Suspected opioid-induced hyperalgesia in an infant

Hallett, Ben; Chalkiadis, George

doi:10.1093/bja/aer332

Cited by 20 publications

(14 citation statements)

References 13 publications

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“…Tolerance is defined as the decreased effect of a drug over time despite consistent doses, and higher doses may be needed to maintain the same therapeutic effect. 13,14,16,17,19,20 The time frame for tolerance development remains unclear, with in vitro models suggesting development in hours to days. [21][22][23]24 Development of in vivo tolerance is more difficult to measure, and data are even less conclusive.…”

Section: Discussionmentioning

confidence: 99%

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Fentanyl-Induced Hyperalgesia in Acute Pain Management

Lyons¹,

Rivosecchi²,

Nery³

et al. 2015

Journal of Pain & Palliative Care Pharmacotherapy

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There are safety concerns with the use of fentanyl, including respiratory depression, nausea, constipation, and possibly opioid-induced hyperalgesia (OIH). The purpose of this review is to evaluate the occurrence and significance of opioid-induced hyperalgesia (OIH) after acute fentanyl exposure. A literature search was conducted from October 1995 through January 2015 using MEDLINE, Embase, and Scopus with the terms hyperalgesia, fentanyl, pronociceptive, acute tolerance, and acute. Published articles evaluating the adverse effects of fentanyl during acute pain management (≤96 hours) in humans were included. Opioid-induced hyperalgesia is a phenomenon defined by increasing pain after opioid exposure with the worsening of pain occurring when opioid doses are increased. Hyperalgesia has been described following remifentanil and morphine use, but the question remains about the associated risk with acute fentanyl exposure. Six randomized, controlled trials evaluating the effect of fentanyl on pain in the acute setting have been conducted. Two trials oppose whereas four trials support the occurrence of fentanyl-induced hyperalgesia. The data on OIH after acute fentanyl exposure are limited and conflicting. Hyperalgesia should be considered in patients with uncontrolled pain despite escalating fentanyl doses, since the possibility of fentanyl-induced OIH exists in the acute setting. Well-designed trials are needed to determine the clinical significance of this phenomenon.

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Section: Discussionmentioning

confidence: 99%

“…5 OIH may be characterized by allodynia, or hypersensitivity to touch in a location not originally associated with pain. 14,16,17,20 As with tolerance, the time frame for OIH development is unclear, but the phenomena have been reported in both acute and chronic settings. 13 The questions about clinical significance of OIH remain.…”

Section: Discussionmentioning

confidence: 99%

Fentanyl-Induced Hyperalgesia in Acute Pain Management

Lyons¹,

Rivosecchi²,

Nery³

et al. 2015

Journal of Pain & Palliative Care Pharmacotherapy

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“…Second, the introduction of analgo-sedatives and techniques also resulted in new clinical syndromes such as opioid-induced tolerance, neonatal drug withdrawal syndrome, 48 hyperalgesia 49 or complications such as drug related toxicities 46,50 or toxicity due to loco-regional techniques. 29 Ten-fold dosing errors with intravenous paracetamol 46 and propofol infusion syndrome 50 were reported and a case of hyperalgesia 49 following opioid exposure in a newborn has been published.…”

Section: Clinical Practice and Research Directions: In Search Of Amentioning

confidence: 99%

“…29 Ten-fold dosing errors with intravenous paracetamol 46 and propofol infusion syndrome 50 were reported and a case of hyperalgesia 49 following opioid exposure in a newborn has been published. Caregivers should be aware of contemporary management of the above-mentioned complications.…”

Section: Clinical Practice and Research Directions: In Search Of Amentioning

confidence: 99%

Pharmacological treatment of neonatal pain: In search of a new equipoise

Allegaert

Tibboel

Anker

2013

Seminars in Fetal and Neonatal Medicine

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SUMMARY Inadequate management of pain in early human life contributes to impaired neurodevelopmental outcome and alters pain thresholds, pain or stress-related behavior and physiological responses. However, there are also emerging animal experimental data on the impact of exposure to analgo-sedatives on the incidence and extent of neuro-apoptosis. Since this association has also been suggested in humans, the pharmacological treatment of neonatal pain is in search of a new equipoise since these ‘conflicting’ observations are the main drivers to further reconsider our current treatment regimens. This review focuses on new data concerning clinical pharmacology of morphine, followed by data on more recently introduced opioids like remifentanil and tramadol, locoregional anesthesia and minimally invasive techniques in neonates, and finally with data on intravenous paracetamol. Since the available data are still incomplete, priorities for both clinical management and future research will be proposed.

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“…Alongside the regulatory agencies, investigators and clinicians should also remain vigilant for such effects and report specific observations. To illustrate this, we refer to recent reports on opioid‐induced hyperalgesia , delirium , and propofol infusion syndrome in early infancy.…”

Section: How To Handle Ever More Compounds In Search Of Guidance?mentioning

confidence: 99%

Neonatal clinical pharmacology

Allegaert

Velde

Anker

2013

Pediatric Anesthesia

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Effective and safe drug administration in neonates should be based on integrated knowledge on the evolving physiological characteristics of the infant who will receive the drug, and the pharmacokinetics (PK) and pharmacodynamics (PD) of a given drug. Consequently, clinical pharmacology in neonates is as dynamic and diverse as the neonates we admit to our units while covariates explaining the variability are at least as relevant as median estimates. The unique setting of neonatal clinical pharmacology will be highlighted based on the hazards of simple extrapolation of maturational drug clearance when only based on ‘adult’ metabolism (propofol, paracetamol). Secondly, maturational trends are not at the same pace for all maturational processes. This will be illustrated based on the differences between hepatic and renal maturation (tramadol, morphine, midazolam). Finally, pharmacogenetics should be tailored to neonates, not just mirror adult concepts. Because of this diversity, clinical research in the field of neonatal clinical pharmacology is urgently needed, and facilitated through PK/PD modeling. In addition, irrespective of already available data to guide pharmacotherapy, pharmacovigilance is needed to recognize specific side effects. Consequently, paediatric anesthesiologists should consider to contribute to improved pharmacotherapy through clinical trial design and collaboration, as well as reporting on adverse effects of specific drugs.

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Suspected opioid-induced hyperalgesia in an infant

Cited by 20 publications

References 13 publications

Fentanyl-Induced Hyperalgesia in Acute Pain Management

Fentanyl-Induced Hyperalgesia in Acute Pain Management

Pharmacological treatment of neonatal pain: In search of a new equipoise

Neonatal clinical pharmacology

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