Adverse Events of the Long-Term Use of Opioids for Chronic Non-cancer Pain: A Narrative Review

Altawili, Abdullh A; Altawili, Mohammed A; Alzarar, Amnah H; Abdulrahim, Noor M; Alquraish, Haidar H; Alahmari, Maryam A; Basyouni, Marouj  H; Almohaya, Yara A; Alhabshan, Wafa Mohammed S; Alshahrani, Abdullah Mohammed A; Alamrad, Jafar Faraj  A; Aljumaah, Ahmad S; Alsalman, Mohammed A; Alhafith, Abdullah A

doi:10.7759/cureus.51475

Cited by 3 publications

References 77 publications

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Assessing the clinical advantage of opioid-reduced anesthesia in thoracoscopic sympathectomy: a prospective randomized controlled trial

Minqiang,

Mingfei,

Fengzhu

et al. 2024

BMC Anesthesiol

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Background Opioid-reduced multimodal analgesia has been used clinically for many years to decrease the perioperative complications associated with opioid drugs. We aimed to assess the clinical effects of opioid-reduced anesthesia during thoracoscopic sympathectomy. Methods Surgical patients ( n = 151) with palmar hyperhidrosis were randomly divided into control (Group C, 73 patients) and test (Group T, 78 patients) groups. All patients were administered general anesthesia using a laryngeal mask. In Group C, patients received propofol, fentanyl, and cisatracurium for anesthesia induction, and maintenance was achieved with propofol and remifentanil, along with mechanical ventilation during the operation. In Group T, anesthesia was induced with propofol, dezocine, and dexmedetomidine (DEX) and maintained with propofol, DEX, and an intercostal nerve block, along with spontaneous breathing throughout the operation. Perioperative complications related to opioid use include hypotension, bradycardia, hypertension, tachycardia, hypoxemia, nausea, vomiting, urine retention, itching, and dizziness were observed. To assess the impact of these complications, we recorded and compared vital signs, blood gas indices, visual analogue scale (VAS) scores, adverse events, and patient satisfaction between the two groups. Results Perioperative complications related to opioid use were similar between groups. There were no significant differences in the type of perioperative sedation, analgesia index, respiratory and circulatory indicators, blood gas analysis, postoperative VAS scores, adverse reactions, propofol dosage, postoperative recovery time, and patient satisfaction. Conclusions In minimally invasive surgeries such as thoracoscopic sympathectomy, opioid-reduced anesthesia was found to be safe and effective; however, this method did not demonstrate clinical advantages. Trial registration Chinese Clinical Trial Register: ChiCTR2100055005, on December 30, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-024-02711-6.

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Assessing the clinical advantage of opioid-reduced anesthesia in thoracoscopic sympathectomy: a prospective randomized controlled trial

Minqiang,

Mingfei,

Fengzhu

et al. 2024

BMC Anesthesiol

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Assessing the clinical advantage of opioid-reduced anesthesia in thoracoscopic sympathectomy: A prospective randomized controlled trial

Minqiang,

Mingfei,

Fengzhu

et al. 2024

Preprint

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Background: Opioid-reduced multimodal analgesia has been clinically used for years to reduce perioperative complications related to opioid drugs. We aimed to assess the clinical effects of opioid-reduced anesthesia during thoracoscopic sympathectomy. Methods: Surgical patients (n=151) with palmar hyperhidrosis were randomly divided into a control group (Group C, 73 patients) and a weak opioid group (Group W, 78 patients). All patients were administered general anesthesia using a laryngeal mask. In Group C, the patients were anesthetized with propofol, fentanyl, and cisatracurium, and mechanical ventilation was used during the operation. In Group W, the patients received propofol, dezocine, and dexmedetomidine (DEX), and spontaneous breathing was maintained during surgery. Perioperative complications related to opioids include hypotension, bradycardia, hypertension, tachycardia, hypoxemia, nausea, vomiting, urine retention, itching, and dizziness; vital signs, blood gas index, visual analog scale (VAS) score, and other adverse events; patient satisfaction between groups were also recorded. Results: Perioperative complications related to opioids were similar between groups. There were no significant differences in the type of perioperative sedation, analgesia index, respiratory and circulatory indicators, blood gas analysis, postoperative VAS scores, adverse reactions, propofol dosage, postoperative recovery time, and patient satisfaction (P > 0.05). Conclusions: In minimally invasive surgeries such as thoracoscopic sympathectomy, opioid-reduced anesthesia was safe and effective; however, this method did not show clinical advantages. Trial registration Chinese Clinical Trial Register: ChiCTR2100055005, on December 30, 2021.

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Fentanyl enhances immune cell response through TLR4/MD-2 complex

Chemello,

Facci,

Marcolin

et al. 2024

Front. Pharmacol.

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IntroductionOpioids have been shown to induce neuroinflammation and immune cell activation, that might contribute to some of the opioid side effects, such as opioid-induced tolerance and paradoxical hyperalgesia. In this context, TLR4/MD-2 complex has been proposed as an off-target site for opioid action. This study was aimed at investigating the effect of fentanyl on lipopolysaccharide (LPS)-induced TLR4/MD-2 activation in rat primary microglia and human monocyte-derived macrophages (MDM).Materials and MethodsThe effect of fentanyl was first explored by measuring the expression and release of different proinflammatory mediators in primary rat microglia and human MDM by real-time PCR and ELISA. Then, the involvement of TLR4/MD-2 signaling was investigated studying NF-κB activation in HEK293 cells stably transfected with human TLR4, MD-2, and CD14 genes (HEK-Blue hTLR4 cells) and in human MDM.ResultsFentanyl increased mRNA levels, as well as the LPS-induced secretion of proinflammatory mediators in primary microglia and MDM. Two inhibitors of TLR4/MD-2 signaling, namely the oxazoline derivative of N-palmitoylethanolamine (PEA-OXA) and CLI-095, blocked the production and release of proinflammatory cytokines by microglia stimulated with LPS and fentanyl, suggesting that TLR4/MD-2 could be the target of the proinflammatory activity of fentanyl. Finally, we showed that fentanyl in combination with LPS activated NF-κB signaling in human MDM and in HEK-Blue hTLR4 cells and this effect was blocked by inhibitors of TLR4/MD-2 complex.DiscussionThese results provide new insight into the mechanism of the proinflammatory activity of fentanyl, which involves the activation of TLR4/MD-2 signaling. Our findings might facilitate the development of novel inhibitors of TLR4/MD-2 signaling to combine with opioid-based analgesics for effective and safe pain management.

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Adverse Events of the Long-Term Use of Opioids for Chronic Non-cancer Pain: A Narrative Review

Cited by 3 publications

References 77 publications

Assessing the clinical advantage of opioid-reduced anesthesia in thoracoscopic sympathectomy: a prospective randomized controlled trial

Assessing the clinical advantage of opioid-reduced anesthesia in thoracoscopic sympathectomy: a prospective randomized controlled trial

Assessing the clinical advantage of opioid-reduced anesthesia in thoracoscopic sympathectomy: A prospective randomized controlled trial

Fentanyl enhances immune cell response through TLR4/MD-2 complex

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