Antinociceptive and immunosuppressive effect of opioids in an acute postoperative setting: an evidence-based review
| Autor: | S Ramaswamy, RM Langford |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
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business.industry medicine.medical_treatment Paradoxical reaction Perioperative 03 medical and health sciences 0302 clinical medicine Anesthesiology and Pain Medicine Opioid 030202 anesthesiology Anesthesia Hyperalgesia medicine Vomiting 030212 general & internal medicine medicine.symptom Adverse effect business medicine.drug Desensitization (medicine) |
| Zdroj: | BJA Education. 17:105-110 |
| ISSN: | 2058-5349 |
| DOI: | 10.1093/bjaed/mkw030 |
| Popis: | Key points Opioids remain the mainstay of perioperative pain management for many surgical procedures and settings. However, they are well known to cause side-effects, including nausea, vomiting, hallucinations, urinary retention, constipation, somnolence, and respiratory depression. More recently, there have been some concerns regarding their long-term antinociceptive effects due to the development of tolerance or hyperalgesia.1 There have also been reports of suppression of the immune system by opioids.1 In this review, the evidence and the possible mechanisms for the occurrence of acute tolerance, hyperalgesia, and immunosuppression in the perioperative setting will be explored. Evidence-based opioid-sparing treatments may be used in the perioperative setting to diminish the dose-related adverse effects of opioids. ### Opioid tolerance and hyperalgesia Tolerance occurs when a patient's response to a drug reduces over time and necessitates an increase in dose to maintain the desired result. This results from desensitization of opioid receptors due to a number of mechanisms as outlined below. Opioid-induced hyperalgesia (OIH) is a state of pain receptor sensitization caused by exposure to opioids. Clinically, this is recognized by a paradoxical response to opioid analgesics. While opioids are being used to manage the pain, they may actually result in an increase in sensitivity to painful stimuli. Therefore, any further increase in the opioid dose could result in an increased perception of painful stimuli.2 There is strong positive evidence from animal studies, … |
| Databáze: | OpenAIRE |
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