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Moshiri M, Chaeideh B, Ebrahimi M, Dadpour B, Ghodsi A, Haghighizadeh A, Etemad L. Buprenorphine induced opioid withdrawal syndrome relieved by adjunctive Magnesium: A clinical trial. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 160:209307. [PMID: 38309436 DOI: 10.1016/j.josat.2024.209307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/20/2023] [Accepted: 01/24/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Precipitated opioid withdrawal syndrome (OWS) is a severe and intolerable situation that may occur by a pharmaceutical agent. Reactivation of inhibited N-methyl-d-aspartate (NMDA) receptor in person with prolonged opioid use can led to severe OWS. We conducted a double-blind, randomized clinical trial to assess the effect of magnesium sulfate (MGSO4) as an NMDA receptor antagonist on OWS. MATERIALS AND METHODS The study randomly divided forty patients with precipitated OWS due to partial agonist (buprenorphine) use referred to the emergency unit of Toxicology Department of Mashhad University of Medical Sciences, Iran; into two groups. The control group received conventional therapies, including clonidine 0.1 mg tablet each hour, intravenous infusion of 10 mg diazepam every 30 min, and IV paracetamol (Acetaminophen) 1 g, while the intervention group received 3 g of MGSO4 in 20 min and then 10 mg/kg/h up to 2 h, in addition to the conventional treatment. The clinical opiate withdrawal scale (COWS) evaluated OWS at the start of the treatment, 30 min, and 2 h later. RESULTS Both groups had similar demographic, opiate types, and COWS severity at the start of the intervention. COWS was lower in the intervention than the control group at 30 min (11.20 ± 2.86 and 14.65 ± 2.36, respectively, P = 0.002) and at 2 h (3.2 ± 1.61 and 11.25 ± 3.27, respectively, P < 0.001) after treatment. The intervention group received lesser doses of clonidine (0.12 ± 0.51 and 0.17 ± 0.45 mg, P = 0.003) and Diazepam (13.50 ± 5.87, 24.0 ± 6.80 mg, P = 0.001) than the control group. Serum magnesium levels raised from 1.71 ± 0.13 mmol/L to 2.73 ± 0.13 mmol/L in the intervention group. CONCLUSION Magnesium can significantly reduce the severity of OWS. Additional studies are required to confirm these results.
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Affiliation(s)
- Mohammad Moshiri
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Clinical Toxicology and Poisoning, Imam Reza (p) Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mohsen Ebrahimi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bita Dadpour
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Clinical Toxicology and Poisoning, Imam Reza (p) Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Ghodsi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Atoosa Haghighizadeh
- Department of Pharmaceutical and Food Control, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leila Etemad
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
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Monteiro BP, Otis C, Nitulescu R, Troncy E. Quantitative sensory testing in canine musculoskeletal pain: Findings from a systematic review, meta-analysis feasibility assessment, and limitations. Vet J 2024; 304:106102. [PMID: 38492631 DOI: 10.1016/j.tvjl.2024.106102] [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] [Received: 08/11/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
Quantitative sensory testing (QST) allows the study of pain mechanisms, patient phenotyping, and response to therapy. The goals of this study were to conduct a systematic review of the use of QST in dogs with musculoskeletal disease including osteoarthritis (OA), and to assess, by means of a meta-analysis, the ability of QST to differentiate affected dogs from healthy controls. The study protocol was registered; three bibliographic databases were screened. Studies involving QST in healthy dogs and those with musculoskeletal disease were included. Data were extracted using a standardized form. Assessment of quality and risk of bias were performed using the CAMARADES critical assessment tool. Twenty-nine articles met the inclusion criteria [systematic review (n = 11); meta-analysis (n = 28)]. In the systematic review, ten studies performed static QST: mechanical [punctate tactile (n = 6); mechanical pressure (n = 5)]; thermal [cold (n = 3); hot (n = 4)]; electrical (n = 1); and one study performed dynamic QST [conditioned pain modulation (n = 1)]. Most studies were of good scientific quality and showed low to moderate risk of bias. A meta-analysis was not possible due to numerous and severe issues of heterogeneity of data among studies. Methods to reduce risk of bias and use of reporting guidelines are some of the most needed improvements in QST research in dogs. Standardization of QST methodology is urgently needed in future studies to allow for data synthesis and a clear understanding of the sensory phenotype of dogs with and without chronic pain including OA.
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Affiliation(s)
- B P Monteiro
- Research Group in Animal Pharmacology of Quebec (GREPAQ), Université de Montréal, Saint-Hyacinthe, Québec J2S 2M2, Canada
| | - C Otis
- Research Group in Animal Pharmacology of Quebec (GREPAQ), Université de Montréal, Saint-Hyacinthe, Québec J2S 2M2, Canada
| | - R Nitulescu
- University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec H2X 0A9, Canada; Centre d'intégration et d'analyse des données médicales (CITADEL) du Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec H2X 0A9, Canada
| | - E Troncy
- Research Group in Animal Pharmacology of Quebec (GREPAQ), Université de Montréal, Saint-Hyacinthe, Québec J2S 2M2, Canada; University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec H2X 0A9, Canada.
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Debuigne M, Chesnel MA, Chebroux A. The analgesic effects of magnesium in veterinary patients: a qualitative evidence synthesis. Vet Anaesth Analg 2024; 51:115-125. [PMID: 38331673 DOI: 10.1016/j.vaa.2024.01.002] [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] [Received: 07/28/2022] [Revised: 11/06/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To perform a qualitative evaluation of the analgesic effects of magnesium in domestic animals, including its anaesthetic sparing effects. STUDY DESIGN All database searches were made using PubMed and Google Scholar. Studies published after 1990, evaluating the use of magnesium and reporting information on analgesia, in dogs, cats, horses, cows, goats and sheep were selected (last search in August 2023). A reference check in the selected papers was performed to identify any study which was omitted. The CERQual (Confidence in Evidence from Reviews of Qualitative research) approach was used to assess confidence and analyse the evidence. RESULTS A total of 20 studies relevant to the analgesic effects of magnesium in veterinary patients and two reviews were included. All were published after 2006. Of the 20, five studies provided information about analgesia in the postoperative period in dogs with heterogenous results. Magnesium added epidurally increased the duration of the sensory block in several species. Motor block was also observed when added to spinal analgesia. Results regarding volatile agents sparing effect were conflicting. Occasional moderate adverse effects were reported in dogs, such as nausea and vomiting, when administered as a bolus in conscious animals, and hypotension when administered intraperitoneally. Collapse was reported in horses after epidural administration. CONCLUSIONS AND CLINICAL RELEVANCE The evidence of an analgesic effect of magnesium in veterinary patients remains scarce considering the paucity and low quality of published data. Further research may be helpful to establish the efficacy and indications of magnesium in multimodal analgesia in animals.
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La Rosa L, Twele L, Duchateau L, Gasthuys F, Kästner SB, Schauvliege S. The Antinociceptive Effect of Magnesium Sulphate Administered in the Epidural Space in Standing Horses. J Equine Vet Sci 2023; 123:104202. [PMID: 36592662 DOI: 10.1016/j.jevs.2022.104202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 11/20/2022] [Accepted: 12/22/2022] [Indexed: 01/01/2023]
Abstract
To study the antinociceptive properties of epidural magnesium sulphate (MgSO4) in standing horses Experimental, placebo-controlled, masked, cross-over A group of six healthy horses Through an epidural catheter, 1 mg kg -1 MgSO4 (treatment Mg) diluted to a volume of 15 mL or the same volume of saline (treatment S) was administered over 15 minutes. Electrical, thermal and mechanical nociceptive thresholds were determined on the pelvic limb before and 20, 40, 60, 80, 100, 120, 140, 160 and 180 minutes after the start of the injection. Heart rate (HR) and respiratory frequency (fR) were recorded every 10 minutes. Blood samples were collected before treatment and every 30 minutes throughout the study period. Data were assessed for normality using a Shapiro-Wilk test. A linear mixed model with horse as random effect and time, treatment and their interaction as fixed effects was used. Treatments were compared at 20, 60, 120 and 180 minutes using the Wilcoxon rank sum test stratified for horse (global α = 0.05, with Bonferroni correction α = 0.0125). Epidural MgSO4 caused a significant increase in the electrical threshold (mA) (P = .0001), but no significant differences in thermal and mechanical nociceptive thresholds. During the injection of MgSO4, two horses collapsed. One stood up within 20 minutes and was able to continue the study, the second one was excluded. A significant difference was found for HR at T180 (Mg 44 ± 23 beats minute-1; S 32 ± 9 beats minute-1) (P = .0090). Epidural administration of MgSO4 caused an increase in the electrical threshold of the pelvic limbs of horses. Caution is warranted however, as with the current dose, 2 horses collapsed.
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Affiliation(s)
- Lavinia La Rosa
- Department of Surgery and Anesthesia of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
| | - Lara Twele
- Equine Clinic, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Luc Duchateau
- Department of Comparative Physiology and Biometrics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Frank Gasthuys
- Department of Surgery and Anesthesia of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Sabine Br Kästner
- Equine Clinic, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Stijn Schauvliege
- Department of Surgery and Anesthesia of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Sliusarenko DV, Ilnitskiy МG, Bilyi DD, Bobrytska OM, Kovalova LO. Regional anesthesiological support for the implementation of surgical interventions in the abdomen of dogs. REGULATORY MECHANISMS IN BIOSYSTEMS 2021. [DOI: 10.15421/022108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Widespread use of surgical interventions in the abdomen of dogs determines the relevance of the study. The research tested the influence of therapeutic epidural blockade with 0.2% bupivacaine after surgical interventions on the background of potentiated local anaesthesia on the body of clinically healthy dogs undergoing ovariohysterectomy. In the control group postoperative analgesia was performed with the nonsteroidal anti-inflammatory drug rimadyl on the background of potentiated thiopental anaesthesia. Wound healing rates were determined in 10 animals of both control and experimental groups; blood counts and the level of inflammatory response were indicated in 5 animals of each group. The dynamics of reparative processes and complete wound healing in dogs of the experimental group occurred earlier than in animals of the control group, which confirmed the fact that the use of bupivacaine had a beneficial effect on tissue regeneration. The results of morphological and biochemical parameters of blood in animals of the experimental group manifested only an increase of leukocytes by 1.58 times, fibrinogen by 2.02 times, while in dogs of the control group the level of erythrocytes, haemoglobin and hematocrit decreased, leukocytes increased by 1.74 times, platelets decreased by 2.87 times and fibrinogen increased by 1.72 times. Among the stress response markers in the control group there was a 1.94 times increase in glucose level after surgery. In the experimental group there was a decrease in the intensity of the inflammatory reaction in dogs, accompanied by an increase of anti-inflammatory interleukin 4 (IL-4) only on the seventh day – 1.86 times, while in the control group the level of anti-inflammatory interleukin 1 receptor antagonist (IL-1RA) after three days increased by 2.30 times, after seven days – by 2.48 times, and the level of proinflammatory interleukin 6 (IL-6) after surgery increased by 2.57 times. It will be promising to conduct further research on the influence of therapeutic blockades with bupivacaine in animals in cases of various surgical interventions and pathological conditions, which will lead to faster recovery of animals and alleviate pathological processes.
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Elsharkawy RA, Farahat TE, Abdelhafez MS. Analgesic effect of adding magnesium sulfate to epidural levobupivacaine in patients with pre-eclampsia undergoing elective cesarean section. J Anaesthesiol Clin Pharmacol 2018; 34:328-334. [PMID: 30386015 PMCID: PMC6194846 DOI: 10.4103/joacp.joacp_1_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background and Aims: Magnesium is a physiological antagonist of NMDA receptor and a calcium channel blocker. This study was designed to test the analgesic effect of magnesium sulfate (MgSO4) when added to epidural anesthesia in mild pre-eclampsia. Material and Methods: Sixty parturients with mild pre-eclampsia were allocated randomly to two equal groups. The Placebo group received 20 ml levobupivacaine hydrochloride 0.5% plus 5 ml isotonic saline 0.9% using two separate syringes. The Magnesium group received the same amount of local anesthetic plus 5 ml of 10% MgSO4(500 mg) using two separate syringes. The primary outcome was pain free period. While, the secondary outcomes were the onset of motor block and the time needed to achieve complete motor block. The analgesic profile was evaluated by visual analog scale (VAS) during rest or motion, the time to first request for analgesia, and the total analgesic consumption. Results: The pain-free period was significantly longer in the Magnesium group (311.3 ± 21.4) compared to placebo group (153.1 ± 22.18). The total postoperative consumption of fentanyl was significantly lower in the Magnesium group (42.4 ± 5.3) than that in the placebo group (94.4 ± 9.9), with a P value 0. 01. Both the onset time of motor block and the time needed to achieve complete motor block were significantly shorter among the Magnesium group (4.4 ± 1.4 and 8.2 ± 0.4, respectively), with a P value of 0. 01. Conclusion: The addition of 500 mg MgSO4 to epidural anesthesia fastens both sensory and motor blockade and improves postoperative analgesic profile.
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Affiliation(s)
| | - Tamer Elmetwally Farahat
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Egypt
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Bradbrook C, Clark L. State of the art analgesia-Recent developments pharmacological approaches to acute pain management in dogs and cats: Part 2. Vet J 2018; 236:62-67. [PMID: 29871752 DOI: 10.1016/j.tvjl.2018.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
Abstract
There has been considerable interest in the area of acute pain management over recent years, focusing on pain assessment, pharmacological and non-pharmacological interventions. The evidence base for our clinical decision making and treatment of patients is ever increasing and becoming more robust. There is still a tendency to base some aspects of pain management on poor quality evidence and this requires further input in years to come. With new literature come new ideas and this review will detail the current knowledge base behind pharmacological management of acute pain in dogs and cats. The known mechanisms of action of each analgesic and its evidence will be considered. The second part of this review will consider the non-traditional analgesics, describing their component drugs individually, thereby focusing on their mechanisms of action and the current evidence for their use in acute pain management.
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Affiliation(s)
| | - L Clark
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Herts, SG5 3HR, UK
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Abstract
This paper is the thirty-ninth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2016 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia, stress and social status, tolerance and dependence, learning and memory, eating and drinking, drug abuse and alcohol, sexual activity and hormones, pregnancy, development and endocrinology, mental illness and mood, seizures and neurologic disorders, electrical-related activity and neurophysiology, general activity and locomotion, gastrointestinal, renal and hepatic functions, cardiovascular responses, respiration and thermoregulation, and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and CUNY Neuroscience Collaborative, Queens College, City University of New York, Flushing, NY 11367, United States.
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Lardone E, Peirone B, Adami C. Combination of magnesium sulphate and ropivacaine epidural analgesia for hip arthroplasty in dogs. Vet Anaesth Analg 2017; 44:1227-1235. [DOI: 10.1016/j.vaa.2016.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 10/20/2016] [Accepted: 11/10/2016] [Indexed: 11/26/2022]
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Zeng C, Li YS, Wei J, Xie DX, Xie X, Li LJ, Gao SG, Luo W, Xiong YL, Xiao WF, Lei GH. Analgesic effect and safety of single-dose intra-articular magnesium after arthroscopic surgery: a systematic review and meta-analysis. Sci Rep 2016; 6:38024. [PMID: 27901095 PMCID: PMC5128786 DOI: 10.1038/srep38024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 11/03/2016] [Indexed: 12/17/2022] Open
Abstract
To examine the analgesic effect and safety of single-dose intra-articular (IA) magnesium (Mg) after arthroscopic surgery. Pubmed, Embase and Cochrane library were searched through in January 2016. Eight RCTs and eight experimental studies were included. The IA Mg exhibited a significantly lower pain score when compared with placebo (MD, -0.41, 95% CI, -0.78 to -0.05, p = 0.03). There was no significant difference between Mg and bupivacaine in terms of pain relief and the time to first analgesic request. Furthermore, statistically significant differences both in pain score (MD, -0.62, 95% CI, -0.81 to -0.42, p < 0.00001) and time to first analgesic request (MD, 6.25, 95% CI, 5.22 to 7.29, p < 0.00001) were observed between Mg plus bupivacaine and bupivacaine alone. There was no statistically significant difference among the various groups with respect to adverse reactions. Most of the included in vitro studies reported the chondrocyte protective effect of Mg supplementation. There were also two in vivo studies showing the cartilage protective effect of IA Mg. The single-dose IA Mg following arthroscopic surgery was effective in pain relief without increasing adverse reactions, and it could also enhance the analgesic effect of bupivacaine. In addition, Mg seemed to possess the cartilage or chondrocyte protective effect based on experimental studies.
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Affiliation(s)
- Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, 410008, China
| | - Yu-sheng Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, 410008, China
| | - Jie Wei
- Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan Province, 410008, China
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan Province, 410008, China
| | - Dong-xing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, 410008, China
| | - Xi Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, 410008, China
| | - Liang-jun Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, 410008, China
| | - Shu-guang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, 410008, China
| | - Wei Luo
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, 410008, China
| | - Yi-lin Xiong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, 410008, China
| | - Wen-feng Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, 410008, China
| | - Guang-hua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, 410008, China
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Adami C, Casoni D, Noussitou F, Rytz U, Spadavecchia C. Addition of magnesium sulphate to ropivacaine for spinal analgesia in dogs undergoing tibial plateau levelling osteotomy. Vet J 2016; 209:163-8. [DOI: 10.1016/j.tvjl.2015.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 11/13/2015] [Accepted: 11/27/2015] [Indexed: 11/30/2022]
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