Perineural morphine in patients with chronic ischemic lower extremity pain: efficacy and long-term results

Keskinbora, Kader; Aydınlı, Işık

doi:10.1007/s00540-008-0700-9

Cited by 12 publications

(14 citation statements)

References 41 publications

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“…Consistent with the animal data, pain relief from local application of opioids has been reported in patients with chronic rheumatoid and osteoarthritis, ischemic pain, dental pain, pancreatitis, and postoperative visceral pain (Dionne et al, 2001; Duckett et al, 1997; Eisenach et al, 2003; Keskinbora et al, 2009; Likar et al, 2001; Modi et al, 2009; Rorarius et al, 1999). …”

Section: Introductionsupporting

confidence: 78%

“…Accumulating studies provide a compelling rationale for targeting peripheral ORs as a novel treatment for various types of pain (Keskinbora et al, 2009). Peripheral application of DOR agonists produces potent anti-hyperalgesic effects under inflammatory and neuropathic pain conditions (Kabli et al, 2007; Pacheco et al, 2005; Shinoda et al, 2007; Stein et al, 1989).…”

Section: Discussionmentioning

confidence: 99%

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Activation of peripheral delta-opioid receptors leads to anti-hyperalgesic responses in the masseter muscle of male and female rats

Saloman

Niu

2011

Neuroscience

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In this project, we examined peripheral δ-opioid receptor (DOR)-mediated anti-hyperalgesic responses in the context of an acute orofacial muscle pain condition in both male and female rats. We also investigated whether the ATP-sensitive K+ channel (KATP), a downstream target of OR signaling, contributes to DOR-mediated anti-hyperalgesic responses. Local pretreatment of the masseter with a DOR agonist, DPDPE, dose-dependently attenuated capsaicin-induced mechanical hypersensitivity in both male and female rats. However, there were sex differences in the potency of local DPDPE in that a 10 fold higher dose of DPDPE was required in female rats to produce the level of anti-hyperalgesia achieved in male rats. The sex differences in the DPDPE effect may not be fully explained by DOR expression level since there was no significant sex difference in DOR mRNA levels in trigeminal ganglia (TG). Finally, pretreatment of the masseter with the KATP antagonist, glibenclamide significantly blocked the effects of DPDPE in male rats suggesting that the peripheral DOR effect is mediated by the KATP. These studies revealed novel information about sex differences with regards to peripherally localized DOR-mediated anti-hyperalgesia under an orofacial muscle pain condition.

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Section: Introductionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Activation of peripheral delta-opioid receptors leads to anti-hyperalgesic responses in the masseter muscle of male and female rats

Saloman

Niu

2011

Neuroscience

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“…Keskinbora et al recently examined the use of bupivacaine versus bupivacaine plus morphine administered via a popliteal catheter for patients with chronic lower extremity pain. The study included a short-term single bolus treatment phase where morphine was noted to prolong analgesia by approximately three hours compared to bupivacaine alone [ 28 ]. It should be noted, however, that the morphine group experienced significantly greater side effects (nausea and somnolence).…”

Section: Resultsmentioning

confidence: 99%

Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review

et al. 2015

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BackgroundThe use of peripheral nerve blocks for anesthesia and postoperative analgesia has increased significantly in recent years. Adjuvants are frequently added to local anesthetics to prolong analgesia following peripheral nerve blockade. Numerous randomized controlled trials and meta-analyses have examined the pros and cons of the use of various individual adjuvants.ObjectivesTo systematically review adjuvant-related randomized controlled trials and meta-analyses and provide clinical recommendations for the use of adjuvants in peripheral nerve blocks.MethodsRandomized controlled trials and meta-analyses that were published between 1990 and 2014 were included in the initial bibliographic search, which was conducted using Medline/PubMed, Cochrane Central Register of Controlled Trials, and EMBASE. Only studies that were published in English and listed block analgesic duration as an outcome were included. Trials that had already been published in the identified meta-analyses and included adjuvants not in widespread use and published without an Investigational New Drug application or equivalent status were excluded.ResultsSixty one novel clinical trials and meta-analyses were identified and included in this review. The clinical trials reported analgesic duration data for the following adjuvants: buprenorphine (6), morphine (6), fentanyl (10), epinephrine (3), clonidine (7), dexmedetomidine (7), dexamethasone (7), tramadol (8), and magnesium (4). Studies of perineural buprenorphine, clonidine, dexamethasone, dexmedetomidine, and magnesium most consistently demonstrated prolongation of peripheral nerve blocks.ConclusionsBuprenorphine, clonidine, dexamethasone, magnesium, and dexmedetomidine are promising agents for use in prolongation of local anesthetic peripheral nerve blocks, and further studies of safety and efficacy are merited. However, caution is recommended with use of any perineural adjuvant, as none have Food and Drug Administration approval, and concerns for side effects and potential toxicity persist.

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“…The evidence supporting the role of peripheral opioid receptors in suppressing pain and hyperalgesia has been accumulated for decades (Stein et al, 2003). Not only in preclinical studies (Garlicki et al, 2006;Nunez et al, 2007;Guan et al, 2008;Obara et al, 2009), but clinical studies in patients also demonstrated the effects of peripheral opioid in multiple pain conditions (Duckett et al, 1997;Rorarius et al, 1999;Dionne et al, 2001;Likar et al, 2001;Eisenach et al, 2003;Keskinbora and Aydinli, 2009). We previously demonstrated the role of peripheral opioid receptors in attenuating mechanical hypersensitivity (Nunez et al, 2007;Saloman et al, 2011;Auh and Ro, 2012).…”

Section: Discussionmentioning

confidence: 99%

Peripheral G protein‐coupled inwardly rectifying potassium channels are involved in δ‐opioid receptor‐mediated anti‐hyperalgesia in rat masseter muscle

Chung

Cho

Bae

et al. 2013

European Journal of Pain

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Background Although the efficacy of peripherally administered opioid has been demonstrated in preclinical and clinical studies, the underlying mechanisms of its anti-hyperalgesic effects are poorly understood. G protein-coupled inwardly rectifying potassium (GIRK) channels are linked to opioid receptors in the brain. However, the role of peripheral GIRK channels in analgesia induced by peripherally administered opioid, especially in trigeminal system, is not clear. Methods Expression of GIRK subunits in rat trigeminal ganglia (TG) was examined with RT-PCR, western blot and immunohistochemistry. Chemical profiles of GIRK expressing neurons in TG were further characterized. Behavioral and Fos experiments were performed to examine the functional involvement of GIRK channels in delta opioid receptor (DOR)-mediated anti-hyperalgesia under an acute myositis condition. Results TG expressed mRNA and proteins for GIRK1 and GIRK2 subunits. Majority of GIRK1- and GIRK2-expressing neurons were non-peptidergic afferents. Inhibition of peripheral GIRK using Tertiapin-Q (TPQ) attenuated anti-nociceptive effects of peripherally administered DOR agonist, DPDPE, on mechanical hypersensitivity in masseter muscle. Furthermore, TPQ attenuated the suppressive effects of peripheral DPDPE on neuronal activation in the subnucleus caudalis of the trigeminal nucleus (Vc) following masseteric injection of capsaicin. Conclusions Our data indicate that peripheral DOR agonist-induced suppression of mechanical hypersensitivity in the masseter muscle involves the activity of peripheral GIRK channels. These results could provide a rationale for developing a novel therapeutic approach using peripheral GIRK channel openers to mimic or supplement the effects of peripheral opioid agonist.

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Perineural morphine in patients with chronic ischemic lower extremity pain: efficacy and long-term results

Cited by 12 publications

References 41 publications

Activation of peripheral delta-opioid receptors leads to anti-hyperalgesic responses in the masseter muscle of male and female rats

Activation of peripheral delta-opioid receptors leads to anti-hyperalgesic responses in the masseter muscle of male and female rats

Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review

Peripheral G protein‐coupled inwardly rectifying potassium channels are involved in δ‐opioid receptor‐mediated anti‐hyperalgesia in rat masseter muscle

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