| Autor: |
Jarrard CP; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.; Applied Clinical Research Department, University of Texas Southwestern Medical Center, Dallas, Texas, United States., McKenna ZJ; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States., Atkins WC; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States., Foster J; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.; Centre for Human and Applied Physiological Sciences, King's College London, London, United Kingdom., Hendrix JM; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.; Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, United States., Jouett NP; Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, United States., Oldham ZR; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.; Department of Applied Physiology and Sport Management, Southern Methodist University, Dallas, Texas, United States., LeBlanc BJ; University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas, Texas, United States., Watso JC; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.; Applied Clinical Research Department, University of Texas Southwestern Medical Center, Dallas, Texas, United States.; Department of Health, Nutrition, and Food Sciences, Florida State University, Tallahassee, Florida, United States., Crandall CG; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States. |
| Abstrakt: |
Hemorrhage is a leading cause of death in the prehospital setting. Since trauma-induced pain often accompanies a hemorrhagic insult, the administered pain medication must not interfere with critical autonomic regulation of arterial blood pressure and vital organ perfusion. The purpose of this study was to test two unrelated hypotheses: 1 ) sublingual sufentanil (Dsuvia) impairs tolerance to progressive central hypovolemia and 2 ) sublingual sufentanil attenuates pain sensation and the accompanying cardiovascular responses to a noxious stimulus. Twenty-nine adults participated in this double-blinded, randomized, crossover, placebo-controlled trial. After sublingual administration of sufentanil (30 μg) or placebo, participants completed a progressive lower-body negative pressure (LBNP) challenge to tolerance ( aim 1 ). After a recovery period, participants completed a cold pressor test (CPT; aim 2 ). Addressing the first aim, tolerance to LBNP was not different between trials ( P = 0.495). Decreases in systolic blood pressure from baseline to the end of LBNP also did not differ between trials (time P < 0.001, trial P = 0.477, interaction P = 0.587). Finally, increases in heart rate from baseline to the end of LBNP did not differ between trials (time P < 0.001, trial P = 0.626, interaction P = 0.424). Addressing the second aim, sufentanil attenuated perceived pain ( P < 0.001) in response to the CPT, though the magnitude of the change in mean blood pressure during the CPT ( P = 0.078) was not different between trials. These data demonstrate that sublingual sufentanil does not impair tolerance to progressive central hypovolemia. Additionally, sublingual sufentanil attenuates perceived pain, but not the accompanying mean blood pressure responses to the CPT. NEW & NOTEWORTHY Addressing two unique aims, we observed that sublingual sufentanil administration does not impair tolerance or cardiovascular responses to lower-body negative pressure (LBNP)-induced progressive central hypovolemia. Second, despite pain perception being reduced, sublingual sufentanil did not attenuate mean blood pressure responses to a cold pressor test (CPT). |
