Epidural haloperidol enhances epidural morphine analgesia: Three case reports

Colclough, George W.; McLarney, J. Thomas; Sloan, Paul A.; McCoun, K. Todd; Rose, Gregory L; Grider, Jay S.; Steyn, P.

doi:10.5055/jom.2008.0021

Cited by 11 publications

(2 citation statements)

References 24 publications

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“…Although haloperidol has not demonstrated direct effect on pain receptors, its isomeric similarity to meperidine may make it active at opiate receptors . In addition, studies in animals have shown its effect in the NDMA pain modulation pathway, which might also explain its effectiveness for pain control . The analgesic mechanisms attributed to haloperidol might not be clearly elucidated, but randomized clinical trials of intravenous haloperidol have shown safety and effectiveness in treating patients with migraine headache and acute pain in palliative care .…”

Section: Discussionmentioning

confidence: 99%

Randomized Controlled Double‐blind Trial Comparing Haloperidol Combined With Conventional Therapy to Conventional Therapy Alone in Patients With Symptomatic Gastroparesis

Roldan

Chambers

Paniagua

et al. 2017

Academic Emergency Medicine

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Section: Discussionmentioning

confidence: 99%

Randomized Controlled Double‐blind Trial Comparing Haloperidol Combined With Conventional Therapy to Conventional Therapy Alone in Patients With Symptomatic Gastroparesis

Roldan

Chambers

Paniagua

et al. 2017

Academic Emergency Medicine

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“…Excluded references assessing neuroleptanalgesia for abdominal pain included three case reports,48,49,61 three case series,54,59,84 and one non-randomized controlled trial 61. Ramirez et al34 was excluded as it had a retrospective cohort design.…”

Section: Resultsmentioning

confidence: 99%

<p>Neuroleptanalgesia for acute abdominal pain: a systematic review</p>

Miller¹,

Khan²,

A³

et al. 2019

JPR

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Background Acute abdominal pain (AAP) comprises up to 10% of all emergency department (ED) visits. Current pain management practice is moving toward multi-modal analgesia regimens that decrease opioid use. Objective This project sought to determine whether, in patients with AAP (population), does administration of butyrophenone antipsychotics (intervention) compared to placebo, usual care, or opiates alone (comparisons) improve analgesia or decrease opiate consumption (outcomes)? Methods A structured search was performed in Cochrane CENTRAL, CINAHL, Database of Abstracts of Reviews of Effects, Directory of Open Access Journals, Embase, IEEE-Xplorer, Latin American and Caribbean Health Sciences Literature, Magiran, PubMed, Scientific Information Database, Scopus, TÜBİTAK ULAKBİM, and Web of Science. Clinical trial registries ( ClinicalTrials.gov , World Health Organization International Clinical Trials Registry Platform, and Australian New Zealand Clinical Trials Registry), relevant bibliographies, and conference proceedings were also searched. Searches were not limited by date, language, or publication status. Studies eligible for inclusion were prospective randomized clinical trials enrolling patients (age ≥18 years) with AAP treated in acute care environments (ED, intensive care unit, postoperative). The butyrophenone must have been administered either intravenously or intra-muscularly. Comparison groups included placebo, opiate only, corticosteroids, non-steroidal anti-inflammatory drugs, or acetaminophen. Results We identified 7,217 references. Six studies met inclusion criteria. One study assessed ED patients with AAP associated with gastroparesis, whereas five studies assessed patients with postoperative AAP: abdominal hysterectomy (n=4), sleeve gastrectomy (n=1). Three of four studies found improvements in pain intensity with butyrophenone use. Three of five studies reported no change in postoperative opiate consumption, while two reported a decrease. One ED study reported no change in patient satisfaction, while one postoperative study reported improved satisfaction scores. Both extrapyramidal side effects (n=3) and sedation (n=3) were reported as unchanged. Conclusion Based on available evidence, we cannot draw a conclusion on the efficacy or benefit of neuroleptanalgesia in the management of patients with AAP. However, preliminary data suggest that it may improve analgesia and decrease opiate consumption.

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