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Gupta AK, Mena S, Jin Z, Gan TJ, Bergese S. Postoperative pain: a review of emerging therapeutic options. Expert Rev Neurother 2021; 21:1085-1100. [PMID: 34461794 DOI: 10.1080/14737175.2021.1974840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Postoperative pain is often managed by opioid medications, even though they carry a risk of adverse effects such as vomiting, constipation, sedation, respiratory depression and physical dependence. Furthermore, opioid use in the healthcare setting has likely contributed to the epidemic. However, the mismanagement of postoperative pain can result in delayed recovery time, impaired physical function, increased risk of morbidity and mortality, chronic pain, and higher healthcare costs. AREAS COVERED This review explores emerging therapeutic options and strategies in the management of acute postoperative pain and focuses on opioid-sparing, multimodal analgesia. This includes regional anesthetic techniques, non opioid pharmacotherapy, novel opioids and non-pharmacologic therapy. We have also discussed examples of novel analgesics and formulations which have potential benefits in reducing postoperative pain and opioid use after surgery. EXPERT OPINION The development of novel regional anesthesia techniques allows for opioid minimization in increasing number of surgical procedures. This synergizes with the availability of novel non-opioid analgesic adjucts. In addition, several novel opioid drugs have been developed which may be pathway selective and associated with less adverse effect than conventional opioids.
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Affiliation(s)
- Abhishek K Gupta
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, United States
| | - Shayla Mena
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, United States
| | - Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, United States
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, United States
| | - Sergio Bergese
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, United States.,Department of Neurological Surgery, Stony Brook University Health Science Center, Stony Brook, United States
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Cuřínová P, Hájek P, Janků K, Holakovský R. Method for determination of optical purity of 2‐arylpropanoic acids using urea derivatives based on a 1,1′‐binaphthalene skeleton as chiral NMR solvating agents: Advantages and limitations thereof. Chirality 2019; 31:410-417. [DOI: 10.1002/chir.23067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Petra Cuřínová
- Institute of Chemical Process FundamentalsCzech Academy of Sciences Prague Czech Republic
| | - Peter Hájek
- Department of Organic ChemistryUniversity of Chemistry and Technology Prague Czech Republic
| | - Kristýna Janků
- Department of Organic ChemistryUniversity of Chemistry and Technology Prague Czech Republic
| | - Roman Holakovský
- Department of Organic ChemistryUniversity of Chemistry and Technology Prague Czech Republic
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Piirainen A, Kokki M, Lidsle HM, Lehtonen M, Ranta VP, Kokki H. Absorption of ibuprofen orodispersible tablets in early postoperative phase - a pharmacokinetic study. Curr Med Res Opin 2018; 34:683-688. [PMID: 29043849 DOI: 10.1080/03007995.2017.1394832] [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] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Patient-controlled oral analgesia has gained popularity in postoperative pain management. Anesthesia and surgery delay gastrointestinal tract function and this may therefore decrease bioavailability of drugs taken by mouth. To hasten absorption, an orodispersible ibuprofen tablet has been developed. In this study, we evaluated the pharmacokinetics and feasibility of orodispersible ibuprofen tablets in spine surgery patients. METHODS The study design was a prospective clinical trial where each patient served as her/his own control. Fifteen patients aged 19-75 years were given two orodispersible ibuprofen 200 mg tablets the day before surgery and two more tablets immediately after surgery. Blood samples for ibuprofen concentrations were taken at intervals for 6 hours following pre- and postsurgical administration of ibuprofen. RESULTS The mean preoperative area under time-concentration curve for ibuprofen (AUC0-360) was 4806 (SD 1104) min·mg/L, and after surgery it was 2141 (583) min·mg/L (mean difference 2664, 95% CI for difference 2003 to 3325, p < .001). The mean of the maximum preoperative plasma concentration of ibuprofen was three times higher, 26.7 (7.7) mg/L, than the postoperative value of 8.6 (2.1) mg/L (mean diff. 18.1, 95% CI 13.9 to 22.4, p < .001). Times to maximum concentration were similar pre- and postoperatively at 155 (58) minutes and 169 (113) minutes (p = .67). No serious or unexpected adverse events were recorded. CONCLUSIONS While orodispersible ibuprofen tablets were feasible, ibuprofen absorption decreased immediately after surgery compared to the day before surgery. Thus, further studies are needed to establish the adequate initial postoperative dose.
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Affiliation(s)
- A Piirainen
- a Department of Anaesthesia and Operative Services , Kuopio University Hospital , Kuopio , Finland
- b Department of Anaesthesiology and Intensive Care, School of Medicine, Faculty of Health Sciences , University of Eastern Finland
| | - M Kokki
- a Department of Anaesthesia and Operative Services , Kuopio University Hospital , Kuopio , Finland
- b Department of Anaesthesiology and Intensive Care, School of Medicine, Faculty of Health Sciences , University of Eastern Finland
| | - H M Lidsle
- c School of Pharmacy, Faculty of Health Sciences , University of Eastern Finland , Kuopio , Finland
| | - M Lehtonen
- c School of Pharmacy, Faculty of Health Sciences , University of Eastern Finland , Kuopio , Finland
| | - V P Ranta
- c School of Pharmacy, Faculty of Health Sciences , University of Eastern Finland , Kuopio , Finland
| | - H Kokki
- a Department of Anaesthesia and Operative Services , Kuopio University Hospital , Kuopio , Finland
- b Department of Anaesthesiology and Intensive Care, School of Medicine, Faculty of Health Sciences , University of Eastern Finland
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Toledo MV, Briand LE. Relevance and bio-catalytic strategies for the kinetic resolution of ketoprofen towards dexketoprofen. Crit Rev Biotechnol 2017; 38:778-800. [PMID: 29124963 DOI: 10.1080/07388551.2017.1399249] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This review presents the most relevant investigations concerning the biocatalytic kinetic resolution of racemic ketoprofen to dexketoprofen for the last 22 years. The advantages related to the administration of the dex-enantiomer in terms of human health, the so called "chiral switch" in the pharmaceutical industry and the sustainability of biotransformations have been the driving forces to develop innovative technology to obtain dexketoprofen. In particular, the kinetic resolution of racemic ketoprofen through enantiomeric esterification and hydrolysis using lipases as biocatalysts are thoroughly revised and commented upon. In this context, the biocatalysts, acyl-acceptors (alcohols), reaction conditions, conversion, enantiomeric excess, and enantiomeric ratio among others are discussed. Moreover, the investigations concerning scaling up processes in order to obtain an optically pure enantiomer of the profen are presented. Finally, some guidelines about perspectives of the technology and research opportunities are given.
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Affiliation(s)
- María Victoria Toledo
- a Centro de Investigación y Desarrollo en Ciencias Aplicadas-Dr. Jorge J. Ronco (CINDECA) , Universidad Nacional de La Plata, CONICET , La Plata , Buenos Aires , Argentina
| | - Laura Estefanía Briand
- a Centro de Investigación y Desarrollo en Ciencias Aplicadas-Dr. Jorge J. Ronco (CINDECA) , Universidad Nacional de La Plata, CONICET , La Plata , Buenos Aires , Argentina
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Toledo MV, Llerena Suster CR, Ferreira ML, Collins SE, Briand LE. Molecular recognition of an acyl–enzyme intermediate on the lipase B from Candida antarctica. Catal Sci Technol 2017. [DOI: 10.1039/c7cy00245a] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Ketoprofen and serine form an acyl–enzyme intermediate species that vibrates at 1756 cm−1 in the infrared spectra.
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Affiliation(s)
- María V. Toledo
- Centro de Investigación y Desarrollo en Ciencias Aplicadas-Dr. Jorge J. Ronco
- Universidad Nacional de La Plata
- CONICET
- Buenos Aires
- Argentina
| | - Carlos R. Llerena Suster
- Centro de Investigación y Desarrollo en Ciencias Aplicadas-Dr. Jorge J. Ronco
- Universidad Nacional de La Plata
- CONICET
- Buenos Aires
- Argentina
| | - María L. Ferreira
- Planta Piloto de Ingeniería Química – PLAPIQUI
- CONICET
- Universidad Nacional del Sur
- 8000 Bahía Blanca
- Argentina
| | - Sebastián E. Collins
- Instituto de Desarrollo Tecnológico para la Industria Química INTEC
- Universidad Nacional del Litoral
- CONICET
- 3000 Santa Fe
- Argentina
| | - Laura E. Briand
- Centro de Investigación y Desarrollo en Ciencias Aplicadas-Dr. Jorge J. Ronco
- Universidad Nacional de La Plata
- CONICET
- Buenos Aires
- Argentina
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Piirainen A, Kokki M, Hautajärvi H, Lehtonen M, Miettinen H, Pulkki K, Ranta VP, Kokki H. The Cerebrospinal Fluid Distribution of Postoperatively Administred Dexketoprofen and Etoricoxib and Their Effect on Pain and Inflammatory Markers in Patients Undergoing Hip Arthroplasty. Clin Drug Investig 2016; 36:545-55. [PMID: 27086319 DOI: 10.1007/s40261-016-0400-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Based on earlier literature, etoricoxib may have a delayed analgesic effect in postoperative setting when analgesic efficacy of nonselective nonsteroidal anti-inflammatory drug dexketoprofen is rapid. This may be caused by slow penetration of etoricoxib into the central nervous system (CNS). Therefore we decided to determine the plasma and cerebrospinal fluid (CSF) pharmacokinetics and pharmacodynamics of dexketoprofen and etoricoxib in patients with hip arthroplasty. METHODS A total of 24 patients, scheduled for an elective primary hip arthroplasty were enrolled. After surgery, 12 subjects were randomized to received a single intravenous dose of dexketoprofen, and 12 subjects were given oral etoricoxib. Paired blood and CSF samples were taken up to 24 h for measurement of drug concentrations, interleukin (IL)-6, IL-1ra and blood for interleukin 10. RESULTS In CSF the highest measured concentration (C max) of dexketoprofen was 4.0 (median) ng/mL (minimum-maximum 1.9-13.9) and time to the highest concentration (t max) 3 h (2-5), and for etoricoxib C max 73 ng/mL (36-127) and t max 5 h (1-24), respectively. Opioid consumption during the first 24 postoperative hours was similar in the two groups. Dexketoprofen and etoricoxib had a similar effect on the postoperative inflammatory response. No significant differences considering pain relief or adverse events were found between the two groups. CONCLUSION Dexketoprofen and etoricoxib entered the CNS readily, already at 30 min after administration dexketoprofen was detected in the CSF in most subjects and etoricoxib after 60 min. A single dose of dexketoprofen and etoricoxib provided a similar anti-inflammatory and analgesic response after major orthopaedic surgery.
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Affiliation(s)
- Annika Piirainen
- Department of Anaesthesia and Operative Services, Kuopio University Hospital, PO Box 100, 70029, Kuopio, Finland.,Department of Anaesthesiology and Intensive Care, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Merja Kokki
- Department of Anaesthesia and Operative Services, Kuopio University Hospital, PO Box 100, 70029, Kuopio, Finland. .,Department of Anaesthesiology and Intensive Care, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
| | | | - Marko Lehtonen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Hannu Miettinen
- Department of Orthopaedic Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Kari Pulkki
- Department of Clinical Chemistry University of Eastern Finland, Eastern Finland Laboratory Centre Joint Authority Enterprise (ISLAB), Kuopio, Finland
| | - Veli-Pekka Ranta
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Hannu Kokki
- Department of Anaesthesia and Operative Services, Kuopio University Hospital, PO Box 100, 70029, Kuopio, Finland.,Department of Anaesthesiology and Intensive Care, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Shavlovskaya OA. [Dexketoprofen trometamol in dorsalgia treatment]. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:88-92. [PMID: 27735904 DOI: 10.17116/jnevro20161169188-92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lower back pain (LBP) remains an important problem due to its high prevalence. LBP is the fifth in frequency among reasons for seeking treatment, and one of the most common among the chronic pain syndromes. Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered to be the «gold standard» in relieving back pain. In treatment of acute musculoskeletal pain syndromes, special attention is drawn to drugs characterized by high analgesic activity and a short half-life. Among the drugs in this group, dexketoprofen (a derivative of propionic acid), a water-soluble salt of the dextrorotatory enantiomer of ketoprofen, deserves special attention. Over the last decade, a number of studies have shown the high efficacy of dexketoprofen trometamol.
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Piirainen A, Kokki H, Immonen S, Eskelinen M, Häkkinen MR, Hautajärvi H, Kokki M. A Dose-Finding Study of Dexketoprofen in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Clinical Trial on Effects on the Analgesic Concentration of Oxycodone. Drugs R D 2016; 15:319-28. [PMID: 26364041 PMCID: PMC4662948 DOI: 10.1007/s40268-015-0107-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Dexketoprofen has been shown to provide efficient analgesia and an opioid-sparing effect after orthopedic surgery. In this dose-finding study, we evaluated the analgesic efficacy and opioid-sparing effect of dexketoprofen administered intravenously (i.v.) after laparoscopic cholecystectomy (LCC). Methods Twenty-four patients undergoing LCC were randomized to receive dexketoprofen 10 or 50 mg i.v. 15 min before the end of the surgery. Subjects were provided with 0.2 mg/kg of oxycodone at anesthesia induction. In the recovery room, pain was assessed with an 11-point numerical rating scale (NRS; score of 0 = no pain, score of 10 = most severe pain) every 10 min. When the NRS score was ≥3/10 at rest or ≥5/10 at wound compression, a plasma sample was taken for analysis of oxycodone [to determine the minimum effective concentration (MEC)], its metabolites, and dexketoprofen. After that, subjects were titrated with oxycodone 2 or 3 mg i.v. every 10 min until the NRS score was <3/10 at rest and <5/10 at wound compression. At this point, a second plasma sample was taken for analysis of oxycodone [minimum effective analgesic concentration (MEAC)], its metabolites, and dexketoprofen. Results At the onset of pain, the plasma oxycodone concentrations (MEC) were similar in the two groups: median 60 ng/mL (range 37–73) in the 10 mg group and median 52 ng/mL (range 24–79) in the 50 mg group. At the time of pain relief, the MEACs were 98 ng/mL (range 59–150) in the 10 mg group and 80 ng/mL (range 45–128) in the 50 mg group. The total doses of oxycodone needed to achieve pain relief were similar: 0.11 mg/kg (range 0–0.33) in the 10 mg group and 0.08 mg/kg (range 0–0.24) in the 50 mg group. Eleven subjects developed mild desaturation or a decreased respiratory rate after oxycodone titration. Conclusion In the present double-blinded, randomized clinical trial, the need for a rescue opioid analgesic, oxycodone, was similar with the two dose levels of dexketoprofen—10 and 50 mg i.v.—after LCC.
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Affiliation(s)
- Annika Piirainen
- Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Anesthesia and Operative Services, Kuopio University Hospital, PO Box 100, 70029, Kuopio, Finland
| | - Hannu Kokki
- Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Anesthesia and Operative Services, Kuopio University Hospital, PO Box 100, 70029, Kuopio, Finland
| | - Satu Immonen
- Department of Anesthesia and Operative Services, Kuopio University Hospital, PO Box 100, 70029, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Matti Eskelinen
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Merja R Häkkinen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | | | - Merja Kokki
- Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland. .,Department of Anesthesia and Operative Services, Kuopio University Hospital, PO Box 100, 70029, Kuopio, Finland.
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