Hemodynamic and respiratory effects of morphine and butorphanol

Popio, Kenneth A.; Jackson, Donald H.; Ross, Andrew B.; Schreiner, Bernard F.; Yu, Paul N.

doi:10.1002/cpt1978233281

Cited by 76 publications

(24 citation statements)

References 6 publications

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“…Normally, the dominant control of ventilation is mediated through an increase in PaCO 2 , which strongly stimulates central chemoreceptors, 119 leading to increased ventilation. RD from morphine is characterized by a dose-related, naloxone-reversible depression of resting minute ventilation (Ve) with proportional reduction of tidal volume (Vt), [120][121][122] decreased PaO 2 and pH, increased PaCO 2 , 121,123 and decreased ventilatory drive stimulated by hypercapnia and hypoxia. 124,125 In volunteers, ITM caused a dose-related depression of medullary respiratory centre sensitivity to ventilatory stimulus.…”

Section: Discussionmentioning

confidence: 99%

Définitions de la “dépression respiratoire” de l’analgésie postopératoire réalisée avec de la morphine intrathécale : une revue documentaire

Goldstein

VanDenKerkhof

2003

Can J Anesth/J Can Anesth

108

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P Pu ur rp po os se e: : To review the postoperative intrathecal morphine (ITM) analgesia literature for their definitions of "respiratory depression" (RD).S So ou ur rc ce e: : Medline (1966 -June Week 5 2001) and reference lists were searched for original studies involving bolus-dose ITM for postoperative analgesia, which used "respiratory depression" or similar terms. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The search identified 209 studies. These were included if ITM use was appropriate (bolus dose, postoperative analgesia) and the term "respiratory depression" was used, which left 96 studies remaining. Forty-four (46%) did not define "RD" despite using this term. A further 24 (25%) defined RD with respiratory rate (RR) alone. Only 28 (29%) defined RD with more than RR alone. There was no statistically significant association between the presence of a definition for RD with study design, study size or publication period. Also, no significant association existed between rigorousness of RD definitions and the above factors.C Co on nc cl lu us si io on n: : The term "respiratory depression" has no clear definition from a review of the literature on ITM use for postoperative analgesia. While defining RD with bradypnea is superior to having no definition, this is still inadequate. In future research, the consistent use of terms with specific meanings will facilitate understanding the true incidence of ITM's respiratory effects. If "respiratory depression" is used, then an explicit definition of its meaning should be provided. Future research must also address what is clinically significant respiratory impairment from intrathecal opioids, and how to optimally monitor for this. Further delineating their risks vs benefits will allow for more optimal dosing. Objectif : Passer en revue les documents sur l'analgésie postopéra-toire, réalisée avec la morphine intrathécale (MIT), quant à leurs défi-nitions de la "dépression respiratoire" (DR). Source : La base Medline (1966 -Semaine 5, juin 2001) et les listes de lectures de référence ont été fouillées à la recherche d'études originales sur des bolus de MIT administrés comme analgésie postopéra-toire, et dans lesquelles on retrouve le terme "dépression respiratoire" ou des termes similaires. Constatations principales : La recherche nous a fourni 209 études. Les études (96) comportant un usage approprié de la MIT (dose en bolus, analgésie postopératoire) et l'utilisation du terme

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Section: Discussionmentioning

confidence: 99%

Définitions de la “dépression respiratoire” de l’analgésie postopératoire réalisée avec de la morphine intrathécale : une revue documentaire

Goldstein

VanDenKerkhof

2003

Can J Anesth/J Can Anesth

108

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“…Any possible significance has been determined considering it statistically significant if it's P < 5% level of significance. In 1978, Popio et al, 5 compared the haemodynamic and respiratory effects of Morphine and Butorphanol. A total of 20 patients were studied at the time of diagnostic cardiac catheterization.…”

Section: Methodsmentioning

confidence: 99%

A Comparative Study of Epidural Butorphanol and Epidural Morphine for the Relief of Postoperative Pain

Devulapalli¹,

Verma²

2015

jemds

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Epidural administration of various anaelgesics gained increasing popularity following the discovery of opioid receptors in the spinal cord capable of producing potential analgesia. \the analgesic effect seems to be more when epidural anesthesia is continued in the post-operative period as epidural analgesia. It is now clear that epidural administration of opioids relieves patient of extended pain post-operatively. Ours was a comparative study of epidural butorphanal and epidual morphine for the relief of postoperative pain. METHODS: Sixty adult patients in ASA class I and II, weighing 45 to 60kgs of either sex, belonging to 21-60 years of age, posted for elective lower abdominal & lower limb surgeries in orthopaedics, gynaecological, urological, plastic and general surgeries under epidural anaesthesia were selected for the study. The study was undertaken to evaluate the efficacy and safety of epidural butorphanol 2 mg diluted to 10 ml of normal saline in comparison with epidural morphine 2.5 mg diluted to 10 ml of normal saline given for relief of postoperative pain. In the post-operative period the following parameters were studied, 1. Onset of analgesia, 2. Duration of analgesia, 3. Quality of analgesia, 4. Side effects like nausea, vomiting, hypotension, respiratory depression, and pruritus allergic reaction were looked for. RESULTS: Mean onset of analgesia was 14.66+4.34 (S. D) minutes in group-A, and in group-B was 34.76+5.73 (S. D) minutes. The Statistical analysis by Student's unpaired t-test showed that time of onset of analgesia in group-A was significantly less when compared to group-B. (t = 15.29 with df-54,

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“…Amide 12 was converted to the amine by reduction with LiAlH 4 , 16) and treated with HCHO and HCO 2 H to yield 13. After debenzylation using Pd(OH) 2 , acylation of the secondary amine gave the target compounds 5a and b. Compounds 6a and b were synthesized from 1-benzyl-4-piperidone (14) using the Horner-Wadsworth-Emmons reaction to give olefin 15.…”

Section: Synthesismentioning

confidence: 99%

“…11) Although intracerebroventricular pretreatment with an antiserum against dynorphin A (1-17) did not affect the antinociceptive effect induced by subcutaneous (s.c.) treatment of 1 and 2, the antinociceptive effect was greatly attenuated by intrathecal (i.t.) pretreatment with an antiserum against dynorphin A (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) in mice. This suggested that the antinociceptive effect induced by s.c. treatment of 1 and 2 occurred without binding to the KOR in the ventricles of the brain, in where might stimulate the descending dynorphinergic neuron and production of dynorphin in the spinal cord.…”

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confidence: 99%

Design and Synthesis of a Piperidinone Scaffold as an Analgesic through Kappa-Opioid Receptor: Structure–Activity Relationship Study of Matrine Alkaloids

et al. 2016

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The matrine-type alkaloid 4-dimethylamino-1-pentanoylpiperidine (3a) has an antinociceptive effect through its impact on the κ-opioid receptor (KOR). Derivatives of 3a were synthesized by altering its amide and tertiary amine groups, and were evaluated for their antinociceptive effects. The results indicated that the distance between these groups on 3a was optimal for the antinociceptive effect. The effects obtained with compounds 8 and 9 indicated that the relative configuration of the 3-and 4-substituents influenced the effect mediated through the KOR.Key words antinociception; kappa opioid receptor (KOR); matrine; piperidone; acetic acid-induced abdominal contraction test; mouse Narcotic analgesics such as morphine are administered for pain relief to cancer patients. Most narcotic analgesics are µ-opioid receptor (MOR) agonists and have adverse effects such as addiction, 1) respiratory depression, 2) and constipation.3,4) Although stimulation of the κ-opioid receptor (KOR) results in significant analgesia, KOR agonists do not suffer from the same adverse effects as MOR agonists. Many KOR agonists, including ethylketocyclazocine, U-50,488H, and nalfurafine (TRK-820), have been developed and investigated for their analgesic, anti-inflammatory and antipruritic activity 5,6) ( Fig. 1). However, these agonists suffer from dose-limiting dysphoria, sedation, and psychotomimetic effects. 7,8) Consequently, the development of a KOR agonist that does not cause adverse effects is important.We previously reported that (+)-matrine (1) and (+)-allomatrine (2), typical matrine-type lupine alkaloids produced by Sophora Leguminosae, have antinociceptive properties identical to those of pentazocine.9) The effects of 1 were mediated mainly through activation of the KOR and partially through the MOR, and those of 2 were mediated only through the KOR.10) Furthermore, we found that neither 1 nor 2 provided the activation in the guanosine-5′-O-(3-[ 11) Although intracerebroventricular pretreatment with an antiserum against dynorphin A (1-17) did not affect the antinociceptive effect induced by subcutaneous (s.c.) treatment of 1 and 2, the antinociceptive effect was greatly attenuated by intrathecal (i.t.) pretreatment with an antiserum against dynorphin A (1-17) in mice. This suggested that the antinociceptive effect induced by s.c. treatment of 1 and 2 occurred without binding to the KOR in the ventricles of the brain, in where might stimulate the descending dynorphinergic neuron and production of dynorphin in the spinal cord.Because the pharmacological mechanism of action and chemical structures of 1 and 2 differ from conventional KOR agonists, we performed structure-activity relationship (SAR) studies for 1 and 2 and their antinociceptive activity using modifications of the A-D ring systems. The SAR studies showed that the amide group, tertiary amine group, and Cring of 1 and 2 were important in determining their activity. 4-Dimethylamino-1-pentanoylpiperidine (3) was identified as a lead compound through the antinociceptive eff...

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Hemodynamic and respiratory effects of morphine and butorphanol

Cited by 76 publications

References 6 publications

Définitions de la “dépression respiratoire” de l’analgésie postopératoire réalisée avec de la morphine intrathécale : une revue documentaire

Définitions de la “dépression respiratoire” de l’analgésie postopératoire réalisée avec de la morphine intrathécale : une revue documentaire

A Comparative Study of Epidural Butorphanol and Epidural Morphine for the Relief of Postoperative Pain

Design and Synthesis of a Piperidinone Scaffold as an Analgesic through Kappa-Opioid Receptor: Structure–Activity Relationship Study of Matrine Alkaloids

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