30 publications

Effects of dezocine and sufentanyl for postoperative analgesia on activity of NK, CD4+ and CD8+ cells in patients with breast cancer

Effects of dezocine and sufentanyl for postoperative analgesia on activity of NK, CD4+ and CD8+ cells in patients with breast cancer

Clinical effect and safety evaluation of hydromorphone combined with sufentanil in patient‑controlled intravenous analgesia for patients with hepatocellular cancer and its effect on serum immune factors

Repeated Administration of Clinically Relevant Doses of the Prescription Opioids Tramadol and Tapentadol Causes Lung, Cardiac, and Brain Toxicity in Wistar Rats

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