1
|
Zhou L, Huang J, Chen C. Most effective pain-control procedure for open liver surgery: a network meta-analysis. ANZ J Surg 2018. [PMID: 29534349 DOI: 10.1111/ans.14456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND To determine the most effective pain-control procedure for open liver surgery through a network meta-analysis and provide a best developing direction in this field. METHODS PubMed, Embase and Cochrane Library database were searched for randomized controlled trials up to 1 July 2016. We extracted data on post-operative pain score at the 4th-8th hour and 24th hour from studies that compared various pain-control strategies. Network meta-analysis was conducted in Aggregate Data Drug Information System software by evaluating the parametric pain score at rest and on movement. Cumulative probability value was utilized to rank the procedures under examination. The inconsistency would also be tested by node-splitting models. RESULTS Twelve articles containing 661 patients were included. Intrathecal analgesia plus intravenous analgesia played the most effective role in pain controlling at post-operative 4-8 h (both at rest and on movement, P = 0.49 and P = 0.62, respectively) and at post-operative 24 h (both at rest and on movement, P = 0.46 and P = 0.29, respectively). Node-splitting models test revealed that no significant inconsistency existed in this research. CONCLUSIONS Intrathecal analgesia plus intravenous analgesia revealed the most effective clinical pain-control value for open liver surgery. More importantly, we believed that creating a better comprehensive and systematic combined pain-control procedure should be considered as the developing direction in this field.
Collapse
Affiliation(s)
- Ling Zhou
- Dermatological Department, Central Hospital of Enshi Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi, China
| | - Jian Huang
- Department of Oncological Surgery, The First Affiliated Hospital of Kunming Medical College, Kunming, China
| | - Changwang Chen
- Department of Gastrointestinal Surgery, Central Hospital of Enshi Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi, China
| |
Collapse
|
2
|
Exploring Nonopioid Analgesic Agents for Intrathecal Use. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00068-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
3
|
The antinociceptive effects and pharmacological properties of JM-1232(-): a novel isoindoline derivative. Anesth Analg 2009; 108:1008-14. [PMID: 19224817 DOI: 10.1213/ane.0b013e318193678f] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND An isoindoline derivative, JM-1232(-) was developed as a sedative and analgesic drug. We performed the present study to investigate its antinociceptive effects on three different nociceptions in mice. METHODS Mail ddY mice were administered intraperitoneal (i.p.) JM-1232(-) 1,3 or 10 mg/kg (n = 8 for each dose in each test). Saline was used as a control. The hotplate or tail pressure test was performed for 120 min after i.p. drug injection. Acetic acid 0.6% solution in 10 mL/kg was i.p. administered 15 min after i.p. drug injection in the acetic acid test. The number of abdominal constriction episodes was counted for 10 min, starting 5 min after i.p. administration of the acid. When the analgesic effect was observed, naloxone or flumazenil was subcutaneously administered before administration of the maximum effective dose of JM-1232(-). Using the wheel running test, the number of wheel revolutions was recorded every 5 min for 120 min. RESULTS In the hotplate, tail pressure and acetic acid tests, i.p. JM-1232(-) produced significant antinociceptive effects with a 50% effective dose of 2.96 mg/kg (CI: 2.65-3.30 mg/kg), 3.06 mg/kg (CI: 2.69-3.47 mg/kg) and 2.27 mg/kg (CI: 1.46-3.53 mg/kg), respectively. In all tests, JM-1232(-)-induced antinociception was antagonized by flumazenil (5 mg/kg) but not by naloxone (10 mg/kg). In the running wheel test, there was no dose-dependent effect of JM-1232(-) on locomotor activity. CONCLUSION Systemically administered JM-1232(-) had antinociceptive effects on acute thermal, mechanical-induced pain, and visceral pain in mice. These effects might be mediated by benzodiazepine-gamma-aminobutyric acid type A receptors but not by opioid receptors.
Collapse
|
4
|
Chiba S, Nishiyama T, Yoshikawa M, Yamada Y. The antinociceptive effects of midazolam on three different types of nociception in mice. J Pharmacol Sci 2009; 109:71-7. [PMID: 19122369 DOI: 10.1254/jphs.08094fp] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Antinociceptive effects of systemically administered midazolam remain controversial. The present study was performed to investigate its antinociceptive effects on different types of nociception in mice. Four different doses of midazolam (1, 3, 10, and 30 mg/kg) were administered intraperitoneally (i.p.). Saline was used as a control. The hot plate test, tail pressure test, acetic acid writhing test, the running wheel test, and the balance beam test were performed following the drug administration. In the hot plate test and tail pressure test, i.p. midazolam produced significant antinociceptive effects with the 50% effective dose (ED(50)) of 3.46 mg/kg [confidence interval (CI), 1.99 - 6.01 mg/kg] and 3.52 mg/kg (CI, 2.77 - 4.47 mg/kg), respectively. In the acetic acid writhing test, i.p. midazolam also produced significant antinociceptive effects. In the running wheel test, no mice stopped running after saline or midazolam at 1, 3, or 10 mg/kg, but all mice stopped running 30 and 45 min after i.p. administration of midazolam at 30 mg/kg. In the balance beam test, 30 min after i.p. administration of saline or midazolam at 1, 3, and 10 mg/kg, all mice were able to stay on the beam for 90 s, none of them could with midazolam at 30 mg/kg. In conclusion, systemically administered midazolam had antinociceptive effects on acute thermal, acute mechanical, and acute inflammatory-induced nociception in mice. The antinociceptive potency of midazolam was the same for both acute thermal-induced nociception and mechanical-induced nociception.
Collapse
Affiliation(s)
- Shunsuke Chiba
- Department of Anesthesiology, The University of Tokyo, Faculty of Medicine, Tokyo, Japan.
| | | | | | | |
Collapse
|
5
|
Ho KM, Ismail H. Use of Intrathecal Midazolam to Improve Perioperative Analgesia: A Meta-Analysis. Anaesth Intensive Care 2008; 36:365-73. [PMID: 18564797 DOI: 10.1177/0310057x0803600307] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intrathecal midazolam binds with gamma aminobutyric acid-A receptors in the spinal cord leading to an analgesic effect. Clinical studies suggested that intrathecal midazolam may also reduce nausea and vomiting when used as an adjunct to other spinal medications. However, the potential neurotoxic effect of intrathecal midazolam remains a concern. This meta-analysis aims to evaluate the effectiveness and side-effects of intrathecal midazolam in the perioperative and peripartum settings. Thirteen randomised controlled studies from MEDLINE (from 1966 to July 1 2007), EMBASE and Cochrane Controlled Trials Register databases, involving a total of 672 patients, were considered. Volunteer, animal and chronic pain studies were excluded. Adding intrathecal midazolam to other spinal medications reduced the incidence of nausea and vomiting (odds ratio 0.50, 95% confidence interval [CI] 0.27 to 0.90, P=0.02; I 2 =4%) and delayed the time to request for rescue analgesia (weighted-mean-difference=98.7 min, 95% CI: 76.1 to 121.4, P <0.00001; I=98.5%). Intrathecal midazolam did not affect the duration of motor blockade (weighted-mean-difference =25.1 min, 95% CI -7.6 to 57.8, P=0.13, I 2 =94.8%). The incidence of neurological symptoms after intrathecal midazolam was uncommon (1.8%) and did not differ from placebo (odds ratio 1.20, 95% CI 0.22 to 6.68, P=0.84). Based on the limited data available, intrathecal midazolam appears to improve perioperative analgesia and reduce nausea and vomiting during caesarean delivery. A multicentre registry or large randomised controlled study with a prolonged follow-up period would be useful to confirm the clinical safety of intrathecal midazolam.
Collapse
Affiliation(s)
- K. M. Ho
- Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia, Australia
- Specialist in Intensive Care Medicine
| | - H. Ismail
- Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia, Australia
- Peter McCallum Cancer Centre, Melbourne, Victoria
| |
Collapse
|
6
|
Murali Krishna T, Panda NB, Batra YK, Rajeev S. Combination of low doses of intrathecal ketamine and midazolam with bupivacaine improves postoperative analgesia in orthopaedic surgery. Eur J Anaesthesiol 2008; 25:299-306. [PMID: 17892610 DOI: 10.1017/s0265021507002645] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Intrathecal ketamine produces a short period of analgesia with stable haemodynamics. Midazolam with bupivacaine prolongs the duration of analgesia when administered intrathecally but does not prevent hypotension. The objective of this study was to assess the effect of a combination of intrathecal bupivacaine, ketamine and midazolam on the duration of analgesia and haemodynamic parameters. METHODS A prospective, randomized, double-blind study was carried out in 60 ASA I and II patients undergoing lower limb surgery under spinal anaesthesia. Patients were divided into three groups of 20 each. Patients in all the three groups received 3 mL of hyperbaric bupivacaine (0.5%) intrathecally. In addition, patients in Groups II and III received intrathecal ketamine (0.1 mg kg-1) and the same dose of ketamine along with midazolam (0.02 mg kg-1), respectively. All patients were evaluated for block characteristics, duration of pain-free period, total rescue analgesic requirement in the 24-h postoperative period, total dose of mephenteramine to treat hypotension and any central or neurological complication. RESULTS No patients in Group II required mephenteramine while 40% of patients in Group I and 10% in Group III required mephenteramine to maintain blood pressure after spinal anaesthesia. The mean +/- standard deviation duration of pain-free period was 331.5 +/- 89.9, 369.7 +/- 124.2 and 730.5 +/- 81.5 min in Group I, II and III, respectively. The pain-free interval was significantly greater in Group III compared to Groups I and II (P < 0.001). No patient had any complications. CONCLUSION A low dose of midazolam and ketamine with bupivacaine intrathecally results in prolonged analgesia and less haemodynamic fluctuations. However, the safety of this combination needs to be proved before its use in clinical practice.
Collapse
Affiliation(s)
- T Murali Krishna
- Postgraduate Institute of Medical Education and Research, Department of Anaesthesia and Intensive Care, Chandigarh, India
| | | | | | | |
Collapse
|
7
|
Wang X, Xie H, Wang G. Improved postoperative analgesia with coadministration of preoperative epidural ketamine and midazolam. J Clin Anesth 2007; 18:563-9. [PMID: 17175423 DOI: 10.1016/j.jclinane.2006.03.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Revised: 03/03/2006] [Accepted: 03/06/2006] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To assess postoperative pain regulation and pharmacokinetic effects of preoperative administration of ketamine and midazolam. DESIGN Double-blind, randomized clinical study. SETTING University hospital. PATIENTS 46 ASA physical status I and II patients (age, 26-58 yrs), scheduled for gastrectomy. INTERVENTIONS Patients were randomly assigned to three treatment groups: a preoperative epidural injection of 10 mL (1) ketamine (0.5 mg/kg) solution (Ket group); (2) ketamine (0.5 mg/kg) plus midazolam (0.05 mg/kg) solution (KM group); or (3) normal saline solution (Ctr group). MEASUREMENTS Analgesic effects were evaluated by Visual Analog Scale (VAS) pain scores at rest, time to first request for analgesic (TFA), and morphine consumption during the initial postoperative time of 48 hours. Plasma concentration of ketamine in the Ket group and the KM group was measured by high-performance liquid chromatography, and the elimination half-life of ketamine was calculated. MAIN RESULTS Compared with the Ctr group, the Ket and KM groups had lower VAS pain scores, longer TFA, and lower morphine consumption. The KM group had the longest TFA and the lowest morphine consumption of the three groups. The KM group also had higher plasma concentrations of ketamine 90 to 240 minutes after injection, and a longer elimination half-life of ketamine, than did the Ket group. CONCLUSIONS Preoperative epidural coadministration of a low dose of ketamine with midazolam is more effective in relieving postoperative pain than using ketamine alone. In addition, epidural midazolam prolongs the elimination of ketamine.
Collapse
Affiliation(s)
- Xin Wang
- Department of Anesthesiology, General Hospital of Tianjin Medical University, Tianjin 300052, PR China.
| | | | | |
Collapse
|
8
|
Han DW, Kweon TD, Lee JS, Yoo YC, Lee YW, Kim S. The Interaction between Intrathecal NMDA Receptor Antagonist and 5-HT 3Receptor Agonist in the Rat Formalin Test. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.52.6.694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Dong Woo Han
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Dong Kweon
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Seok Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Chul Yoo
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Youn-Woo Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - SunChong Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| |
Collapse
|
9
|
Lim J, Lim G, Sung B, Wang S, Mao J. Intrathecal midazolam regulates spinal AMPA receptor expression and function after nerve injury in rats. Brain Res 2006; 1123:80-8. [PMID: 17049496 PMCID: PMC1974870 DOI: 10.1016/j.brainres.2006.09.059] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 09/18/2006] [Accepted: 09/18/2006] [Indexed: 12/29/2022]
Abstract
Spinal gamma-aminobutyric acid (GABA) and alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors have been implicated in the mechanisms of neuropathic pain after nerve injury; however, how these two receptors interact at the spinal level remains unclear. Here we show that intrathecal midazolam through activation of spinal GABAA receptors attenuated the expression and function of spinal AMPA receptors in rats following peripheral nerve injury. Thermal hyperalgesia and mechanical allodynia induced by chronic constriction nerve injury (CCI) in rats were attenuated by the short-acting benzodiazepine midazolam (20=10>5 mug>vehicle) administered intrathecally once daily for 7 postoperative days. CCI-induced upregulation of AMPA receptors within the spinal cord dorsal horn was also significantly reduced by the intrathecal midazolam (10, 20 mug) treatment. The inhibitory effects of midazolam (10, 20 mug) on neuropathic pain behaviors and AMPA receptor expression were prevented by co-administration of midazolam with the GABAA receptor antagonist bicuculline (3 mug), whereas intrathecal treatment with bicuculline (1 or 3 mug) alone in naive rats induced the upregulation of spinal AMPA receptor expression and nociceptive responses, indicating a tonic regulatory effect from endogenous GABAergic activity on the AMPA receptor expression and spinal nociceptive processing. These results indicate that modulation of spinal AMPA receptor expression and function by the GABAergic activity may serve as a mechanism contributory to the spinal nociceptive processing.
Collapse
Affiliation(s)
- Jeongae Lim
- Department of Anesthesia and Pain Medicine, Konkuk University, Seoul, Korea
| | - Grewo Lim
- Pain Research Group, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Backil Sung
- Pain Research Group, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Shuxing Wang
- Pain Research Group, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Jianren Mao
- Pain Research Group, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
- *Correspondence to: Jianren Mao, M.D., Ph.D., Pain Research Group, Division of Pain Medicine, WACC 324, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, Boston, MA 02114, Phone: 6177262338, Fax: 6177242719,
| |
Collapse
|
10
|
Miao FJP, Green PG, Benowitz N, Levine JD. Central terminals of nociceptors are targets for nicotine suppression of inflammation. Neuroscience 2004; 123:777-84. [PMID: 14706790 DOI: 10.1016/j.neuroscience.2003.10.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Spinal intrathecal administration of nicotine inhibits bradykinin-induced plasma extravasation, a component of the inflammatory response, in the knee joint of the rat in a dose-related fashion. Nociceptors contain nicotinic receptors and activation of a nociceptor at its peripheral terminal, by capsaicin, also produces inhibition of inflammation. Therefore the aim of this study was to test the hypothesis that the spinal target for this effect of nicotine is the central terminal of the primary afferent nociceptor. Intrathecal administration of the neurokinin-1 receptor antagonist, (3aR,7aR)-7,7-diphenyl-2-(1-imino-2(2-methoxyphenyl)-ethyl) perhydroisoindol-4-1 hydrochloride or the N-methyl-D-aspartate receptor antagonist, DL-2-amino-5-phosphonovaleric acid, both antagonists of the action of primary afferent neurotransmitters, markedly attenuated the inhibition of bradykinin-induced plasma extravasation produced by both intrathecal nicotine and intraplantar capsaicin.Conversely, intrathecal administration of an alpha-adrenoceptor antagonist, phentolamine or an opioid receptor antagonist, naloxone, to block descending antinociceptive controls, which provide inhibitory input to primary afferent nociceptors, enhanced the action of both nicotine and capsaicin. These findings support the hypothesis that the central terminal of the primary afferent nociceptor is a CNS target at which nicotine acts to inhibit inflammation.
Collapse
Affiliation(s)
- F J P Miao
- NIH Pain Center UCSF, University of California at San Francisco, Schools of Medicine and Dentistry, 521 Parnassus Avenue, 94143-0440, San Francisco, CA, USA
| | | | | | | |
Collapse
|
11
|
Nishiyama T, Hanaoka K. Midazolam can potentiate the analgesic effects of intrathecal bupivacaine on thermal- or inflammatory-induced pain. Anesth Analg 2003; 96:1386-1391. [PMID: 12707139 DOI: 10.1213/01.ane.0000057606.82135.7d] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Epidurally administered midazolam can potentiate analgesia by epidural bupivacaine. However, whether this effect is synergistic or additive is not known. In this study, we investigated the spinally-mediated analgesic interaction between midazolam and bupivacaine by using the tail-flick and formalin tests in rats with chronically implanted catheters. Behavioral effects were also observed. The dose dependency of analgesia and the 50% effective doses of intrathecal midazolam and bupivacaine were determined, and then the interaction of these two drugs was examined with an isobolographic analysis. Both drugs had dose-dependent analgesic effects in both the tail-flick test and the formalin test. The 50% effective dose values of the combination were significantly lower than the calculated additive values in both tests (P = 0.023 in the tail-flick test; P = 0.0025 in Phase 1 and 0.047 in Phase 2 of the formalin test). Behavioral side effects decreased in the combination group compared with each drug alone. In conclusion, intrathecally administered midazolam and bupivacaine had synergistic analgesic effects on acute thermal- or inflammatory-induced pain, with decreased behavioral side effects. IMPLICATIONS In both acute thermal- and inflammatory-induced pain, intrathecally administered midazolam and bupivacaine produced synergistic analgesia with decreased side effects in intrathecally catheterized rats.
Collapse
Affiliation(s)
- Tomoki Nishiyama
- Department of Anesthesiology, The University of Tokyo, Tokyo, Japan
| | | |
Collapse
|