The immunomodulatory effects of opioids and implications for intensive care unit populations

Mefford, Breanne; Donaldson, John C.; Bissell, Brittany D

doi:10.1002/phar.2602

Cited by 4 publications

(1 citation statement)

References 46 publications

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“…A small number of patients were admitted to the hospital to receive pain control before their procedure. In this, the general approach is to substitute the opioid analgesia in current use with transdermal buprenorphine (reduced to 50% of the equianalgesic dose) [14]. Opioid conversion is calculated using the Faculty of Pain Medicine Opioid Calculator [15].…”

Section: Methodsmentioning

confidence: 99%

Implementation of a peri‐operative pain‐management algorithm reduces the use of opioid analgesia following pelvic exenteration surgery

et al. 2022

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Aim This study aimed to investigate the implementation and pain‐related outcomes of a peri‐operative pain‐management regimen for patients undergoing pelvic exenteration surgery at a university teaching hospital. Method This is a single‐site prospective observational cohort study involving 100 patients who underwent pelvic exenteration surgery between January 2017 and December 2018. A pain‐management algorithm regarding the use of opioid‐sparing multimodal analgesia was developed between the departments of anaesthesia, pain management and intensive care. The primary outcomes were: compliance with a pain‐treatment algorithm compared with a similar retrospective surgical patient cohort in 2013–2014; and requirements for regular doses of opioid analgesia at discharge, measured in oral morphine equivalent daily dose (oMEDD). Results Following the introduction of a pain‐management algorithm, regional anaesthesia techniques (spinal anaesthesia, transversus abdominus plane block, preperitoneal catheters or epidural analgesia) were used in 83/98 (84.7%) of the 2017–2018 cohort compared with 13/73 (17.8%) of the 2013–2014 cohort (p < 0.001). There was a reduction in the median dose of opioid analgesics (oMEDD) at time of discharge, from 150 mg (interquartile range [IQR]: 75.0–235.0 mg) in the 2013–2014 cohort to 10 mg (IQR: 0.00–45.0 mg) in the 2017–2018 cohort (p < 0.001). There was no change in pain intensity (assessed using the Verbal Numerical Rating Score) or oMEDD in the first 7 days following surgery. Conclusion Since implementation of a novel peri‐operative pain‐treatment algorithm, the use of opioid‐sparing regional techniques and preperitoneal catheters has increased. Additionally, the dose of opioids required at the time of discharge has reduced significantly.

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Section: Methodsmentioning

confidence: 99%

Implementation of a peri‐operative pain‐management algorithm reduces the use of opioid analgesia following pelvic exenteration surgery

et al. 2022

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Immunomodulation by tramadol combined with acetaminophen or dexketoprofen: In vivo animal study

Filipczak-Bryniarska,

Nazimek,

Nowak

et al. 2023

International Immunopharmacology

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Effect of an opioid-free anesthetic on postoperative opioid consumption after laparoscopic bariatric surgery: a prospective, single-blinded, randomized controlled trial

Perez,

Strunk,

Preciado

et al. 2024

Reg Anesth Pain Med

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IntroductionOpioid administration has the benefit of providing perioperative analgesia but is also associated with adverse effects. Opioid-free anesthesia (OFA) may reduce postoperative opioid consumption and adverse effects after laparoscopic bariatric surgery. In this randomized controlled study, we hypothesized that an opioid-free anesthetic using lidocaine, ketamine, and dexmedetomidine would result in a clinically significant reduction in 24-hour postoperative opioid consumption when compared with an opioid-inclusive technique.MethodsSubjects presenting for laparoscopic or robotic bariatric surgery were randomized in a 1:1 ratio to receive either standard opioid-inclusive anesthesia (group A: control) or OFA (group B: OFA). The primary outcome was opioid consumption in the first 24 hours postoperatively in oral morphine equivalents (OMEs). Secondary outcomes included postoperative pain scores, patient-reported incidence of opioid-related adverse effects, hospital length of stay, patient satisfaction, and ongoing opioid use at 1 and 3 months after hospital discharge.Results181 subjects, 86 from the control group and 95 from the OFA group, completed the study per protocol. Analysis of the primary outcome showed no significant difference in total opioid consumption at 24 hours between the two treatment groups (control: 52 OMEs vs OFA: 55 OMEs, p=0.49). No secondary outcomes showed statistically significant differences between groups.ConclusionsThis study demonstrates that an OFA protocol using dexmedetomidine, ketamine, and lidocaine for laparoscopic or robotic bariatric surgery was not associated with a reduction in 24-hour postoperative opioid consumption when compared with an opioid-inclusive technique using fentanyl.

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The immunomodulatory effects of opioids and implications for intensive care unit populations

Cited by 4 publications

References 46 publications

Implementation of a peri‐operative pain‐management algorithm reduces the use of opioid analgesia following pelvic exenteration surgery

Implementation of a peri‐operative pain‐management algorithm reduces the use of opioid analgesia following pelvic exenteration surgery

Immunomodulation by tramadol combined with acetaminophen or dexketoprofen: In vivo animal study

Effect of an opioid-free anesthetic on postoperative opioid consumption after laparoscopic bariatric surgery: a prospective, single-blinded, randomized controlled trial

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