Nitroglycerin Plus Morphine on Iv Patient Controlled Analgesia for Abdominal Surgery: The Effect on Postoperative Pain

Karbasy, Seyyed Hasan; Azadeh, Sekhavati; Sabertanha, Amir; Shakhsemampour, Bibifatemeh

doi:10.5812/aapm.99582

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…Although we used TNG to deliberately restrict MAP variations intraoperatively in the normal to low ranges in one group of patients, in the literature, there was no analgesic effect attributable to TNG ( 42 ). If TNG has any unknown analgesic effects, this effect is still in favor of our results, because the same group of patients who received TNG (group B) had more postoperative pain intensity and analgesic requirements in our study.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Pneumoperitoneum-induced Hypertension During Laparoscopic Cholecystectomy Under General Anesthesia on Postoperative Pain: A Randomized Clinical Trial

et al. 2022

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Background: Acute postoperative pain is a significant cause of morbidities. This study aimed to evaluate the effect of intraoperative blood pressure during laparoscopic cholecystectomy under general anesthesia on postoperative pain in patients without underlying disorders. Methods: In this randomized clinical trial, 72 patients undergoing general anesthesia for elective laparoscopic cholecystectomy were randomly assigned into two groups: Group A with higher than baseline preoperative blood pressure (MAP allowed to increase up to 20% higher than baseline MAP by inducing pneumoperitoneum) and group B with normal to low blood pressure (MAP deliberately controlled at a tight limit from normal baseline MAP values to 20% less than baseline by titrating TNG infusion). The Visual Analog Scale (VAS) after 2, 8, 12, and 24 hours of surgery, and the total dose of meperidine used to manage postoperative pain were recorded and compared between the two groups. Results: The pain scores in group A were significantly lower than group B (P = 0.001). The postoperative analgesia request time was different between the two groups (P = 0.53). During the first 24 hours, the total meperidine consumption dose in group A was significantly lower than in group B (P = 0.001). Conclusions: High intraoperative blood pressure may affect the postoperative pain after laparoscopic cholecystectomy and lead to less postoperative pain score and analgesic requirements.

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Section: Discussionmentioning

confidence: 99%

The Effect of Pneumoperitoneum-induced Hypertension During Laparoscopic Cholecystectomy Under General Anesthesia on Postoperative Pain: A Randomized Clinical Trial

et al. 2022

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“…The µand κ-opioid receptors have been studied and shown to decrease NK cell activity. Morphine, a commonly used opioid, may promote tumor neovascularization and expansion (32,33). Its use in IV and epidural injections inhibit an immune response by targeting the production of IFN-γ by CD8 cells (34,35).…”

Section: Opioids and Cancer Recurrencementioning

confidence: 99%

The Influence of Analgesic Modalities on Postoperative Cancer Recurrence

et al. 2022

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: The potential for cancer cells to grow and to metastasize depends on complex interactions between inflammatory signals and pathways, immune cells, and elements of the stromal tissue in which they invade. Related to the nature of many cancers, the probability of recurrence can potentially be quite high for some patients. Immunology, lifestyle modifications, timing of disease, genetics, age, gender, and race are only a handful of ways the likelihood of cancer recurrence can be influenced. The quantity, or density, of certain immunological cells or factors, plays a role in the propagation of cancer cells. Opioids are often used in cancer patients for acute postoperative and chronic pain management. While they can produce significant pain relief, the type of analgesic utilized is important, as it may influence cancer propagation. In this regard, certain opioids have been found to increase T regulatory cells while suppressing NK cell function. Morphine may promote tumor neovascularization and expansion. Fentanyl administration significantly diminishes NK-cells and CD8+ cytotoxic T-cells. In a recent meta-analysis, propofol-based anesthesia improved both cancer-free survival and overall survival. COX inhibitors have also shown promise in persevering cancer immune function, as in literature involving ketorolac and celecoxib. In summary, inhaled anesthesia and opioids may contribute to a pro-tumor metastasis environment also known as cancer propagation; whereas propofol and COX inhibitors may provide a better alternative to reduce cancer recurrence and propagation.

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“…To reduce the consumption of perioperative opioids, various drugs and methods have been studied to date, including non-opioids, adjuvants, and regional, peripheral, and neuraxial blocks. Nevertheless, the application of each of these methods and drugs requires specific knowledge, experience, equipment, arrangements, and care (3)(4)(5)(6)(7). Many clinical studies have been published on the application of multimodal analgesia in a variety of surgeries.…”

mentioning

confidence: 99%