The Rational Use of Intrathecal and Extradural Opioids

Morgan, M.

doi:10.1093/bja/63.2.165

Cited by 199 publications

(81 citation statements)

References 221 publications

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“…The unsuitableness of therapy is often related to legal restrictions on the availability of opioid analgesics (Weber et al, 2012), furthermore adverse effects limit the use of these drugs (Morgan, 1989). Along with increase in the prevalence of chronic pain, long-term therapies with opioids exacerbate toxicity and the development of analgesic tolerance (Williams et al, 2013) and dependence is a significant limit in their clinical applications (Koob and Bloom, 1988).…”

Section: Discussionmentioning

confidence: 99%

Acute and subchronic antinociceptive effects of nociceptin/orphanin FQ receptor agonists infused by intrathecal route in rats

Micheli

Mannelli

Guerrini

et al. 2015

European Journal of Pharmacology

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a b s t r a c tSevere pain occurs in the context of many diseases and conditions and is a leading cause of disability. Nociceptin/orphanin FQ (N/OFQ) is the endogenous ligand of the N/OFQ peptide (NOP) receptor. This peptidergic system controls pain transmission and in particular spinally administered N/OFQ has robust antinociceptive properties.The aim of this study was to investigate the spinal antinociceptive properties of NOP peptide agonists after acute and subchronic treatment in rats. Doses unable to alter motor coordination were selected. UFP-112 (full NOP agonist) and UFP-113 (partial NOP agonist) were administered intrathecally (i.t.) by spinal catheterization. Acute injection of UFP-112 induced antinociceptive response at lower dosages (0.03-1 nmol i.t.) compared to morphine and similar to N/OFQ. UFP-113 was effective in a 0.001-1 nmol i.t. dose range. The antinociceptive effects of NOP ligands were no longer evident in rats knockout for the NOP gene, while those of morphine were maintained. The continuous spinal infusion (by osmotic pumps) of 0.1 nmol/h UFP-112 and UFP-113 showed antinociceptive action comparable to 1-3 nmol/h morphine or N/OFQ. The antinociceptive effect of morphine progressively decreased and was no longer significant after 6 days of treatment. Similar results were obtained with N/OFQ, UFP-112, and UFP-113. The acute i.t. injection of morphine in animals tolerant to N/OFQ and UFP-112 evoked analgesic effects. Neither morphine nor N/OFQ induced antinociceptive effects in morphine-and UFP-113-tolerant rats. In conclusion this study highlights the analgesic efficacy and potency of UFP-112 and UFP-113 underlining the relevance of NOP system in analgesia.

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Section: Discussionmentioning

confidence: 99%

Acute and subchronic antinociceptive effects of nociceptin/orphanin FQ receptor agonists infused by intrathecal route in rats

Micheli

Mannelli

Guerrini

et al. 2015

European Journal of Pharmacology

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“…. However, pruritus, nausea, vomiting, urinary retention, activation of herpes labialis [8] and risk of unpredictable respiratory depression [9,10] have directed the clinicians to use a lower dose of tramadol that can be used intrathecally to produce effective and prolonged analgesia without such complications.…”

mentioning

confidence: 99%

A Comparative Study Effect of Intrathaecal Tramadol (20mg) Use as Adjuvant With Hyperbaric Bupivacaine (15mg) and Hyperbaric Bupivacaine for Postoperative Analgesia in Infraumbilical Surgeries.

Meena¹,

Agarwal²,

Sunar³

2017

IJAR

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“…118 However, the most practical and effective method for detecting hypoxemia and/or hypoventilation after ITM is unknown. 5,104 Perhaps the term "respiratory depression" should only be used for experimental situations, when there is a depressed ventilatory response to hypercapnia or hypoxemia. Then, a low RR would be better referred to as "bradypnea" and not "respiratory depression".…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5] Intrathecal morphine (ITM) was the opioid involved in many of the cases of delayed RD, 6-8 a serious but rare complication. ITM produces a dose-related analgesia and RD 2-4,9-14 via separate receptor mechanisms.…”

mentioning

confidence: 99%

Définitions de la “dépression respiratoire” de l’analgésie postopératoire réalisée avec de la morphine intrathécale : une revue documentaire

Goldstein

VanDenKerkhof

2003

Can J Anesth/J Can Anesth

108

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P Pu ur rp po os se e: : To review the postoperative intrathecal morphine (ITM) analgesia literature for their definitions of "respiratory depression" (RD).S So ou ur rc ce e: : Medline (1966 -June Week 5 2001) and reference lists were searched for original studies involving bolus-dose ITM for postoperative analgesia, which used "respiratory depression" or similar terms. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The search identified 209 studies. These were included if ITM use was appropriate (bolus dose, postoperative analgesia) and the term "respiratory depression" was used, which left 96 studies remaining. Forty-four (46%) did not define "RD" despite using this term. A further 24 (25%) defined RD with respiratory rate (RR) alone. Only 28 (29%) defined RD with more than RR alone. There was no statistically significant association between the presence of a definition for RD with study design, study size or publication period. Also, no significant association existed between rigorousness of RD definitions and the above factors.C Co on nc cl lu us si io on n: : The term "respiratory depression" has no clear definition from a review of the literature on ITM use for postoperative analgesia. While defining RD with bradypnea is superior to having no definition, this is still inadequate. In future research, the consistent use of terms with specific meanings will facilitate understanding the true incidence of ITM's respiratory effects. If "respiratory depression" is used, then an explicit definition of its meaning should be provided. Future research must also address what is clinically significant respiratory impairment from intrathecal opioids, and how to optimally monitor for this. Further delineating their risks vs benefits will allow for more optimal dosing. Objectif : Passer en revue les documents sur l'analgésie postopéra-toire, réalisée avec la morphine intrathécale (MIT), quant à leurs défi-nitions de la "dépression respiratoire" (DR). Source : La base Medline (1966 -Semaine 5, juin 2001) et les listes de lectures de référence ont été fouillées à la recherche d'études originales sur des bolus de MIT administrés comme analgésie postopéra-toire, et dans lesquelles on retrouve le terme "dépression respiratoire" ou des termes similaires. Constatations principales : La recherche nous a fourni 209 études. Les études (96) comportant un usage approprié de la MIT (dose en bolus, analgésie postopératoire) et l'utilisation du terme

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The Rational Use of Intrathecal and Extradural Opioids

Cited by 199 publications

References 221 publications

Acute and subchronic antinociceptive effects of nociceptin/orphanin FQ receptor agonists infused by intrathecal route in rats

Acute and subchronic antinociceptive effects of nociceptin/orphanin FQ receptor agonists infused by intrathecal route in rats

A Comparative Study Effect of Intrathaecal Tramadol (20mg) Use as Adjuvant With Hyperbaric Bupivacaine (15mg) and Hyperbaric Bupivacaine for Postoperative Analgesia in Infraumbilical Surgeries.

Définitions de la “dépression respiratoire” de l’analgésie postopératoire réalisée avec de la morphine intrathécale : une revue documentaire

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