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Kheirabadi D, Minhas D, Ghaderpanah R, Clauw DJ. Problems with opioids beyond misuse. Best Pract Res Clin Rheumatol 2024:101935. [PMID: 38429184 DOI: 10.1016/j.berh.2024.101935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 03/03/2024]
Abstract
The U.S. is grappling with an opioid epidemic, with millions of adults on long-term opioid therapy (LTOT). Although patients often report pain relief and improved daily function with opioids, research shows no significant differences in short-term outcomes between opioid and non-opioid users, as well as no long-term opioid benefits. This scoping review aims to identify lesser-known side effects of long-term opioid use and increase awareness of them, allowing healthcare providers and patients to better assess the risks and benefits of opioid use. Our data search from PubMed and Google Scholar used keywords related to opioids, chronic pain, hypogonadism, endocrinopathies, cancer progression, cardiovascular events, renovascular events, sleep disturbances, mood disorders and others, narrowing down to English-language full articles published from January 2018 to April 2023. This review emphasizes the probable serious adverse consequences of long-term opioid use on various body systems in patients with chronic pain. Given the lack of long-term benefits and significant adverse effects, our review underscores the critical need for healthcare providers to include these risks in discussions with patients when considering the long-term use of opioid therapy.
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Affiliation(s)
- Dorna Kheirabadi
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, United States.
| | - Deeba Minhas
- Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, 300 North Ingalls Building, Ann Arbor, MI, 48109-5422, United States.
| | - Rezvan Ghaderpanah
- Department of Physiology and Aging, College of Medicine, University of Florida, United States.
| | - Daniel J Clauw
- Departments of Anesthesiology, Medicine (Rheumatology), and Psychiatry, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, United States.
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Park JB, Song IS, Kang PY, Ji SH, Jang YE, Kim EH, Lee JH, Kim HS, Kim JT. Ultrasound-guided selective supraclavicular nerve block for postoperative pain control in children receiving Hickman catheter or chemoport insertion: A randomized controlled trial. Paediatr Anaesth 2024; 34:35-41. [PMID: 37587734 DOI: 10.1111/pan.14745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Optimal pain management after insertion of a central venous catheter in children remains unclear. AIM This study aimed to evaluate the effects of a selective supraclavicular nerve block on postoperative analgesia in pediatric patients undergoing hickman catheter or chemoport insertion. METHODS Fifty patients aged 3-18 years scheduled for elective Hickman or chemoport insertion were randomized into two groups of 25 each: one group received an ultrasound-guided selective supraclavicular nerve block with 0.1 mL/kg of 0.5% ropivacaine (SSCNB group), and the other group did not receive a nerve block (control group). The primary outcome was the postoperative Wong-Baker Faces Pain Rating Scale score measured between 10 and 30 min after surgery. Secondary outcomes included pain scores at 1, 3, and 24 h after the surgery, block-related complications, length of stay in the postanesthesia care unit, postoperative analgesic consumption, and time to first analgesic use 24 h after surgery. RESULTS The worst pain score within 30 min in the recovery room was significantly lower in the SSCNB group compared to the control group (6 [5-7] vs. 3 [2-4]; median difference, -3; 95% CI, -4 to -1; p < .001). Pain scores at 1, 3, and 24 h after surgery were also significantly lower in the SSCNB group. The need for both opioid and non-opioid analgesics in the postoperative period was significantly lower in the SSCNB group (36.0% vs. 0%; p = .002 and 44.0% vs. 16.0%; mean difference, -28%; 95% CI, -56 to 0.19; p = .033, respectively), while other secondary outcomes were not significantly different between the two groups. CONCLUSIONS Ultrasound-guided SSCNB is an effective method for managing postoperative pain in children undergoing Hickman catheter or chemoport insertion, reducing the need for analgesics within 24 h after surgery.
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Affiliation(s)
- Jung-Bin Park
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - In-Sun Song
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Pyo-Yoon Kang
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Hu X, Luo B, Qiu L, Chen S, Wu Q, Chen Q, Liu X, Ling C, Deng S, Yuan M, Hu P. Dezocine Has the Potential to Regulate the Clinical and Biological Features of Tumors. Drug Des Devel Ther 2022; 16:1121-1129. [PMID: 35478934 PMCID: PMC9035457 DOI: 10.2147/dddt.s356863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/09/2022] [Indexed: 12/14/2022] Open
Abstract
Cancer is the second leading cause of death following ischemic heart disease in the world and the primary clinical, social and economic burden. Surgical resection is the main measure for the treatment of the vast majority of solid tumors. However, the recurrence and metastasis of tumors occur at different periods after surgery in many cases undergoing radical tumor surgery, which is the main cause of death of tumor patients. Moreover, tumor patients are prone to suffer from mental depression, which may increase the morbidity and mortality of tumors. Tumors have a series of clinical biological signs with the following five main features: postoperative pain and cancerous pain; suppression of antitumor immunity; angiogenesis in tumors; proliferation, growth and metastasis of tumors; and mental depression. Surgery is the first treatment in the majority of cancer patients with solid tumors. Opioids are required for anesthesia and postoperative analgesia. For cancerous pain control, patients undergo surgery, and their quality of life of is improved. However, traditional opioids, such as morphine, may inhibit antitumor immunity, induce vascular growth of tumors and promote the proliferation, invasion and migration of cancer cells, and traditional opioids can induce a risk of somatic dependence. However, studies have found that not all opioids share the effects of immunosuppression, tumor proliferation promotion and angiogenesis induction. Dezocine, a novel opioid with specific pharmacological mechanisms, has been demonstrated to regulate the five clinical and biological features of tumors. We reviewed the preclinical and clinical studies of dezocine on postoperative pain and cancer pain in tumor patients as well as the immune system, tumor angiogenesis, tumor proliferation, tumor growth, tumor metastasis and mental depression. We proposed that dezocine may be the best choice of opioids for anesthesia and analgesia in cancer patients.
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Affiliation(s)
- Xudong Hu
- Department of Anesthesiology, The Second People's Hospital of Foshan, Foshan, 528000, People's Republic of China
| | - Bing Luo
- Department of Surgery, The Second People's Hospital of Foshan, Foshan, 528000, People's Republic of China
| | - Lei Qiu
- Department of Surgery, The Second People's Hospital of Foshan, Foshan, 528000, People's Republic of China
| | - Shaosen Chen
- Department of Respiratory and Critical Care Medicine, The Second People's Hospital of Foshan, Foshan, 528000, People's Republic of China
| | - Qing Wu
- Department of Surgery, The Second People's Hospital of Foshan, Foshan, 528000, People's Republic of China
| | - Qingbiao Chen
- Department of Surgery, The Second People's Hospital of Foshan, Foshan, 528000, People's Republic of China
| | - Xingqing Liu
- Department of Anesthesiology, The Second People's Hospital of Foshan, Foshan, 528000, People's Republic of China
| | - Chen Ling
- Department of Anesthesiology, The Second People's Hospital of Foshan, Foshan, 528000, People's Republic of China
| | - Shuping Deng
- Department of Internal Medicine, Huanshi Hospital, People's Hospital of Chancheng District, Foshan, 528000, People's Republic of China
| | - Manjuan Yuan
- Department of Respiratory and Critical Care Medicine, The Second People's Hospital of Foshan, Foshan, 528000, People's Republic of China
| | - Peicun Hu
- Department of Respiratory and Critical Care Medicine, The Second People's Hospital of Foshan, Foshan, 528000, People's Republic of China
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Scroope CA, Singleton Z, Hollmann MW, Parat MO. Opioid Receptor-Mediated and Non-Opioid Receptor-Mediated Roles of Opioids in Tumour Growth and Metastasis. Front Oncol 2022; 11:792290. [PMID: 35004315 PMCID: PMC8732362 DOI: 10.3389/fonc.2021.792290] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/06/2021] [Indexed: 01/02/2023] Open
Abstract
Opioids are administered to cancer patients in the period surrounding tumour excision, and in the management of cancer-associated pain. The effects of opioids on tumour growth and metastasis, and their consequences on disease outcome, continue to be the object of polarised, discrepant literature. It is becoming clear that opioids contribute a range of direct and indirect effects to the biology of solid tumours, to the anticancer immune response, inflammation, angiogenesis and importantly, to the tumour-promoting effects of pain. A common misconception in the literature is that the effect of opioid agonists equates the effect of the mu-opioid receptor, the major target of the analgesic effect of this class of drugs. We review the evidence on opioid receptor expression in cancer, opioid receptor polymorphisms and cancer outcome, the effect of opioid antagonists, especially the peripheral antagonist methylnaltrexone, and lastly, the evidence available of a role for opioids through non-opioid receptor mediated actions.
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Affiliation(s)
- Claudia A Scroope
- School of Pharmacy, The University of Queensland, St Lucia, QLD, Australia
| | - Zane Singleton
- School of Pharmacy, The University of Queensland, St Lucia, QLD, Australia
| | - Markus W Hollmann
- Department of Anaesthesiology, Amsterdam University Medical Center, Academic Medical Center (AMC), Amsterdam, Netherlands
| | - Marie-Odile Parat
- School of Pharmacy, The University of Queensland, St Lucia, QLD, Australia
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Stéphane H, Marianne G, Julie N, Patrizia L, Jean C, Patrice F, Pierre L. Opioid-free versus opioid-based anesthesia in pancreatic surgery. BMC Anesthesiol 2022; 22:9. [PMID: 34983396 PMCID: PMC8725294 DOI: 10.1186/s12871-021-01551-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Opioid-free anesthesia (OFA) is associated with significantly reduced cumulative postoperative morphine consumption in comparison with opioid-based anesthesia (OBA). Whether OFA is feasible and may improve outcomes in pancreatic surgery remains unclear. METHODS Perioperative data from 77 consecutive patients who underwent pancreatic resection were included and retrospectively reviewed. Patients received either an OBA with intraoperative remifentanil (n = 42) or an OFA (n = 35). OFA included a combination of continuous infusions of dexmedetomidine, lidocaine, and esketamine. In OBA, patients also received a single bolus of intrathecal morphine. All patients received intraoperative propofol, sevoflurane, dexamethasone, diclofenac, neuromuscular blockade. Postoperative pain management was achieved by continuous wound infiltration and patient-controlled morphine. The primary outcome was postoperative pain (Numerical Rating Scale, NRS). Opioid consumption within 48 h after extubation, length of stay, adverse events within 90 days, and 30-day mortality were included as secondary outcomes. Episodes of bradycardia and hypotension requiring rescue medication were considered as safety outcomes. RESULTS Compared to OBA, NRS (3 [2-4] vs 0 [0-2], P < 0.001) and opioid consumption (36 [24-52] vs 10 [2-24], P = 0.005) were both less in the OFA group. Length of stay was shorter by 4 days with OFA (14 [7-46] vs 10 [6-16], P < 0.001). OFA (P = 0.03), with postoperative pancreatic fistula (P = 0.0002) and delayed gastric emptying (P < 0.0001) were identified as only independent factors for length of stay. The comprehensive complication index (CCI) was the lowest with OFA (24.9 ± 25.5 vs 14.1 ± 23.4, P = 0.03). There were no differences in demographics, operative time, blood loss, bradycardia, vasopressors administration or time to extubation among groups. CONCLUSIONS In this series, OFA during pancreatic resection is feasible and independently associated with a better outcome, in particular pain outcomes. The lower rate of postoperative complications may justify future randomized trials to test the hypothesis that OFA may improve outcomes and shorten length of stay.
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Affiliation(s)
- Hublet Stéphane
- Department of Anesthesiology, Université Libre de Bruxelles, CUB Érasme, Brussels, Belgium
| | - Galland Marianne
- Department of Anesthesiology, Université Libre de Bruxelles, CUB Érasme, Brussels, Belgium
| | - Navez Julie
- Department of Abdominal Surgery and Transplantation, Université Libre de Bruxelles, CUB Érasme, Brussels, Belgium
| | - Loi Patrizia
- Department of Abdominal Surgery and Transplantation, Université Libre de Bruxelles, CUB Érasme, Brussels, Belgium
| | - Closset Jean
- Department of Abdominal Surgery and Transplantation, Université Libre de Bruxelles, CUB Érasme, Brussels, Belgium
| | - Forget Patrice
- Clinical Chair in Anaesthesia, University of Aberdeen, Aberdeen, UK
| | - Lafère Pierre
- Department of Anesthesiology, Université Libre de Bruxelles, CUB Érasme, Brussels, Belgium.
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Mefford B, Donaldson JC, Bissell BD. The immunomodulatory effects of opioids and implications for intensive care unit populations. Pharmacotherapy 2021; 41:668-675. [PMID: 34129683 DOI: 10.1002/phar.2602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 11/05/2022]
Abstract
Analgesia within the intensive care unit (ICU) is often achieved via the utilization of opioids in alignment with current guidelines. Recent evidence has not only demonstrated the potential impact of opioids in suppression of immune function, but also the potential harm of immunosuppression of patients within the ICU. Despite the potential immunosuppression seen with opioids in this at-risk population, their use remains frequent. In this review, we highlight the potential immunomodulatory impact of opioids within the critically ill and considerations for their use.
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