The analgesic effect of morphine on postoperative pain in diabetic patients

Karcı, Ayşe; Taşdöğen, Aydın; Erkin, Yüksel; Aktas, Guler; Elar, Zahi̇de

doi:10.1111/j.1399-6576.2004.00387.x

Cited by 44 publications

(36 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies showed that the expression of MOP receptors is down-regulated in the spinal cord of rodents with either nerve injury or type 1 diabetes [54, 55]. These findings may partially explain the reduced analgesic efficacy of opioids in patients with chronic pain and/or neuroinflammatory diseases [7, 9, 56]. Interestingly, emerging evidence shows that pro-inflammatory chemokines such as CCL3-CCR5 signaling is capable of desensitizing MOP receptors, and CCR5 and MOP receptors may engage in crosstalk through dimerization [57, 58].…”

Section: Discussionmentioning

confidence: 99%

Altered expression of glial markers, chemokines, and opioid receptors in the spinal cord of type 2 diabetic monkeys

Kiguchi

Ding

Peters

et al. 2017

Biochimica et Biophysica Acta (BBA) - Molecular Basis of Diseas

View full text Add to dashboard Cite

Neuroinflammation is a pathological condition that underlies diabetes and affects sensory processing. Given the high prevalence of pain in diabetic patients and crosstalk between chemokines and opioids, it is pivotal to know whether neuroinflammation-associated mediators are dysregulated in the central nervous system of diabetic primates. Therefore, the aim of this study was to investigate whether mRNA expression levels of glial markers, chemokines, and opioid receptors are altered in the spinal cord and thalamus of naturally occurring type 2 diabetic monkeys (n=7) compared with age-matched non-diabetic monkeys (n=6). By using RT-qPCR, we found that mRNA expression levels of both GFAP and IBA1 were up-regulated in the spinal dorsal horn (SDH) of diabetic monkeys compared with non-diabetic monkeys. Among all chemokines, expression levels of three chemokine ligand-receptor systems, i.e., CCL2-CCR2, CCL3-CCR1/5, and CCL4-CCR5, were up-regulated in the SDH of diabetic monkeys. Moreover, in the SDH, seven additional chemokine receptors, i.e., CCR4, CCR6, CCR8, CCR10, CXCR3, CXCR5, and CXCR6, were also up-regulated in diabetic monkeys. In contrast, expression levels of MOP, KOP, and DOP, but not NOP receptors, were down-regulated in the SDH of diabetic monkeys, and the thalamus had fewer changes in the glial markers, chemokines and opioids. These findings indicate that neuroinflammation, manifested as glial activation and simultaneous up-regulation of multiple chemokine ligands and receptors, seems to be permanent in type 2 diabetic monkeys. As chemokines and opioids are important pain modulators, this first-in-primate study provides a translational bridge for determining the functional efficacy of spinal drugs targeting their signaling cascades.

show abstract

Section: Discussionmentioning

confidence: 99%

Altered expression of glial markers, chemokines, and opioid receptors in the spinal cord of type 2 diabetic monkeys

Kiguchi

Ding

Peters

et al. 2017

Biochimica et Biophysica Acta (BBA) - Molecular Basis of Diseas

View full text Add to dashboard Cite

show abstract

“…Not only experimental, but also clinical studies have suggested that diabetes or hyperglycemia altered opioid responsiveness. Karci A. et al reported that the analgesic effect of morphine was attenuated in hyperglycemic condition and a large dose of morphine may be administered to diabetic patients for effective postoperative analgesia [13]. Several investigators have studied the endogenous opioid system in type 2 patients that did not respond to stress caused by breathing against fatiguing inspiratory resistive load [14].…”

Section: Introductionmentioning

confidence: 98%

Endomorphins Restored the Endothelium-Dependent Relaxation of the Rabbit Aorta Rings Exposed to High D-Glucose Condition Via NO-cGMP Pathway

Liu¹,

Wei²,

Che³

et al. 2006

PPL

View full text Add to dashboard Cite

Rings of rabbit aorta that were both incubated in a high concentration of D-glucose and contracted submaximally by phenylephrine showed significantly decreased endothelium-dependent relaxations induced by acetylcholine. The cGMP production of aorta rings was also reduced. Treatment with endomorphins (1-1000 nmol/L) restored acetylcholine-induced relaxations of aorta rings incubated in high glucose concentrations and increased the cGMP synthesis. Moreover, this effect of endomorphins on endothelium was antagonized by naloxone, and the increase in the production of cGMP was also blocked.

show abstract

“…Karci et al showed that the analgesic effect of morphine is negatively affected by high blood glucose in patients scheduled for elective total abdominal hysterectomy. According to data on postoperative intravenous patient-controlled analgesia (PCA), patients with diabetes require more opioids than 3 patients without diabetes [4]. Glycated hemoglobin (HbA1c) is a highly reliable indicator of glycemic control over the previous 8 to 12 weeks [5].…”

Section: Introductionmentioning

confidence: 99%

“…The VAS score during activity 24 hours after the operation was higher for the GDM group than for the NGDM group (5[5-6] vs 5 [4][5], P=0.03). No significant between-group differences were found in the pain scores at the 6-hour postoperative rest/activity measurement or at the 24-hour postoperative rest measurement.…”

mentioning

confidence: 95%

The effect of gestational diabetes mellitus on sufentanil consumption after cesarean section: A prospective cohort study

yang

Geng

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Previous studies have shown that patients with long-term diabetes require more opioids after surgery than patients without diabetes. Gestational diabetes mellitus (GDM) normally only lasts for a brief period; nevertheless, its effect on sufentanil consumption after cesarean section is unknown. Methods: This prospective cohort study included two groups: a GDM group (n=32) and a matched non-GDM (NGDM) group (n=32). All patients underwent routine combined spinal-epidural anesthesia for cesarean delivery. Sufentanil consumption through an intravenous patient-controlled analgesia (PCA) pump, the frequency of PCA requests, and visual analog scale (VAS) scores 6 and 24 hours after surgery were compared between groups. Results: Sufentanil consumption (µg) 6 hours after surgery was higher in the GDM group than in the NGDM group (24.0±6.6 vs 20.1±5.7, P=0.023). PCA was used more frequently 6 and 24 hours after surgery by the GDM group than by the NGDM group (1[0-2] vs 0[0-1], P=0.001; 6[4-8] vs 3[1-5], P=0.001, respectively). The VAS score during activity 24 hours after surgery was higher in the GDM group than in the NGDM group (5[5-6] vs 5[4-5], respectively, P=0.03). Conclusion: Pregnant women with GDM require more opioids during the immediate postoperative period after cesarean section than those without GDM.

show abstract

The analgesic effect of morphine on postoperative pain in diabetic patients

Abstract: The findings of the study appear to support experimental and clinical impressions that the analgesic effect of morphine is attenuated in hyperglycemic conditions. Therefore, larger doses of morphine may be administered to diabetic patients for effective postoperative analgesia.

Cited by 44 publications

References 11 publications

Altered expression of glial markers, chemokines, and opioid receptors in the spinal cord of type 2 diabetic monkeys

Altered expression of glial markers, chemokines, and opioid receptors in the spinal cord of type 2 diabetic monkeys

Endomorphins Restored the Endothelium-Dependent Relaxation of the Rabbit Aorta Rings Exposed to High D-Glucose Condition Via NO-cGMP Pathway

The effect of gestational diabetes mellitus on sufentanil consumption after cesarean section: A prospective cohort study

Contact Info

Product

Resources

About