Influence of pain treatment by epidural fentanyl and bupivacaine on homing of opioid-containing leukocytes to surgical wounds
Female; Humans; Male; Pain; Analgesics; Aged; Middle Aged; Longitudinal Studies; Analgesia; Anesthetics; Biomarkers of Pain; Anesthesia; Epidural; Enkephalin; Adjuvants; Anesthesia/immunology/pharmacology; beta-Endorphin/drug effects/immunology/metabolism; Bupivacaine/immunology/therapeutic use; Cell Movement/drug effects/immunology; Fentanyl/immunology/therapeutic use; Leukocytes/drug effects/immunology/metabolism; Local/immunology/therapeutic use; Methionine/drug effects/immunology/metabolism; Nociceptors/drug effects/immunology; Opioid/immunology/therapeutic use; Patient-Controlled; Pirinitramide/therapeutic use; Postganglionic/drug effects/immunology; Postoperative/immunology/prevention & control; Subcutaneous Tissue/immunology; Sympathetic Fibers; Wound Healing/drug effects/immunology
Endogenous opioids released from leukocytes extravasating into injured tissue can interact with peripheral opioid receptors to inhibit nociception. Animal studies have shown that the homing of opioid-producing leukocytes to the injured site is modulated by spinal blockade of noxious input. This study investigated whether epidural analgesia (EDA) influences the migration of beta-endorphin (END) and/or met-enkephalin (ENK)-containing leukocytes into the subcutaneous wound tissue of patients undergoing abdominal surgery. In part I patients received general anesthesia combined either with intra- and postoperative EDA (with bupivacaine and fentanyl) or with postoperative patient controlled intravenous analgesia (PCIA; with the opioid piritramide). In part II patients received general anesthesia combined with either epidural fentanyl or bupivacaine which was continued postoperatively. Samples of cutanous and subcutanous tissue were taken from the wound site at the beginning, at the end and at various times after surgery, and were examined by immunohistochemistry for the presence of END and ENK. We found that (i) epidural bupivacaine, fentanyl and PCIA provided similar and clinically acceptable postoperative pain relief; (ii) compared to PCIA, epidural bupivacaine or fentanyl did not change the gross inflammatory reaction within the surgical wound; (iii) opioid-containing leukocytes were almost absent in normal subcutaneous tissue but migrated to the inflamed wound tissue in ascending numbers within a few hours, reaching a peak at about 24 h after surgery; (iv) compared to PCIA, EDA resulted in significantly decreased homing of END-containing leukocytes to the injured site at 24 h after surgery; and (v) the magnitude of this decrease was similar regardless of the epidural medication. These findings suggest that nociceptive but not sympathetic neurons are primarily involved in the attraction of opioid-containing leukocytes during early stages of inflammation.
2007
Heurich M; Mousa SA; Lenzner M; Morciniec P; Kopf A; Welte M; Stein C
Brain, Behavior, And Immunity
2007
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/j.bbi.2006.10.014" target="_blank" rel="noreferrer">10.1016/j.bbi.2006.10.014</a>
Epidural analgesia for postoperative pain control in children
Child; Female; Humans; Male; Pain; Pain Measurement; Prognosis; Treatment Outcome; Drug Therapy; Length of Stay; Analgesia; Anesthetics; adolescent; Preschool; infant; Comparative Study; Dose-Response Relationship; Drug; Fentanyl/administration & dosage; Adjuvants; Postoperative/drug therapy; Combination; Anesthesia/administration & dosage; Bupivacaine/administration & dosage; Epidural/methods; Local/administration & dosage
Ninety-eight continuous postoperative epidurals were administered to 87 children. The patients were divided into two groups: group I included 63 cases in which a 0.0625-0.25% solution of bupivacaine was continuously administered; group II included 35 cases in which a similar solution of bupivacaine mixed with 2-10 micrograms of fentanyl was administered. The dose of the epidural medication was titrated by the anesthesiologist according to the patient's age and anticipated level of postoperative pain. The average pain score for all patients for the first 48 h was 1.43. Supplemental analgesia averaging 0.132 mg intravenous morphine/kg/8 h was required in 49 cases (41 in group I and eight in group II). In group I, the average dose of supplemental analgesia was 0.144 mg intravenous morphine/kg/8 h, whereas in group II, it was only 0.056 mg intravenous morphine/kg/8 h. Continuous epidural analgesia is effective in controlling postoperative pain, and the addition of fentanyl reduces the need for systemic narcotics.
1998
Jones MD; Aronsson DD; Harkins JM; Smail DF; Haugh LD
Journal Of Pediatric Orthopedics
1998
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/01241398-199807000-00018" target="_blank" rel="noreferrer">10.1097/01241398-199807000-00018</a>