Continuous physostigmine combined with morphine-based patient-controlled analgesia in the postoperative period
| Autor: | Benzion Beilin, L. Papismedov, Marta Weinstock, Yehuda Shavit, Hanna Bessler |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Physostigmine medicine.medical_treatment Analgesic Pharmacology Humans Hypnotics and Sedatives Medicine Aged Pain Measurement Immunoassay Pain Postoperative Morphine Interleukin-6 business.industry Patient-controlled analgesia Analgesia Patient-Controlled General Medicine Middle Aged Analgesics Opioid Anesthesiology and Pain Medicine Nociception Anesthesia Postoperative Nausea and Vomiting Hyperalgesia Cholinergic Drug Therapy Combination Female Cholinesterase Inhibitors medicine.symptom Opiate business Interleukin-1 medicine.drug |
| Zdroj: | Acta Anaesthesiologica Scandinavica. 49:78-84 |
| ISSN: | 1399-6576 0001-5172 |
| DOI: | 10.1111/j.1399-6576.2004.00548.x |
| Popis: | Background: Recently, new drugs and techniques for the treatment of postoperative pain were introduced, with the goal of enhancing opiates' analgesia while minimizing their side-effects. Cholinergic agents play an antinociceptive role, but their clinical use is quite limited, due to side-effects. Physostigmine is a cholinesterase inhibitor, which crosses the blood–brain barrier and elevates brain acetylcholine level. Physostigmine can produce analgesia by itself, and enhance opiate analgesia; but these effects are of short duration following bolus administration. Methods: We compared pain intensity and morphine consumption in two postoperative treatment groups: One group received continuous physostigmine infusion combined with morphine-based patient-controlled analgesia (PCA), and the other received PCA alone. Cholinergic anti-inflammatory pathways have recently been described. We therefore also compared changes in proinflammatory cytokine production in the two pain management groups. Results: Continuous infusion of physostigmine combined with morphine-based PCA in the postoperative period significantly reduced opiate consumption, and enhanced the analgesic response. Patients in the physostigmine group also exhibited reduced ex-vivo production of the proinflammatory cytokine, IL-1β. At the same time, physostigmine increased nausea and vomiting, mostly in the first 2 h of the postoperative period. Conclusions: Physostigmine combined with morphine in the postoperative period reduced morphine consumption, enhanced analgesia, and attenuated production of the proinflammatory cytokine, IL-1β. This latter finding may account for the decreased pain observed in this group; this cytokine is known to mediate basal pain sensitivity and induce hyperalgesia in inflammatory conditions. Taking into account the other potential beneficial effects of physostigmine, we suggest that a continuous infusion of physostigmine should be considered as a useful component in multimodal postoperative analgesia. |
| Databáze: | OpenAIRE |
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