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Barratt DT, Klepstad P, Dale O, Kaasa S, Somogyi AA. Pharmacokinetic and neuroimmune pharmacogenetic impacts on slow-release morphine cancer pain control and adverse effects. THE PHARMACOGENOMICS JOURNAL 2024; 24:18. [PMID: 38824169 PMCID: PMC11144121 DOI: 10.1038/s41397-024-00339-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 06/03/2024]
Abstract
The aim was to determine if opioid neuroimmunopharmacology pathway gene polymorphisms alter serum morphine, morphine-3-glucuronide and morphine-6-glucuronide concentration-response relationships in 506 cancer patients receiving controlled-release oral morphine. Morphine-3-glucuronide concentrations (standardised to 11 h post-dose) were higher in patients without pain control (median (interquartile range) 1.2 (0.7-2.3) versus 1.0 (0.5-1.9) μM, P = 0.006), whereas morphine concentrations were higher in patients with cognitive dysfunction (40 (20-81) versus 29 (14-60) nM, P = 0.02). TLR2 rs3804100 variant carriers had reduced odds (adjusted odds ratio (95% confidence interval) 0.42 (0.22-0.82), P = 0.01) of opioid adverse events. IL2 rs2069762 G/G (0.20 (0.06-0.52)), BDNF rs6265 A/A (0.15 (0.02-0.63)) and IL6R rs8192284 carrier (0.55 (0.34-0.90)) genotypes had decreased, and IL6 rs10499563 C/C increased (3.3 (1.2-9.3)), odds of sickness response (P ≤ 0.02). The study has limitations in heterogeneity in doses, sampling times and diagnoses but still suggests that pharmacokinetics and immune genetics co-contribute to morphine pain control and adverse effects in cancer patients.
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Affiliation(s)
- Daniel T Barratt
- Discipline of Pharmacology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
- Discipline of Physiology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
| | - Pål Klepstad
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesiology and Intensive Care Medicine, St Olavs University Hospital, Trondheim, Norway
| | - Ola Dale
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stein Kaasa
- Department of Oncology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Andrew A Somogyi
- Discipline of Pharmacology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, Australia
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Yao M, Fang B, Yang J, Chen P, Chen F. Esketamine combined with sufentanil versus sufentanil in patient-controlled intravenous analgesia: a meta-analysis. Front Pharmacol 2024; 15:1247646. [PMID: 38384296 PMCID: PMC10879558 DOI: 10.3389/fphar.2024.1247646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024] Open
Abstract
Objective: Patient-controlled intravenous analgesia (PCIA) can alleviate pain to some extent, and several randomized controlled trials (RCTs) have examined the efficacy of esketamine-assisted sufentanil in postoperative PCIA. In this research, we conducted a meta-analysis of relevant RCTs to compare the effect and safety of esketamine-sufentanil versus sufentanil alone for postoperative PCIA. Methods: We systematically searched the Cochrane Library, PubMed, Embase, Web of Science, CNKI, and other libraries up to December 2023 to screen out RCTs examining the use of esketamine combined with sufentanil for PCIA. We analysed analgesia scores, sedation scores, adverse drug reactions and postpartum depression scores as outcome indicators. Results: This meta-analysis included 32 RCTs. The results of the meta-analysis were as follows. 1) Visual Analog Scale: The VAS scores at 6, 12, 24, and 48 h were lower in the esketamine-sufentanil group than in the sufentanil alone group, and significant differences were found at all time points (p < 0.05). 2) Ramsay Sedation Scale: The sedation score of the esketamine-sufentanil group at 48 h after surgery was higher than that of the sufentanil group alone [mean difference (MD) = -0.09 points, confidence interval (CI): (-0.26, -0.07), p = 0.27], but this difference was not significant (p > 0.05). 3) Safety: Compared with sufentanil alone, the incidence rates of postoperative nausea-vomiting, dizziness-headache, skin pruritus and respiratory depression were significantly lower in the esketamine-sufentanil group. 4) Postartum depression: The reduction in postpartum depression scores were significantly greater in the esketamine-sufentanil group than in the sufentanil alone group at 3 days [MD = -1.35 points, CI: (-1.89, -0.81), p < 0.00001] and 7 days [MD = -1.29 points, CI: (-2.42, -0.16), p = 0.03]. Conclusion: The meta-analysis showed that the use of esketamine combined with sufentanil for postoperative PCIA could improve postoperative analgesia, alleviate postpartum depression and reduce the rate of postoperative adverse reactions, but there was no significant difference in sedation.
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Affiliation(s)
- Manman Yao
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei, China
- School of Pharmaceutical Sciences, Hubei University of Medicine, Shiyan, Hubei, China
| | - Baoxia Fang
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Jinguo Yang
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Peng Chen
- Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Fuchao Chen
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei, China
- School of Pharmaceutical Sciences, Hubei University of Medicine, Shiyan, Hubei, China
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Yang H, Gu X, Xu M, Yang G, Rao Y, Gao L, Gong G, He S. Preventing nausea and vomiting after gynecological laparoscopic surgery by patient-controlled intravenous analgesia with a naloxone admixture: A randomized controlled trial. Medicine (Baltimore) 2022; 101:e29584. [PMID: 35866767 PMCID: PMC9302326 DOI: 10.1097/md.0000000000029584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Opioid-induced nausea and vomiting are common side effects of patient-controlled intravenous analgesia (PCIA). This study aimed to explore the inhibitory effect of a naloxone admixture on the incidence of sufentanil-induced postoperative nausea and vomiting (PONV). METHODS A total of 132 Uyghur American Society of Anesthesiologists I and II patients scheduled to undergo elective gynecological laparoscopic surgery were recruited; among these, 120 patients were enrolled and randomly allocated into 4 groups: patients receiving PCIA but no naloxone were included in the control group (group A); patients receiving PCIA with a low-dose naloxone admixture at 0.2 μg·kg-1·h-1 were included in group B; patients receiving PCIA with naloxone admixture at 0.4 μg·kg-1·h-1 were included in group C; patients receiving PCIA with naloxone admixture at 0.6 μg·kg-1·h-1 were included in group D. All patients were administered sufentanil at 0.04 kg-1·h-1, butorphanol at 2 kg-1·h-1, and dexmedetomidine at 0.08 kg-1·h-1 using a PCIA device within 2 days of surgery. The occurrence of nausea and vomiting, visual analogue scores for pain intensity, mean arterial pressure, heart rate, oxygen saturation, pruritus, lethargy, respiratory depression, etc, was recorded at 2, 8, 12, 24, and 48 hours postoperatively. RESULTS There was a significant difference in the PONV scores between the groups at 8, 12, and 24 hours after surgery (P < 0.01). At 8 and 12 hours, the score of group C/D was significantly lower than that of group A/B (P < 0.01). At 24 hours after surgery, the PONV score of group B/C/D was significantly lower than that of group A (P < 0.01). No significant difference was observed in the general data and visual analogue scores for postoperative pain between the 4 groups. CONCLUSION Naloxone admixture administered at 0.4 to 0.6 μg·kg-1·h-1 can exert an effective inhibitory effect on the incidence and intensity of PONV in gynecological laparoscopic surgery.
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Affiliation(s)
- Haihong Yang
- Department of Anesthesiology, The General Hospital of Western Theater Command, Sichuan, China
- Department of Anesthesiology, No. 950 Hospital of PLA, Yecheng, China
| | - Xuedong Gu
- Department of Anesthesiology, The General Hospital of Western Theater Command, Sichuan, China
| | - Meiling Xu
- Department of Geriatrics, The General Hospital of Western Theater Command, Sichuan, China
| | - Guan Yang
- Department of Anesthesiology, The General Hospital of Western Theater Command, Sichuan, China
| | - Yunju Rao
- School of Clinical Medicine, Southwest Medical University, Sichuan, China
| | - Liang Gao
- Military Prevention and Treatment Center for Mountain Sickness, No. 950 Hospital of PLA, Yecheng, China
| | - Gu Gong
- Department of Anesthesiology, The General Hospital of Western Theater Command, Sichuan, China
| | - Siyi He
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, Sichuan, China
- * Correspondence: Siyi He, Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, Rongdu Avenue No. 270, Jinniu District, Chengdu City, Sichuan Province 610083, China (e-mail: )
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Kluger MT, Rice DA, Borotkanics R, Lewis GN, Somogyi AA, Barratt DT, Walker M, McNair PJ. Factors associated with persistent opioid use 6–12 months after primary total knee arthroplasty. Anaesthesia 2022; 77:882-891. [DOI: 10.1111/anae.15783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 01/19/2023]
Affiliation(s)
- M. T. Kluger
- Department of Anaesthesiology and Peri‐operative Medicine Waitematā DHB Auckland New Zealand
- Faculty of Medicine and Health Sciences University of Auckland New Zealand
| | - D. A. Rice
- Health and Rehabilitation Research Institute Auckland University of Technology Auckland New Zealand
| | | | - G. N. Lewis
- Health and Rehabilitation Research Institute Auckland University of Technology Auckland New Zealand
| | - A. A. Somogyi
- Discipline of Pharmacology, Faculty of Medicine and Health Sciences University of Adelaide South Australia Australia
| | - D. T. Barratt
- Discipline of Pharmacology, Faculty of Medicine and Health Sciences University of Adelaide South Australia Australia
| | - M. Walker
- Department of Orthopaedic Surgery Waitematā DHB Auckland New Zealand
| | - P. J. McNair
- Auckland University of Technology Auckland New Zealand
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Mustafa S, Evans S, Barry B, Barratt D, Wang Y, Lin C, Wang X, Hutchinson MR. Toll-Like Receptor 4 in Pain: Bridging Molecules-to-Cells-to-Systems. Handb Exp Pharmacol 2022; 276:239-273. [PMID: 35434749 DOI: 10.1007/164_2022_587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Pain impacts the lives of billions of people around the world - both directly and indirectly. It is complex and transcends beyond an unpleasant sensory experience to encompass emotional experiences. To date, there are no successful treatments for sufferers of chronic pain. Although opioids do not provide any benefit to chronic pain sufferers, they are still prescribed, often resulting in more complications such as hyperalgesia and dependence. In order to develop effective and safe medications to manage, and perhaps even treat pain, it is important to evaluate novel contributors to pain pathologies. As such, in this chapter we review the role of Toll-like receptor 4, a receptor of the innate immune system, that continues to gain substantial attention in the field of pain research. Positioned in the nexus of the neuro and immune systems, TLR4 may provide one of the missing pieces in understanding the complexities of pain. Here we consider how TLR4 enables a mechanistical understanding of pain as a multidimensional biopsychosocial state from molecules to cells to systems and back again.
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Affiliation(s)
- Sanam Mustafa
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.
- Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, The University of Adelaide, Adelaide, SA, Australia.
| | - Samuel Evans
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Benjamin Barry
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Daniel Barratt
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Yibo Wang
- Laboratory of Chemical Biology, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, Jilin, China
| | - Cong Lin
- Laboratory of Chemical Biology, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, Jilin, China
| | - Xiaohui Wang
- Laboratory of Chemical Biology, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, Jilin, China
- School of Applied Chemistry and Engineering, University of Science and Technology of China, Hefei, Anhui, China
| | - Mark R Hutchinson
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, The University of Adelaide, Adelaide, SA, Australia
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