Recurrent Herpes Simplex Virus Labialis and the Use of Epidural Morphine in Obstetric Patients

Crone, Lesley-Ann; Conly, John; Clark, Keith M.; Crichlow, Allison C.; Wardell, Gaylord C.; Zbitnew, Audrey; Rea, Lottie M.; Cronk, S. L.; Anderson, Catherine M.; Tan, Leonard; Albritton, William L.

doi:10.1097/00006254-198902000-00013

Cited by 5 publications

(8 citation statements)

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“…Associations between perioperative opioid use and clinical manifestations of immunosuppression, including perioperative infections, herpetic viral lesion recurrence, and the recurrence of several malignancies, have been described. 1,30–34 Several mechanisms likely simultaneously contribute to the observed increase in the recurrence of cancer. Opioid receptor expression is increased in non-small cell lung cancer specimens.…”

Section: Discussionmentioning

confidence: 99%

Suppression of Human Natural Killer Cells by Different Classes of Opioids

Maher

Walia

Heller

2019

Anesthesia &Amp; Analgesia

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BACKGROUND: The use of regional and other opioid-sparing forms of anesthesia has been associated with a decrease in the recurrence of certain malignancies. Direct suppression of human natural killer cells by opioids has been postulated to explain this observation. However, the effect of different classes of opioids on suppression of natural killer cell cytotoxicity has not been systematically characterized. METHODS: After confirming that freshly isolated natural killer cells from peripheral human blood express opioid receptors, cells were incubated with increasing concentrations of clinically used or receptor-specific opioid agonists. We also evaluated the effect of pretreatment with receptor-specific antagonists or naloxone. Treated natural killer cells were then coincubated with a carboxyfluorescein succinimidyl ester-labeled target tumor cell line, K562. Annexin V staining was used to compare the percent of tumor cell apoptosis in the presence of opioid-pretreated and untreated natural killer cells. Treated samples were compared to untreated samples using Kruskal-Wallis tests with a post hoc Dunn correction. RESULTS: Morphine, methadone, buprenorphine, loperamide, [D-Ala2, N-MePhe4, Gly-ol]-enkephalin, and U-50488 significantly decreased natural killer cell cytotoxicity. When natural killer cells were pretreated with naloxone, cyprodime, and nor-binaltorphimine before exposure to morphine, there was no difference in natural killer cytotoxicity, compared to the amount observed by untreated natural killer cells. Fentanyl, O-desmethyltramadol, and [D-Pen2,D-Pen5] enkephalin did not change natural killer cell cytotoxicity compare to untreated natural killer cells. CONCLUSIONS: Incubation of isolated natural killer cells with certain opioids causes a decrease in activity that is not observed after naloxone pretreatment. Suppression of natural killer cell cytotoxicity was observed with μ- and κ-receptor agonists but not δ-receptor agonists. These data suggest that the effect is mediated by μ- and κ-receptor agonism and that suppression is similar with many clinically used opioids. (Anesth Analg 2019;128:1013–21)

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Section: Discussionmentioning

confidence: 99%

Suppression of Human Natural Killer Cells by Different Classes of Opioids

Maher

Walia

Heller

2019

Anesthesia &Amp; Analgesia

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“…It is well documented that opioid abusers have a higher prevalence of opportunistic infections, which may be directly associated with impaired immune function (Roy et al, 2011 ). Studies in healthy non-addicted individuals has revealed that opioid treatment in obstetrics results in reactivation of latent viruses, which can be directly explained by a dampened antiviral immune function (Crone et al, 1988 ). A previous study by the authors indicates that endogenous opioids can control viral infection and could be useful for therapeutic applications (Salimi et al, 2013 ).…”

Section: Opioids and Viral Infectionmentioning

confidence: 99%

Opioids and Viral Infections: A Double-Edged Sword

et al. 2016

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Opioids and their receptors have received remarkable attention because they have the ability to alter immune function, which affects disease progression. In vitro and in vivo findings as well as observations in humans indicate that opioids and their receptors positively or negatively affect viral replication and virus-mediated pathology. The present study reviews recent insights in the role of opioids and their receptors in viral infections and discusses possible therapeutic opportunities. This review supports the emerging concept that opioids and their receptors have both favorable and unfavorable effects on viral disease, depending on the type of virus. Targeting of the opioid system is a potential option for developing effective therapies; however caution is required in relation to the beneficial functions of opioid systems.

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“…[ 6 ] Therefore, tramadol has the potential to provide effective postoperative analgesia, with no risk of respiratory depression after central neuraxial administration. However, pruritus, nausea, vomiting, urinary retention, activation of herpes labialis[ 7 ] and risk of unpredictable respiratory depression[ 8 9 ] have directed the clinicians to use a lower dose of tramadol that can be used intrathecally to produce effective and prolonged analgesia without such complications.…”

Section: Introductionmentioning

confidence: 99%

Intrathecal tramadol added to bupivacaine as spinal anesthetic increases analgesic effect of the spinal blockade after major gynecological surgeries

Chakraborty¹,

Chakrabarti

Bhattacharya

2008

Indian J Pharmacol

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The analgesic effect of the centrally acting opioid, tramadol, is well-known. It has been shown in clinical studies that using tramadol epidurally can provide longer duration of analgesia, without the common side effects of opioids. The study was undertaken to evaluate the duration of analgesia and/or pain free period produced by intrathecal tramadol added to bupivacaine in patients undergoing major gynecological surgery in a randomized double blind placebo controlled protocol. Fifty patients ASA I & II scheduled for Wardmayo's operation and Fothergill's operation were randomly allocated to two equal groups. Group A (n=25) received 3 ml of 0.5% hyperbaric bupivacaine (15 mg) with 0.2 ml of normal saline and Group B (n=25) received 3 ml 0.5% hyperbaric bupivacaine and 0.2 ml (20 mg) tramadol by intrathecal route at L3-4 inter space. Standard monitoring of the vital parameters was done during the study period. Levels of sensory block and sedation score were recorded every two minutes for the first 20 minutes, and then every ten minutes for the rest of the surgical procedure. Assessment of pain was done using Visual Analogue Scale (VAS). The study was concluded when the VAS was more than 40 mm, postoperatively. The patient was medicated and the time was recorded. Duration of analgesia or pain free period was estimated from the time of completion of spinal injection to administration of rescue analgesic or when the VAS score was greater than 40 mm. In Group B patients, the VAS score was significantly lower, as compared to Group A patients. The duration of analgesia was 210 ± 10.12 min in Group A; whereas, in Group B, it was 380 ± 11.82 min, which was found to be significant.

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Recurrent Herpes Simplex Virus Labialis and the Use of Epidural Morphine in Obstetric Patients

Cited by 5 publications

References 0 publications

Suppression of Human Natural Killer Cells by Different Classes of Opioids

Suppression of Human Natural Killer Cells by Different Classes of Opioids

Opioids and Viral Infections: A Double-Edged Sword

Intrathecal tramadol added to bupivacaine as spinal anesthetic increases analgesic effect of the spinal blockade after major gynecological surgeries

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