Alpha-2 agonists in acute pain management

Chan, Albert; Cheung, Chi Wai; Chong, Yeow Kuan

doi:10.1517/14656566.2010.511613

Cited by 110 publications

(67 citation statements)

References 109 publications

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“…Woolf and Salter 2000;Kawasaki et al, 2004;Obata and Noguchi 2004;Ji et al, 2009). Also the activation of α 2 -adrenergic receptors by microinjections of 5 mM clonidine and 0.5 mM tizanidine, two agonists that may have analgesic effects (for review see Eisenach et al, 1996;Pertovaara 2006;Chan et al, 2010), strongly downregulated cough responses (Cinelli et al, 2013). The depressant effects on the cough reflex exerted by clonidine and tizanidine were completely reverted by microinjections of the α 2 -adrenergic receptor antagonist yohimbine (10 mM) performed into the same sites.…”

Section: Cough Downregulation By Drugs Relevant To Chronic Pain Treatmentioning

confidence: 99%

Brainstem mechanisms underlying the cough reflex and its regulation

Mutolo

2017

Respiratory Physiology & Neurobiology

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A B S T R A C TCough is a very important airway protective reflex. Cough-related inputs are conveyed to the caudal nucleus tractus solitarii (cNTS) that projects to the brainstem respiratory network. The latter is reconfigured to generate the cough motor pattern. A high degree of modulation is exerted on second-order neurons and the brainstem respiratory network by sensory inputs and higher brain areas. Two medullary structures proved to have key functions in cough production and to be strategic sites of action for centrally active drugs: the cNTS and the caudal ventral respiratory group (cVRG). Drugs microinjected into these medullary structures caused downregulation or upregulation of the cough reflex. The results suggest that inhibition and disinhibition are prominent regulatory mechanisms of this reflex and that both the cNTS and the cVRG are essential in the generation of the entire cough motor pattern. Studies on the basic neural mechanisms subserving the cough reflex may provide hints for novel therapeutic approaches. Different proposals for further investigations are advanced.

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Section: Cough Downregulation By Drugs Relevant To Chronic Pain Treatmentioning

confidence: 99%

Brainstem mechanisms underlying the cough reflex and its regulation

Mutolo

2017

Respiratory Physiology & Neurobiology

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“…Interestingly, previously published work by Belgrade and Hall also suggests that dexmedetomidine may help physiologically reset opioid sensitivity in otherwise tolerant individuals and in patients suffering from OIH [11]. The precise mechanism of antinociception has not been fully elucidated, but it is α -2 receptor stimulation in the central nervous system and spinal cord is thought to play a vital role [10]. …”

Section: Discussionmentioning

confidence: 99%

“…Dexmedetomidine is a potent anxiolytic, while also providing opioid-sparing analgesic effects [10]. The mechanism of antinociception has not been completely elucidated, but it is believed that it is secondary to α -2 receptor stimulation in the central nervous system and spinal cord.…”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine as Part of a Multimodal Analgesic Treatment Regimen for Opioid Induced Hyperalgesia in a Patient with Significant Opioid Tolerance

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Eldrige

Moeschler

et al. 2017

Case Reports in Anesthesiology

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Acute postoperative pain in patients with opioid tolerance creates a significant management challenge for anesthesiologists and pain medicine physicians. A multimodal approach is key; however other factors can complicate management such as opioid induced hyperalgesia. We present the case of a patient on large amounts of intrathecal opioids for chronic pain syndrome with opioid induced hyperalgesia after an exploratory laparotomy. Dexmedetomidine was utilized successfully as part of a controlled multimodal analgesic plan and should be a consideration for opioid tolerant patients experiencing opioid induced hyperalgesia.

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“…Evidence supporting the use of epidural clonidine is inconclusive, and the risk of arterial hypotension and sedation is increased. 118 It remains unclear as to whether TEA improves postoperative surgical outcomes, especially in the context of an ERAS program. Compared with parenteral opioids, epidural infusion of low-dose local anesthetic and short-acting opioids has been shown to provide better postoperative static and dynamic analgesia for the first 72 hours, 119 accelerate the recovery of gastrointestinal function, 120 reduce insulin resistance, 121 and impact positively on cardiovascular and respiratory complications.…”

Section: Glycemic Controlmentioning

confidence: 99%