Clinical Evaluation of Diazepam for Relief of Postoperative Pain

Singh, Praveen; Sharma, Priyanka; Gupta, Pranav; Pandy, K.

doi:10.1093/bja/53.8.831

Cited by 34 publications

(8 citation statements)

References 4 publications

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“…Although there are reports of synergistic actions of GABA agonists and morphine in rodents 38, 40 and humans 41 , this is the first demonstration that GABA agonists acting at different GABA receptors potentiate and the first report of their preclinical use in the treatment of acute and chronic itch. We believe that a comparable pharmacotherapeutic approach should be considered in the clinical management of acute and chronic itch.…”

Section: Resultsmentioning

confidence: 80%

Synergistic antipruritic effects of gamma aminobutyric acid A and B agonists in a mouse model of atopic dermatitis

Cevikbas

Bráz²,

Wang³

et al. 2017

Journal of Allergy and Clinical Immunology

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Background Despite recent insights into the pathophysiology of acute and chronic itch, chronic itch remains an often intractable condition. Among major contributors to chronic itch is dysfunction of spinal cord GABAergic inhibitory controls. Objective To test the hypothesis that selective GABA agonists as well as cell transplant-derived GABA are antipruritic against acute itch and in a transgenic mouse model of atopic dermatitis produced by overexpression of the TH2 cell-associated cytokine, IL-31 (IL-31Tg mice). Methods We injected wild-type and IL-31Tg mice with combinations of GABA-A (muscimol) or GABA-B (baclofen) receptor agonists 15–20 min prior to injection of various pruritogens (histamine, chloroquine or endothelin-1) and recorded spontaneous scratching before and after drug administration. We also tested the antipruritic properties of intraspinal transplantation of precursors of GABAergic interneurons in the IL-31Tg mice. Results Systemic muscimol or baclofen are antipruritic against both histamine-dependent and independent pruritogens, but the therapeutic window using either ligand alone was very small. In contrast, combined subthreshold doses of baclofen and muscimol produced a significant synergistic antipruritic effect, with no sedation. Finally, transplant-mediated long term enhancement of GABAergic signaling not only reduced spontaneous scratching in the IL-31Tg mice but also dramatically resolved the associated skin lesions. Conclusion Although additional research is clearly needed, existing approved GABA agonists should be considered in the management of chronic itch, notably atopic dermatitis.

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Section: Resultsmentioning

confidence: 80%

Synergistic antipruritic effects of gamma aminobutyric acid A and B agonists in a mouse model of atopic dermatitis

Cevikbas

Bráz²,

Wang³

et al. 2017

Journal of Allergy and Clinical Immunology

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“…The results from 7 trials [26,[31][32][33][34][35][36] were synthesised narratively due to heterogeneity of the type of intervention (i.e. different combinations of hypnotic medicines and other pain medicines), route of administration (i.e.…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

“…There is very low-quality evidence (downgraded due to high risk of bias, imprecision and inconsistency) that in the immediate postoperative period (1 trial, n = 105 [36]) the effect of intramuscular diazepam 10 mg (4 times a day) on pain intensity compared to intramuscular morphine 10 mg (4 times a day) was not significant [WMD 2.00, CI 1.53 to 2.47, p ≤ .01].…”

Section: Benzodiazepines Versus Other Analgesic Medicinesmentioning

confidence: 99%

Zolpidem reduces pain intensity postoperatively: a systematic review and meta-analysis of the effect of hypnotic medicines on post-operative pain intensity

et al. 2020

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Background: This systematic review aimed to investigate whether the administration of hypnotic medicines, zdrugs, melatonin or benzodiazepines, reduced pain intensity postoperatively. Methods: Medline, Embase, Cinahl, Psych info, Central and PubMed databases were searched, from inception to February 2020 to identify relevant trials. The search was extended, post hoc, to include meta-Register of Controlled Trials, the Web of Science and the conference booklets for the 14th, 15th, and 16th International Association for the Study of Pain conferences. Two independent reviewers screened titles and abstracts and cross-checked the extracted data. Results: The search retrieved 5546 articles. After full-text screening, 15 trials were included, which had randomised 1252 participants. There is moderate-quality evidence that in the short-term [WMD − 1.06, CI − 1.48 to − 0.64, p ≤ .01] and low-quality evidence that in the medium-term [WMD − 0.90, CI − 1.43 to − 0.37, p ≤ .01] postoperative period oral zolpidem 5/10 mg with other analgesic medicines reduced pain intensity compared to the same analgesic medicines alone. There is low-quality evidence that melatonin was not effective on postoperative pain intensity compared to placebo. The results of benzodiazepines on pain intensity were mixed. The authors reported no significant adverse events. Conclusions: There is promising evidence that the hypnotic medicine zolpidem, adjuvant to other analgesics, is effective at achieving a minimally clinically important difference in pain intensity postoperatively. There is no consistent effect of melatonin or benzodiazepines on postoperative pain intensity. Readers should interpret these results with some caution due to the lack of data on safety, the small number of trials included in the pooled effects and their sample sizes. Systematic review registration: The protocol for this systematic review was registered with PROSPERO ID= CRD42015025327.

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“…Analgesic effects have also been reported with other benzodiazepines, such as alprazolam [40–42], diazepam [43–44], and midazolam [45–46]. This effect may be related to the facilitation of GABA‐ergic neurotransmission by benzodiazepines, which could in turn activate medullary neurons involved in pain inhibition [47].…”

Section: Discussionmentioning

confidence: 94%

Clonazepam Open Clinical Treatment Trial for Myofascial Syndrome Associated Chronic Pain: Table 1

Fishbain¹,

Cutler²,

Rosomoff³

et al. 2000

Pain Med

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Clinical Evaluation of Diazepam for Relief of Postoperative Pain

Cited by 34 publications

References 4 publications

Synergistic antipruritic effects of gamma aminobutyric acid A and B agonists in a mouse model of atopic dermatitis

Synergistic antipruritic effects of gamma aminobutyric acid A and B agonists in a mouse model of atopic dermatitis

Zolpidem reduces pain intensity postoperatively: a systematic review and meta-analysis of the effect of hypnotic medicines on post-operative pain intensity

Clonazepam Open Clinical Treatment Trial for Myofascial Syndrome Associated Chronic Pain: Table 1

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