Influence of Naloxone Infusion on Analgesia and Respiratory Depression Following Epidural Morphine

Effect of Low-Dose Naloxone Infusion on Fentanyl Requirements in Critically Ill Children

“…26,27,39,[41][42][43][44] It is known that the effect of naloxone on opioid tolerance is dose dependent, 17,20 with lower naloxone doses being more effective. Although some may consider the dose used in this investigation high, 45 our dose was smaller than that used in the study by Levine et al, 27 equal to the naloxone dose of the study by Gan et al, 26 and equivalent to the dose suggested for further study in the retrospective review by Cheung et al 28 It is unclear whether the use of fentanyl in this investigation versus morphine, as used in previous investigations, 21,22,26 could have contributed to the results of this study.…”

Low‐Dose Naloxone for Prophylaxis of Postoperative Nausea and Vomiting: A Systematic Review and Meta‐analysis

“…Lower doses of naloxone may inhibit opioid-related adverse effects, without antagonizing analgesic effects, whereas higher doses of naloxone would reduce the response to opioid analgesic concentrations. 11,12 These theoretical considerations for naloxone concentration-dependent response may have a pharmacologic basis. All opioid receptors (KOR, DOR, MOR) display both excitatory and inhibitory effects through activation of G proteins (G s , G i/o , and G q) involved in transduction of signals following receptor binding.…”

“…10 Whereas opioid analgesic and adverse effects may be dose dependent, each outcome may have differing dose responses to naloxone. 5,11,12 Administration of low doses of naloxone may reduce adverse effects while preserving analgesic efficacy. 11,12 Guidelines for managing patients at high risk of PONV recommend at least two preventive measures, including preoperative antiemetic medications.…”

“…5,11,12 Administration of low doses of naloxone may reduce adverse effects while preserving analgesic efficacy. 11,12 Guidelines for managing patients at high risk of PONV recommend at least two preventive measures, including preoperative antiemetic medications. 3 If medication prophylaxis fails, an alternative class of antiemetic relative to the preoperative agent is suggested.…”

Naloxone reversal of opioid anesthesia revisited: clinical evaluation and plasma concentration analysis of continuous naloxone infusion after anesthesia with high-dose fentanyl

“…3). Without an initial loading, Rawal et al [24] reported a steady-state concentration of 4 ng·ml Ϫ1 obtained after 5-h naloxone infusion at a rate of 5 µg·kg Ϫ1 ·h Ϫ1 . Therefore, naloxone infusion with an appropriate initial loading would appear to be important for reversing postoperative respiratory depression.…”