Developmental differences between high and low affinity opiate binding sites: their relationship to analgesia and respiratory depression

Narcotic Utilization After Cleft Lip Repair: Does Local Anesthetic Choice Matter?

To analyze whether the choice of intraoperative local anesthetic for cleft lip repair is associated with the amount of perioperative narcotic utilization.

Retrospective cohort study.

Hospitals participating in the Pediatric Health Information System.

Primary cleft lip repairs performed in the United States from 2010 to 2020.

Local anesthesia injected-treatment with lidocaine alone, bupivacaine alone, or treatment with both agents.

Perioperative narcotic administration.

During the study interval, 8954 patients underwent primary cleft lip repair. Narcotic utilization for unilateral (P < .001) and bilateral (P = .004) cleft lip repair has decreased over the last 5 years. Overall, 21.8% (n = 1950) of infants were administered perioperative narcotics for cleft lip repair, such that 14.3% (n = 1282) required narcotics on POD 0, and 7.2% (n = 647) required narcotics on POD 1.In this study, 36.5% (n = 3269) patients received lidocaine, 22.0% (n = 1966) patients received bupivacaine, and 19.7% (n = 1762) patients received both local anesthetics. Administration of any perioperative narcotic was significantly lower in patients receiving both lidocaine and bupivacaine than those receiving only lidocaine (P = .001, 17.5% vs 21.7%) or only bupivacaine (P < .001, 17.5% vs 22.9%). Narcotic utilization on the day of surgery was significantly lower in patients receiving both lidocaine and bupivacaine than those receiving only lidocaine (P < .001, 11.5% vs 15.1%) or only bupivacaine (P = .004, 11.5% vs 14.6%). Narcotic utilization on the first postoperative day was significantly lower in patients receiving both lidocaine and bupivacaine than those receiving only bupivacaine (P = .009, 5.9% vs 8.1%).

CONCLUSIONS

In children undergoing cleft lip repair, local anesthetic combination of lidocaine and bupivacaine is associated with decreased perioperative narcotic use compared to lidocaine or bupivacaine alone.

An interview with Dr. Anne Marie Lynn, a pioneering woman in medicine

Dr. Anne Marie Lynn (1949-present), Professor Emeritus of Anesthesiology, Pain Medicine, and Pediatrics at the University of Washington, Seattle, was one of the most influential women in pediatric anesthesiology of her generation. Dr. Lynn embodies the spirit of discovery and advancement that have created the practice of pediatric anesthesiology as we know it today. A pioneer in pain medicine pharmacology, particularly morphine and ketorolac, her research transformed pediatric anesthesia, pediatric pain medicine, and pediatric intensive care medicine. Through her journal articles, book chapters, national and international lectures, mentoring of residents, fellows, and faculty, and leadership in the Society for Pediatric Anesthesia, she inspired a generation of women and men physicians by demonstrating that gender should not be a barrier to undertaking roles once only held only by men. In 2017, for her many contributions, she was awarded the Society for Pediatric Anesthesia's Myron Yaster lifetime achievement award.

Nociception and antinociception during the first week of life in mice: Sex differences and test dependence

This study demonstrates that reliable sex differences in nociceptive and antinociceptive mechanisms are present in even very young subjects. Sex differences were observed in mice tested either on the day of birth or 1 week later on basal tail-flick latency and morphine analgesic magnitude. Female mice had longer tail-withdrawal latencies; male mice demonstrated stronger analgesic responses to morphine. In addition, basal pain behavior and analgesic responsiveness differed between day-old and week-old animals on the hot plate, with day-old mice showing enhanced pain behavior and reduced morphine antinociception compared to week-old subjects. These findings further support the competence of pain processing circuitry in even very young subjects and highlight the early development of nociceptive and antinociceptive mechanisms.

PERSPECTIVE

This study highlights the competence of nociceptive circuitry and the analgesic efficacy of morphine as early as the day of birth in mice, reinforcing the importance of evaluating and treating pain in even the youngest subjects. Sex differences were present, suggesting infant sex as one of several potential factors that predict the experience of procedural or pathological pain and analgesic requirement.

Developmental expression of mu and delta opioid receptors in the rat brainstem: evidence for a postnatal switch in mu isoform expression

Opioid receptors are expressed in the brain during fetal and postnatal development, and the expression patterns vary with developmental age. To investigate the role of opioids in brain development, immunoblotting and immunohistochemical techniques were used to determine mu (MOR) and delta (DOR) opioid receptor expression levels and regional distributions in fetal, early postnatal and adult rat brainstem. Two immunoreactive bands were seen on Western blots of brainstem lysates for both MOR (50 and 70 kDa) and DOR (30 and 60 kDa). The expression levels of the isoforms changed dramatically between 6 and 15 days after birth. Total MOR protein was expressed at low levels in fetal and early postnatal animals with the 50-kDa band predominating. MOR expression then increased in the older animals and the 70-kDa isoform became dominant. Total DOR protein showed the opposite pattern, being high in the fetal and neonatal brainstem and low in the juvenile and adult. A postnatal switch in isoform expression for DOR was not evident in our study. In general, regional brainstem distributions in developing and adult animals were comparable to those reported in the literature, and both receptors were localized in the same areas where opioid receptor expression was high. It was concluded that MOR and DOR are developmentally regulated in the brainstem of the rat, that the isoform ratio switches postnatally from a fetal-neonatal pattern to a juvenile-adult pattern and that both receptors are generally expressed in the same brainstem regions from E16 to adult.

Age-dependency of analgesia elicited by intraoral sucrose in acute and persistent pain models

Treatment of pain in newborns is associated with problematic drug side effects. Previous studies demonstrate that an intraoral infusion of sucrose and other sweet components of mother's milk are effective in alleviating pain in infant rats and humans. These findings are of considerable significance, as sweet tastants are used in pain and stress management in a number of clinical procedures performed in human infants. The ability of sweet stimuli to induce analgesia is absent in adult rats, suggesting that this is a developmentally transient phenomenon. However, the age range over which intraoral sucrose is capable of producing analgesia is not known. We investigated the effects of intraoral sucrose (7.5%) on nocifensive withdrawal responses to thermal and mechanical stimuli in naive and inflamed rats at postnatal days (P) P0-21. In some rats, Complete Freund's adjuvant (CFA) was injected in a fore- or hindpaw to produce inflammation. In non-inflamed animals, for noxious thermal stimuli, sucrose-induced analgesia emerged at P3, peaked at P7-10, then progressively declined and was absent at P17. For mechanical forepaw stimuli, sucrose-induced analgesia emerged, and was maximal at approximately P10, then declined and was absent at P17. By contrast, maximal sucrose-induced analgesia for mechanical hindpaw stimuli was delayed (P13) compared to that for the forepaw, although it was also absent at P17. In inflamed animals, sucrose reduced hyperesthesia and hyperalgesia assessed with mechanical stimuli. Sucrose-induced analgesia in inflamed animals was initially present at P3 for the forepaw and P13 for the hindpaw, and was absent by P17 for both limbs. Intraoral sucrose produced significantly greater effects on responses in fore- and hindpaws in inflamed rats than in naive rats indicating that it reduces hyperalgesia and allodynia beyond its effects on responses in naive animals. These findings support the hypothesis that sucrose has a selective influence on analgesic mechanisms and that an enhanced sucrose effect takes place in hyperalgesic, inflamed animals as compared to naive animals. Taken together, these results indicate that intraoral sucrose alleviates transient pain in response to thermal and mechanical stimuli, and also effectively reduces inflammatory hyperalgesia and allodynia. Sucrose-induced analgesia is age-dependent and limited to the pre-weaning period in rats. The age-dependency of sucrose-induced analgesia and its differential maturation for the fore- and hindpaw may be due to developmental changes in endogenous analgesic mechanisms and developmental modulation of the interaction between gustatory and pain modulatory pathways.

Postnatal development of multiple opioid receptors in the spinal cord and development of spinal morphine analgesia

The postnatal ontogeny of mu, delta and kappa opioid receptor binding sites in the spinal cord of rat pups at various postnatal days was determined using in vitro autoradiographical methods. The functional effect of spinal morphine was also assessed using in vivo electrophysiological methods in rats at P14, P21 and adults (P56). Both mu and kappa opioid receptor binding-sites are present from P0 and spread relatively diffusely throughout the spinal cord. Overall binding peaks at P7 and subsequently decreases to adult levels with the mu opioid receptor binding sites regressing to become denser in the superficial dorsal horn. delta Opioid receptor binding was first seen at P7, and no distinction between superficial and deeper laminae was seen. In the adult, the relative proportions of the opiate receptors in the superficial dorsal horn are 63%, 22% and 15%, for mu, delta and kappa receptor binding sites, respectively. C-fibre evoked dorsal horn neuronal responses recorded from anaesthetized rat pups were highly sensitive to spinal morphine at P21, (EC50 0.005 microgram), compared to the adult (EC50 0.9 microgram). However, the EC50 (0.2 microgram) at P14 was greater than at P21 despite the fact that mu receptor binding was greater at P14. Opioid receptor binding is developmentally regulated and undergoes substantial postnatal reorganization. However, the number of mu receptor binding sites appears not to be the only determinant of functional sensitivity to spinal morphine. Other factors, such as coupling of the receptors are likely to be important.

The use of intravenous opioids to provide analgesia in critically ill, premature neonates: a research critique

The intravenous (i.v.) administration of opioids to neonates is a common method of providing analgesia in the intensive care setting. This paper reviews and critiques the studies that have investigated this intervention. The studies are grouped into four major areas: pharmacokinetic studies; i.v. opioids for anesthesia; i.v. opioids for sedation or analgesia in mechanically ventilated neonates; and cardiorespiratory effects of i.v. opioids. An attempt is made to synthesize current knowledge about the analgesic effects and side effects associated with the use of i.v. opioids in neonates. The intent is to stimulate additional research on the management of neonatal pain using opioid analgesics.

Pain management in newborns: how far have we progressed in research and practice?

Compelling research supports the newborn infant's capacity for pain. Yet, pain is frequently underestimated and undertreated. This is a result of limited understanding of pain pathway development, immediate and long-term consequences, measurement tools and approaches, and safety and efficacy of pain-relieving interventions. This paper reviews recent research in relation to management of pain in the newborn, and presents implications for practice and future research.

Effects of morphine, pentobarbital and amphetamine on formalin-induced behaviours in infant rats: sedation versus specific suppression of pain

The behavioural response of infant rats to intraplantar injection of formalin consists of specific directed behaviours (limb flexion, shaking and licking the injected paw) and non-specific behaviours that are also induced by non-nociceptive stimulation (squirming, hind limb kicks and whole body jerks), with specific indicators becoming more frequent as pups mature. The present study examined the effects of systemic morphine, pentobarbital and D-amphetamine on formalin-induced behaviours and behavioural state in rat pups from 1 to 20 days of age. Morphine (1 mg/kg) almost completely suppressed both specific and non-specific indicators of pain, and produced mild sedation relative to handled control pups. Pentobarbital (10 mg/kg) produced a similar degree of sedation and suppression of non-specific measures as morphine, but only had weak effects on specific measures in pups less than 1 week old, and no effects thereafter. Suppression of both specific and non-specific pain measures after amphetamine (2 mg/kg) emerged during the 2nd week of life and was not associated with sedation. Thus, morphine produced behavioural analgesia in infant rats in a model of injury-induced inflammatory pain from the 1st postnatal day, when their neurological maturity is similar to a 25-week human fetus, and 1 week before antinociception is observed in thermal and pressure tests. The effects of morphine were qualitatively different from a sedative dose of pentobarbital. The data support the contention that opioids have specific analgesic effects in premature human neonates and underline the need for pain measures that discriminate between sedation and analgesia.

Morphine produces a biphasic modulation of substance P release from cultured dorsal root ganglion neurons

We have previously reported that morphine produces a concentration-dependent multiphasic modulation (inhibitions and facilitations) of substance P (SP) release from trigeminal nucleus caudalis slices by activation of distinct populations of mu-, delta- and kappa-opioid receptors. In the present study, we have examined a wide range of morphine concentrations on K(+)-evoked SP release from dissociated rat dorsal root ganglion (DRG) neurons in culture. SP immunoreactivity was measured in the release buffer. Morphine produced a biphasic effect on K(+)-evoked SP release without affecting basal release. A concentration of 30 nM morphine facilitated SP release while a concentration of 1 microM suppressed release. Higher concentrations of morphine (10-30 microM) did not alter SP release. The facilitatory effect evoked by 30 nM morphine was abolished by opioid-receptor blockade with naloxone (30 nM) and the inhibitory effect produced by 1 microM morphine tended to be reversed. We conclude that an intact neuronal circuitry is not required for morphine to produce an opioid receptor mediated biphasic modulation of SP released from unmyelinated primary afferents. It is plausible that the dose-dependent biphasic effects of opioid agonists may also produce biphasic effects on nociception.

Differential ontogenesis of thermal and mechanical antinociception induced by morphine and beta-endorphin

The antinociceptive effects induced by beta-endorphin and morphine given supraspinally have been previously demonstrated to be mediated by the activation of different neural mechanisms. The present experiments were to examine the effects of intraventricular administration of beta-endorphin and morphine in mechanical paw-withdrawal and thermal tail-flick nociceptive tests in rats of 2-28 days of age. 2-4-day-old neonates were not responsive to i.c.v. injection of beta-endorphin or morphine for the inhibition of the tail-flick response. The thermal antinociceptive responses induced by beta-endorphin and morphine started to develop in 7-14-day-old rats and continued to increase at 21-28 days. The inhibition of the mechanical paw-withdrawal response to beta-endorphin was already present in 2-day-old rats and morphine in 4-day-old rats. The mechanical antinociception progressively increased and reached a plateau at 7 days of age for beta-endorphin and 28 days of age for morphine. beta-Endorphin was found to be more efficacious than morphine in producing mechanical antinociception. The results demonstrate that beta-endorphin- and morphine-induced antinociception to mechanical and thermal stimuli develops differently and are consistent with the hypothesis that two descending pain inhibitory systems activated by beta-endorphin and morphine are differentially developed.

A comparison of the antinociceptive effects of opioid agonists in neonatal and adult rats in phasic and tonic nociceptive tests

Changes in the attitudes about neonatal pain and pain management have recently resulted in increases in the administration of opioids to neonates. Little is known, however, about the relative potencies of the various opioid agonists employed, especially in comparison to adult responses. The first objective in the present study was to compare the antinociceptive potency of four clinically relevant opioids in neonatal and adult rats. The second objective was to compare and contrast these agents in two different types of nociceptive tests: tonic (formalin-induced inflammation) and phasic (tail flick and hot plate). Our results indicate that the opioid agonists morphine, meperidine, and fentanyl, and the mixed agonist buprenorphine were all effective antinociceptive agents in both neonates and adults in each of the three tests employed, and that the relative potencies of these agents appeared to be similar in neonates and adults. In general, the pups were more sensitive to the antinociceptive agents when tested in the phasic nociceptive tests, and the drugs were more potent in the tonic test than either of the phasic tests.

Functional development of central nervous system in the rat: ontogeny of nociceptive thresholds

The functional development of central nervous system (CNS) in the rat has been studied from the 10th to the 45th postnatal day, through a sensory function: nociception. Baseline pain responsiveness has been assessed with the tail-flick procedure. The mean tail-flick latency clearly decreases from the 10th to the 25th day, and remains stationary from this age to 45 days. The maturational processes underlying these reductions of tail-flick latencies in developing rats are discussed.

A method for the study of swimming stress and stress-induced antinociception in preweanling rats

Stress-induced antinociception (SIA) which is well characterized in the adult rat can also be observed in young rats, and, by varying swimming times, it can be dissociated into opioid and nonopioid forms. However, swimming ability in the rat does not fully develop until the third postnatal week and this has precluded the study of swim SIA in neonates. We report here the development of a harness device to aid swimming in young rats which we have successfully employed down to the age of 2 days without distress to the animals. Further we have also shown the development of the opioid form of swim SIA in the rat using this device. Swim SIA is absent at days 2 and 5, but at postnatal day 10 a small level of SIA is evident which is reversed by naloxone (10 mg/kg). Swim SIA develops rapidly thereafter, and the adult profile is observed by day 25.

The development of morphine-induced antinociception in neonatal rats: a comparison of forepaw, hindpaw, and tail retraction from a thermal stimulus

Two parallel experiments in rats 2-21 days of age investigated the onset and characteristics of morphine-induced antinociception. One measure of reactivity to pain, limb retraction from a hotplate, was utilized for three different limbs (forepaw, hindpaw, and tail) to chart the development of opioid sensitivity. Morphine-induced antinociception, even in 2-day-old rats, was obtained for all limbs, in a dose-related fashion, and reached peak sensitivity at 6-7 days of age. Naltrexone did not affect limb retraction latencies in nonmorphine treated rats at any age. These studies demonstrate early antinociception to low doses of an opiate and establish that the pain system, like positive reinforcement systems, is opiate sensitive.

Analgesic effects of intraventricular and intrathecal injection of morphine and ketocyclazocine in the infant rat

Little is known of the neural bases of analgesia in immature animals. This experiment examined the effects of intracerebroventricular (i.c.v.) and intrathecal (i.t.) administration of morphine or ketocyclazocine in tests of antinociception in rats aged 3 to 14 days of age. Analgesia tests were conducted using both thermal and mechanical (pressure) noxious stimuli applied to the forepaw, hindpaw or tail. In the 3-day-old morphine-injected i.c.v. produced analgesia in the forepaws when either the mechanical or thermal noxious stimulus was used. There was no effect when the hindpaw or tail was tested. At 10 days of age, when the mechanical stimulus was used, morphine was analgesic in tests on all three appendages but was only effective in the forepaw when the thermal stimulus was used. Morphine was fully effective in all tests with both stimuli at 14 days of age. Ketocyclazocine had no consistent effect when given i.c.v. When injected i.t., morphine produced analgesia in the forepaws in the thermal test at 4 days of age and in all appendages by 10 days. When the mechanical test was used, morphine was effective in all appendages at all ages tested. Ketocyclazocine was analgesic at all appendages for the mechanical stimulus at all ages but was only transiently effective in the thermal test. The results demonstrate differential development of analgesia mediated at different levels of the neural axis and are consistent with the development of descending inhibitory that may mediate analgesia induced by i.c.v. injections of morphine. Neural mechanisms that are involved in the analgesic effects of these drugs against the two types of stimuli are also developmentally distinct.

Differential development of beta-endorphin and mu opioid binding sites in mouse brain

Mouse brains of various ages from embryonal day 14 (E14) to adult were analyzed for opioid receptor binding using the enkephalin analog Tyr-D-Ala-Gly-NMe-Phe-Gly-ol (DAMGE) and the opiate alkaloid dihydromorphine (DHM) as mu-selective radioligands. Binding parameters were estimated from homologous and heterologous competition binding curves. During the postnatal period, Kd values for [3H]DAMGE did not change but Bmax values (fmol/mg protein) increased 2.7 fold from postnatal day 3 (P3) to P7. Minor receptor density fluctuations were evident from P7 to adult. Similar results were obtained with [3H]DHM. In contrast, estimation of total mu binding sites (fmol/brain) revealed a continuous rise from P3 to the adult. The postnatal developmental profile of total mu binding sites was comparable to the weight gain of mouse brain and the increase in protein content. In contrast, during the same period beta-endorphin immunoreactivity (IR) levels undergo an increase that is inversely proportional to mu opioid receptor Bmax values. [3H]DAMGE binding to E14 membrane preparations was inhibited to a greater extent by Gpp(NH)p than that to P1 or adult. Additional characterization of mu receptors was accomplished by heterologous competition binding assays. IC50 values for beta-endorphin in competition with [3H]DHM and [3H]DAMGE were age dependent and differed for the two radioligands. These results suggest that mu receptor selectivity for mu-specific peptide and alkaloid ligands changes as a function of age.

Patient-controlled analgesia for cancer pain: a long-term study of inpatient and outpatient use

The safety and efficacy of patient-controlled analgesia for the long-term control of cancer pain was tested prospectively. Respiratory rates, mental status, and pain relief were recorded at baseline and compared with those during the study period. Patients had a lower analgesic demand (i.e., self-administered less morphine during the nighttime); specifically, dosing declined 48% from the daytime level. Respiratory rates did not change appreciably during the study and no cases of significant respiratory depression were encountered. Patients self-administered sufficient morphine to produce adequate but not complete pain relief in almost all trials. Pain relief was safely achieved by both intravenous and subcutaneous routes of administration in both the inpatient and outpatient settings. Mean 24-h morphine use stayed relatively constant even for patients receiving more than 2 weeks of treatment. In conclusion, patient-controlled analgesia is effective and safe therapy for the long-term control of severe cancer pain.

Transient expression of opioid receptors in defined regions of developing brain: are embryonic receptors selective?

The developmental profile of opioid receptors was studied in rat and guinea pig striatum and hippocampus. The two brain regions show different receptor profiles during development, which are characteristic for each animal. Yet, both tissues and animal species share one common feature; the binding of the universal opioid ligand [3H]diprenorphine per milligram of protein is high at the early embryonic period, it decreases toward birth, and then gradually increases to the adult levels. This apparent transient expression of the receptors during the early developmental stage was manifested in the guinea pig as an actual decrease in the total receptor number. As an attempt to characterize the receptors involved in this process, the binding of the selective mu-opioid ligand [3H]Tyr-D-Ala-Gly-MePhe-NH(CH2)OH [( 3H]DAGO) was studied in striatal membranes of young (P1) and adult (P60) rats. Competition between [3H]DAGO and the delta-selective peptide Tyr-D-Pen-Gly-Phe-D-Pen (DPDPE) shows higher affinity of the delta opioid to P1 membranes than to P60 membranes, though the number of delta receptors in P1 membranes is very small. This observation is in line with a previous study suggesting that opioid receptors in embryonic striatum and hippocampus are less selective to various opioids than those of adult brain. An additional difference between adult and embryonic tissue was observed on Scatchard analysis of [3H]DAGO binding; striatum P60 membranes exhibit one binding site with a KD of 0.8 +/- 0.1 nM and Hill coefficient of 0.96, whereas striatum P1 membranes bind the peptide in an apparent cooperative fashion with an overall Hill coefficient of 1.30.(ABSTRACT TRUNCATED AT 250 WORDS)

Age-dependent changes in the subcellular distribution of rat brain mu-opioid receptors and GTP binding regulatory proteins

The relative subcellular distributions of mu-opioid receptors and guanine nucleotide binding regulatory proteins (G proteins) in 1-day-old (P1) and adult rat forebrain were compared. Light membranes (LMs) were resolved from heavy membranes (HM) by sucrose density gradient centrifugation. Marker enzyme analyses indicated that LMs contained most of the endoplasmic reticulum and Golgi complexes, whereas HMs were enriched in plasma membranes. Binding distribution and properties of mu-opioid sites were assessed using [3H] [D-Ala2,Me-Phe4,Gly-ol5]enkephalin. P1 LMs possessed 43% of the total mu-opioid binding detected compared to 16% in the adult. Although NaCl inhibited mu binding in LMs to a greater extent than in HMs, age-dependent differences were not observed. P1 LM mu binding possessed greater sensitivity to 5'-guanylylimidodiphosphate than their adult counterpart. Moreover, P1 LMs contained more Go alpha protein than P1 HMs or adult LMs, as demonstrated by immunoblotting with antisera against Go alpha after one- or two-dimensional gel electrophoresis. These results suggest that P1 LMs contain a greater proportion of newly synthesized intracellular mu sites than adult LMs.

Ontogeny and distribution of opioid receptors in the rat brainstem

The distribution and postnatal ontogeny of opioid receptors have been investigated using in vitro quantitative receptor autoradiography. Rats were studied at postnatal day 1 (P1), P5, P10, P21 and P120 (adult). Opioid receptor sites for (D-Ala2,N-MePhe4,Gly-ol5)-enkephalin (DAMGO) binding were labelled with 4 nM of 3H-DAMGO; (D-Ala2,D-Leu5)-enkephalin (DADLE) binding sites were labelled with 4 nM of 3H-DADLE in the presence of 1 microM unlabelled mu-agonist (N-MePhe3,D-Pro4)-morphiceptin (PL107). We found that both binding sites have strikingly different distributional patterns. [3H]DADLE binding sites were rather homogeneous, whereas the distribution of [3H]DAMGO binding was very heterogeneous with the highest density in the nucleus of the solitary tract (NTS), ambiguus nucleus, dorsal motor nucleus of the vagus and the parabrachial areas. [3H]DAMGO binding density was 2- to 40-fold higher than [3H]DADLE binding sites in most brainstem nuclei. [3H]DAMGO binding sites appeared in most brainstem nuclei at birth, with a high density in cardiorespiratory-related nuclei, whereas [3H]DADLE binding sites were too scarce to be quantitated at P1. Both binding sites increased with age, but the developing patterns depended on the nucleus and the type of binding site. In most areas, the densities of both binding sites reached a maximum between P10 and P21 and then decreased to an adult level, but in some nuclei (e.g. the caudal part of the NTS and dorsal raphe nucleus), [3H]DAMGO binding sites kept increasing until adulthood. In contrast with the brainstem, cortical areas had a lower binding density in the newborn and reached peak levels later than brainstem regions (post P21). We conclude that (1) since [3H]DAMGO binding sites mainly reflect mu-receptors and [3H]DADLE binding sites delta-receptors (in the presence of PL017), the brainstem is essentially a mu-receptor region through delta-receptors are present; (2) both opioid receptors are present at birth but delta-receptors are very scarce in the newborn; (3) both receptors increase with age, but the time course depended on various nuclei and receptor types; (4) cardiorespiratory-related nuclei have high density of mu-receptors at all ages; and (5) opioid receptors develop earlier in the brainstem than in the cortex.

Evidence for opiate tolerance in newborn rats

It has been reported that tolerance to the antinociceptive effect of morphine does not develop in rats younger than 15 days of age. This may be due to a masking effect of rapidly proliferating opiate receptors during the first 2 postnatal weeks. Newborn rats received morphine (20 mg/kg) or equivolume saline on postnatal days 5, 6, 7, 8 and antinociception was assessed on each day. On day 9, animals of both groups were injected with 0, 0.25, 0.50, 1, 2, 4, 8 or 20 mg/kg of morphine. Antinociception, tested by the tail-flick method, did not diminish over days 5-8, yet on day 9 a rightward shift in the dose-response curve occurred. Thus, tolerance in rats occurs to morphine induced antinociception earlier than 15 days postnatally.

Opioid-induced respiratory depression and analgesia may be mediated by different subreceptors

Use of selective delta opioid antagonists provide evidence that the delta receptor within the brain seems an integrated part in the mediation of respiratory depression induced by a potent analgesic like fentanyl. Low doses of the delta antagonists RX-8008M (3-6 micrograms/kg) as well as ICI 174,864 (3-6 micrograms/kg) reversed fentanyl-related respiratory depression (arterial blood gases) in the unanesthetized canine. Opioid-induced blockade of afferent sensory nerve volleys (amplitude height of the somatosensory-evoked potential) could be reversed only by a high dose (9 micrograms/kg) of RX-8008M. Depression of amplitude height of the SEP could not be reversed by ICI 174,864 over the whole dose range (3-6-9 micrograms/kg). In comparison, naloxone (1-5-10 micrograms/kg) not only reversed depression of PaO2, it also reversed the blockade of afferent sensory nerve impulses in the low (5-micrograms/kg)-dose range. A highly selective delta antagonist may have a therapeutic value in reversing opioid-related respiratory depression, resulting in little or no attenuation of analgesia.

Differential effect of mu, delta, and kappa ligands on G protein alpha subunits in cultured brain cells

Rat and guinea pig fetal brain cell cultures and immunoblotting techniques were used to study the effect of receptor selective opioids on the level of the membrane-bound alpha i and alpha o GTP binding protein subunits. Incubation of rat hindbrain cultures with the mu selective peptide DAGO decreased the amount of both alpha proteins. The reduction observed was equivalent to 36% in alpha o and 41% in alpha i. On the other hand, incubation of rat forebrain cultures with this peptide had an opposite effect, increasing the alpha o and alpha i levels by 66% and 68%, respectively. This differential effect of the peptide on the G proteins at the two brain areas may reflect the selective interaction at the receptor level; DAGO induced a fast and effective receptor down-regulation (50% decrease in Bmax) in hindbrain but not in forebrain cultures. Moreover, delta and mu selective ligands differed in their effect, as indicated by the finding that the delta selective peptide DPDPE increased the amount of both alpha proteins in hindbrain cultures by 40%. Similar experiments conducted with guinea pig brain aggregate cultures indicated that the kappa selective agonist U50,488 decreased the amount of the membrane bound alpha i protein subunit by 56%. The results thus indicate that opioid agonists, interacting selectively with the three types of opioid receptors, induce a complex repertoire of changes in the immunoreactive levels of the membrane-bound alpha GTP binding protein subunits in various CNS structures.

Ontogenesis of cell surface mu-opioid ([3H]DAGO) binding sites in rat hypothalamus and ex vivo determination of blood-brain barrier penetration by opioid peptide FK 33-824

Previous studies have demonstrated that the LH response to naloxone changes during development but the reason(s) for this are unknown. In the present work we have investigated the possibility that variations in cell surface opioid receptor levels (determined in tissue slice/punches) or changes in the ability of opioids to enter the CNS might be responsible. Opioid binding data indicate that both [3H]naloxone and [3H]DAGO-labelled binding sites remain at low levels until 10 days of age after which there is a progressive rise to adult levels at 15 days ([3H]DAGO) and 21 days ([3H]naloxone). Although several peaks and nadirs were observed in this detailed profile of receptor ontogeny, no exact correlation with the time course of LH response to opioid drugs was found. In an adaption of the slice binding assay we are able to quantify drug penetration into the brain (ex vivo binding). Ex vivo binding studies of blood-brain barrier (BBB) ontogeny indicate that there are changes with age in the ability of opioid peptides, injected subcutaneously, to inhibit binding at the mu-receptor. FK 33-824 induced a reduction in [3H]DAGO binding in the mediobasal hypothalamus until 15 days of age. FK in older rats had no effect on [3H]DAGO binding suggesting that formation of the BBB is complete at this age. In contrast, FK injection reduced binding in the median eminence-arcuate nucleus area (outside BBB) until 30 days of age. Surprisingly, this area also became refractory to FK injection after this age.(ABSTRACT TRUNCATED AT 250 WORDS)

Three-dimensional distribution of 3H-naloxone binding to opiate receptors in the human fetal and infant brainstem

Despite the putative role of opioids in disorders of the developing human brainstem, little is known about the distribution and ontogeny of opioid-specific perikarya, fibers, terminals, and/or receptors in human fetuses and infants. This study provides baseline information about the quantitative distribution of opiate receptors in the human fetal and infant brainstem. Brainstem sections were analyzed from three fetuses, 19-21 weeks gestation, and seven infants, 45-68 postconceptional weeks, in whom the postmortem interval was less than or equal to 12 hours. Opiate receptors were localized by autoradiographic methods with the radiolabelled antagonist 3H-naloxone. Computer-based methods permitted quantitation of 3H-naloxone binding in specific nuclei, as well as three-dimensional reconstructions of binding patterns. High 3H-naloxone binding corresponds primarily to sensory and limbic nuclei, and to nuclei whose functions are known to be influenced by opioids, e.g., trigeminal nucleus (pain), nucleus tractus solitarii and nucleus parabrachialis medialis (cardio-respiration), and locus coeruleus (arousal). The regional distribution of opiate receptors as determined by 3H-naloxone binding is similar in human infants to that reported in human adults and animals and corresponds most closely to that of mu receptors. We found, however, that opiate receptor binding is high in the fetal and infant inferior olive, in comparison to low binding reported in this site in adult humans, primates, and rodents. In addition, opiate receptors are sparse in the fetal and infant substantia nigra, as in reports of the adult human substantia nigra, compared to moderate densities reported in primates and rodents. By midgestation, the regional distribution of 3H-naloxone binding in human fetuses is similar, but not identical, to that in infants. Highest 3H-naloxone binding occurs in the inferior olive in fetuses at midgestation, compared to the interpeduncular nucleus in infants. Tritiated naloxone binding quantitatively decreases in virtually all nuclei sampled over the last trimester, but not to the same degree. The most substantial binding decrease (two- to fourfold) occurs in the inferior olive and may reflect programmed regressive events, e.g., neuronal loss, during its development. Definitive developmental trends in 3H-naloxone binding are not observed in the postnatal period studied. The heterogeneous distribution of opiate binding in individual brainstem nuclei underscores the need for volumetric sampling in quantitative studies.

Expression of the three opioid receptor subtypes mu, delta and kappa in guinea pig and rat brain cell cultures and in vivo

Expression of the three opioid receptor subtypes mu, delta and kappa in aggregating cell cultures prepared from embryonic guinea pig or rat brains was compared with the in vivo expression of the receptors in the brain of developing and adult animals of the same species. At the day of culturing, one third of the receptors in the brain of guinea pig embryos were of the kappa type. In culture, however, the aggregating brain cells acquired within 14 days a high percentage (75%) of kappa receptors. As only 28% of the receptors in the adult guinea pig brain are of this subtype, an attempt was made to further analyse the specificity of this developmental process. In guinea pig, the 2-fold increase in kappa receptors in culture was accompanied with a decline in both the percentage and the density (per protein) of mu and delta subtypes. In contrast, a marked increase in delta receptors was observed in rat whole brain, forebrain or hindbrain cultures. Thus, the developmental pattern of the three receptor subtypes in rat brain cultures, but not in guinea pig, was similar to that in vivo. These and additional experiments suggest that at the developmental stage taken to prepare the cultures, neurons expressing opioid receptors were already programmed in the rat but not in guinea pig brain.

Developmental aspects of nociception

Research has documented the existence of multiple, endogenous systems that modulate nociception. Based on the effects of opioid antagonists and endocrine lesions, endogenous analgesia systems have been organized into four classes: neural-opioid, neural-nonopioid; hormonal-opioid; hormonal-nonopioid. Developmental research on the ontogeny of endogenous analgesic function has revealed differential rates of maturation. Front-paw shock, a stimulus that activates a neural-opioid analgesic response, has been shown to be functionally mature by 28 days of age in the rat. Similarly, hind-paw shock, a stimulus that elicits a neural-nonopioid analgesic response, reaches maturity after two months of age. However, the hormonal-opioid analgesic system activated by cold-water immersion reaches adult levels by 10 days of age. Food deprivation produces a hormonal-opioid analgesic response in adult rats, and food deprivation/isolation of rat pups has been found to elicit an analgesic response in 6-day-old rats. From these data it seems that the rate of development of the different endogenous analgesic systems is related to the activation of neural or hormonal components. Whether the differential rates of development and the neural-hormonal distinction are related to the ecological validity of the activating stimulus remains to be determined.

The ontogeny of opiate tolerance and withdrawal in infant rats

The acquisition of morphine analgesic tolerance was investigated in neonatal rats. Morphine was found to produce a potent analgesia, as measured by latency to retract a hindpaw from a 52 degree C hotplate, in rat pups as young as 1 day of age. Morphine analgesic tolerance, however, did not develop in rats until the third week of life. Rats given the same daily morphine regimen starting at 15 days of age or older showed rapid tolerance development. The data from four experiments indicate that experience with morphine prior to this age (Day 15) does not impact on the analgesic efficacy of the drug. Similarly, when morphine treatment was discontinued and the rats given a naloxone challenge, withdrawal symptoms were not observed in very young rats. Opiate withdrawal was first detected in rats that started their daily morphine treatment at 30 days of age and were then challenged with naloxone at 52 days of age. Therefore, two correlates of opiate addiction, tolerance and withdrawal, appear to be relatively late-developing phenomena in the rat.

Management of pediatric pain with opioid analgesics

We have attempted to dispel many of the myths and misconceptions surrounding the use of narcotic analgesics in the treatment of childhood pain. Our hope is that an improved understanding and the application of effective, safe therapy will minimize the suffering of the child with acute or chronic pain.

Ethylketocyclazocine and bremazocine analgesia in neonatal rats

In three experiments we examined the analgesic potency of kappa opioid receptor agonists in 2- and 16-day-old rats. Ethylketocyclazocine (1-50 mg/kg) produced similar dose- and time-dependent increases in the latency to retract a hind paw from a noxious thermal stimulus in rats of both ages. Bremazocine (0.001-10 mg/kg), a kappa agonist with reported antagonist activity at mu receptors, was also effective in producing analgesia in 2-day-old rats. The dose-effect relationship for bremazocine was nonmonotonic. Bremazocine analgesia (0.1 mg/kg) was reversed by both naltrexone and MR2266, a putative kappa opioid antagonist. These results are discussed in terms of the functional integrity of a kappa analgesic system in the developing rat.

Analgesic effects of intrathecally applied noradrenergic compounds in the developing rat: differences due to thermal vs mechanical nociception

Peak noradrenergic receptor development in rat spinal cord has been shown to occur around 12 days of postnatal life. The intent of the present study was to examine the development of analgesia produced by spinally applied noradrenergic agonists. The extent to which these drugs modulate pain information evoked by a thermal vs mechanical stimulus in the infant rat was also addressed. Intrathecal norepinephrine resulted in analgesia that was more pronounced against a mechanical than thermal stimulus and more pronounced in 10-day-olds than 3-day-olds. The alpha 2 receptor agonist clonidine produced a dose-dependent analgesia that first appeared at 7 days of age when tested with a thermal stimulus and 3 days of age when tested with a mechanical stimulus. The analgesic effect of clonidine was also greatest at 10 days of age. The alpha 1 agonist phenylephrine was without analgesic effects. The developmental profile of behavioral analgesia correlates with the ontogeny of noradrenergic receptor activity in the spinal cord. The finding that intrathecal norepinephrine produced a more pronounced analgesia against a mechanical rather than thermal stimulus in the adult is supported by our investigation in the infant rat.

Milk-induced analgesia and comforting in 10-day-old rats: opioid mediation

The effects of slow intraoral milk infusions on the opioid-mediated behaviors of ultrasonic vocalizations and paw removal from a hot plate (48-49 degrees C) were evaluated in 10-day-old rats. Milk reduced distress vocalization by circa 30% while increasing paw lift latencies by about 60%. Alterations in both behaviors were fully reversed by naltrexone (0.5 mg/kg) pretreatments. These data demonstrate the calming and analgesic effects of milk. Implications for a possible role of opioid peptides in mother-young relationships are discussed.

Ontogeny of an endogenous, nonopioid and hormonally mediated analgesic system

Rats of different ages (10-day, 28-day, and 3-month-old) were exposed to cold-water stress in order to activate an endogenous analgesic system. The effects of naltrexone (7 mg/kg) and dexamethasone (.4 mg/kg) were also studied to examine the role of the opioid and hormonal systems in cold-water-induced analgesia. Following cold-water exposure, nociception was measured with the tail-flick procedure for 2 hr. Results revealed that cold water produced a significant level of analgesia in the 10-day, 28-day, and 3-month-old age groups with no differences between age groups. In addition, in each age group naltrexone did not block the analgesia while dexamethasone attenuated the analgesia produced by cold water. The effects of naltrexone and dexamethasone confirm that cold-water immersion activates a nonopioid, hormonally mediated analgesic system in each age group. Thus, this experiment found that the endogenous, nonopioid, and hormonally mediated analgesic system activated by cold water is functional early in the development of the rat. The early development of this hormonally mediated analgesic system is in contrast to the slower development of endogenous analgesia systems that are mediated by the central nervous system.

Developmental differences in the analgesia produced by the central cholinergic system

In order to study the ontogenesis of cholinergically mediated analgesia in the central nervous system (CNS), 10-day-, 28-day-, and 3-month-old rats were injected with .025, .05, and .10 mg/kg of oxotremorine, a muscarinic receptor agonist. To restrict the effect of oxotremorine to the CNS, methylscopolamine, a peripheral muscarinic antagonist, was injected simultaneously (.19 mg/kg, a dose equimolar to .10 mg/kg of oxotremorine). Following drug injections the tail-flick procedure was used to assess analgesia. Results revealed that oxotremorine was completely ineffective in producing analgesia in the 10-day- and 28-day-old age groups. By 3 months of age oxotremorine produced a dose-dependent analgesia. Since most neurochemical markers of cholinergic receptor function are at mature or near mature levels by 28 days of age, neurochemical indexes of receptor function overestimate the analgesic function of the central cholinergic system.

Morphine- and ketocyclazocine-induced analgesia in the developing rat: differences due to type of noxious stimulus and body topography

Patterns of morphine- and ketocyclazocine-induced analgesia in limb withdrawal and tail-flick tests of thermal and mechanical nociception were examined in the preweanling rat. In the forepaw test, morphine was more effective than ketocyclazocine with both thermal and mechanical stimuli. Both drugs first induced analgesia between 3 and 5 days of age. In the tail-flick test, ketocyclazocine-induced analgesia preceded morphine's effects against both thermal and mechanical stimuli by several days. Ketocyclazocine produced robust analgesia between 7 and 10 days of age, while the effects of morphine did not peak until day 14. In the hindpaw, morphine was more effective than ketocyclazocine against a higher intensity mechanical stimulus, while ketocyclazocine was more effective against a lower intensity mechanical stimulus. Morphine-induced analgesia was reversed by lower doses of naloxone than was ketocyclazocine-induced analgesia, regardless of body part tested, against all noxious stimuli. These findings demonstrate differences in morphine- and ketocyclazocine-induced analgesia that are dependent upon age, body topography, stimulus type and intensity and imply different physiologic roles of mu- and chi-opioid receptors in analgesia.

Guanine nucleotide and cation regulation of mu, delta, and kappa opioid receptor binding: evidence for differential postnatal development in rat brain

A study of the onset of cation and guanine nucleotide regulation of delta, mu, and kappa rat brain opioid receptors during postnatal development was undertaken. Site-specific binding assays were utilized for each receptor type and the effects of 0.5 mM MnCl2, 100 mM NaCl, and/or 50 microM guanosine-5'-(beta, gamma-imido) triphosphate [Gpp(NH)p] were assessed. The most pronounced changes of opioid binding were seen in the presence of Mn2+. In adults, agonist binding to delta sites was stimulated by Mn2+, whereas that to mu sites was not affected and kappa binding was inhibited. The postnatal development of Mn2+ regulation for the three receptor subtypes was distinctly different. The largest effects were seen on delta sites detected in the early neonatal period, Mn2+ eliciting a 68% stimulation of binding over controls at day 1. Significant inhibition of kappa site binding by Mn2+ was detected only after the third postnatal week. Mn2+ caused a significant reversal of Gpp(NH)p inhibition of delta binding in the early neonatal period, exceeding that in the absence of regulators. Inhibition of mu and delta receptor binding by Na+ was greater, and the Mn2+ reversal of this effect was smaller, in the first 2 postnatal weeks than in adults. Gpp(NH)p + Na+ regulation did not change appreciably during the postnatal period. However, Mn2+ reversal of the considerable inhibition elicited by the combination of Na+ and Gpp(HN)p was developmental time-dependent. The data are discussed in terms of multiple sites of interaction for guanine nucleotides and cations.(ABSTRACT TRUNCATED AT 250 WORDS)