Opioids and the neuroimmune axis
Humans; Analgesics; Animals; Rats; Opioid; Receptors; Opioid Peptides/physiology; Opioid/pharmacology; Immune System/drug effects/physiology; Inflammation/immunology; mu/metabolism; Neuroimmunomodulation/immunology
2005
Williams JP; Lambert DG
British Journal Of Anaesthesia
2005
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/10.1093/bja/aei287" target="_blank" rel="noreferrer">10.1093/bja/aei287</a>
Increased numbers of opioid expressing inflammatory cells do not affect intra-articular morphine analgesia
Female; Humans; Male; Adult; Analgesics; Aged; Middle Aged; Drug Therapy; Double-Blind Method; Biomarkers of Pain; Injections; Dose-Response Relationship; Drug; Opioid/administration & dosage; Receptors; Arthroscopy; Intra-Articular; Morphine/administration & dosage; Pain Measurement/methods; Combination; Knee Joint/metabolism/surgery; Opioid/metabolism; Pirinitramide/administration & dosage; Synovitis/metabolism/pathology
BACKGROUND: Both locally expressed beta-endorphin (END) and low doses of morphine relieve pain within inflamed knee joints. Here we examined whether enhanced inflammation and END expression within the synovial tissue of patients undergoing arthroscopic knee surgery might shift the analgesic dose-response curve of intra-articular (i.a.) morphine. METHODS: Following IRB approval and informed consent, patients were randomly assigned to the following i.a. treatments at the end of surgery: group I (n=39), isotonic saline; group II (n=40), 1 mg morphine hydrochloride; group III (n=48), 2 mg morphine hydrochloride; group IV (n=39), 4 mg morphine hydrochloride. Postoperative pain intensity was assessed by the visual analogue scale (VAS), by the time to first analgesic request and by the supplemental piritramide consumption. Synovial specimens from each patient were stained for the presence of inflammatory cells and END and were discriminated into groups with low versus high numbers of these cells. Differences between groups were statistically analyzed by chi(2), anova and mancova where appropiate. RESULTS: Patient characteristics and VAS scores did not differ between groups. Total postoperative piritramide consumption decreased and the time to first analgesic request increased significantly with increasing doses of i.a. morphine (P0.05, mancova). CONCLUSIONS: The dose-response relationship of i.a. morphine analgesia is not shifted by enhanced inflammation and END expression within synovial tissue. Thus, the presence of END within inflamed synovial tissue does not seem to interfere with i.a. morphine analgesia.
2004
Likar R; Mousa SA; Philippitsch G; Steinkellner H; Koppert W; Stein C; Schafer M
British Journal Of Anaesthesia
2004
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/10.1093/bja/aeh222" target="_blank" rel="noreferrer">10.1093/bja/aeh222</a>
Pharmacogenetics of codeine metabolism in an urban population of children and its implications for analgesic reliability
Child; Female; Male; Analgesics; Double-Blind Method; Phenotype; Urban Population; Preschool; Non-U.S. Gov't; Anti-Inflammatory Agents; Human; Support; Vomiting/chemically induced; Genotype; Analgesia; Tonsillectomy; Non-Steroidal/administration & dosage; Morphine Derivatives/blood; Central Nervous System Stimulants/blood; Codeine/genetics/metabolism; Diclofenac/administration & dosage; Morphine/metabolism; Opioid/metabolism
BACKGROUND: Codeine analgesia is wholly or mostly due to its metabolism to morphine by the cytochrome P450 enzyme CYP2D6, which shows significant genetic variation in activity. The aims of this study were to investigate genotype, phenotype and morphine production from codeine in children undergoing adenotonsillectomy, and to compare analgesia from codeine or morphine combined with diclofenac. METHODS: Ninety-six children received either codeine 1.5 mg kg(-1) or morphine 0.15 mg kg(-1) in a randomized, double-blind design. Genetic analysis was performed and plasma morphine concentrations at 1 h were determined. Postoperative analgesia and side-effects were recorded. RESULTS: Forty-seven per cent of children had genotypes associated with reduced enzyme activity. Mean (SD) morphine concentrations were significantly lower (P<0.001) after codeine [4.5 (0.3) ng ml(-1)] than after morphine [24.7 (1.5) ng ml(-1)], and morphine and its metabolites were not detected in 36% of children given codeine. There was a significant relationship between phenotype and plasma morphine (P=0.02). More children required rescue analgesia after codeine at both 2 (P<0.05) and 4 h after administration (P<0.01). Fifty-six per cent of children vomited after morphine and 29% after codeine (P<0.01). Neither phenotype nor morphine concentration was correlated with either pain score or the need for rescue analgesia (r=-0.21, 95% confidence interval -0.4, -0.01). CONCLUSIONS: Reduced ability for codeine metabolism may be more common than previously reported. Plasma morphine concentration 1 h after codeine is very low, and related to phenotype. Codeine analgesia is less reliable than morphine, but was not well correlated with either phenotype or plasma morphine in this study.
2002
Williams DG; Patel A; Howard RF
British Journal Of Anaesthesia
2002
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
Ventilatory effects of morphine, pethidine and methadone in children
Child; Female; Humans; Male; Pain; Time Factors; Depression; Preschool; Non-U.S. Gov't; Research Support; Oxygen/blood; Postoperative/prevention & control; Respiration/drug effects; Chemical; Meperidine/pharmacology; Methadone/pharmacology; Morphine/pharmacology; Tidal Volume/drug effects
The ventilatory effects of single i.v. doses of morphine 0.1 mg kg-1, pethidine 0.67 mg kg-1 and methadone 0.1 mg kg-1 were compared after ophthalmic surgery in an open, randomized study in 30 children aged 3-8 yr. Ventilatory changes after each drug had distinctive profiles, with appreciable individual variation. Acutely, the decrease in ventilatory frequency was greater with pethidine and methadone than with morphine. The acute decrease in oxygen saturation was greater with methadone and pethidine than with morphine. Methadone produced a greater and longer lasting increase in end-tidal carbon dioxide and greater decrease in end-tidal oxygen than morphine or pethidine. Changes in end-tidal carbon dioxide and oxygen concentrations and saturation were most transient after pethidine and of longest duration after methadone. No child developed apnoea or hypoventilation requiring assistance.
1993
Hamunen K
British Journal Of Anaesthesia
1993
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/10.1093/bja/70.4.414" target="_blank" rel="noreferrer">10.1093/bja/70.4.414</a>
Patient-controlled analgesia with low dose background infusions after lower abdominal surgery in children
Child; Female; Humans; Male; Pain; Analgesia; Drug Administration Schedule; Non-U.S. Gov't; Research Support; Comparative Study; Infusions; Intravenous; Nausea/chemically induced; Morphine/administration & dosage/adverse effects; Postoperative Period; Sleep/drug effects; Vomiting/chemically induced; Postoperative/drug therapy; Appendectomy; Patient-Controlled/adverse effects/methods
Forty-five children (aged 6-12 yr) undergoing appendicectomy received one of three analgesic regimens using patient-controlled analgesia (PCA) with morphine: no background infusion (BO); background infusion 4 micrograms kg-1 h-1 (B4); background infusion 10 micrograms kg-1 h-1 (B10). Total consumption of morphine was greater in group B10 compared with groups B0 (P < 0.01) and B4 (P < 0.05). There was no significant difference in morphine consumption in groups B0 and B4. All three groups self-administered similar amounts of morphine and there were no significant differences in pain scores or incidence of excessive sedation. Group B4 suffered less hypoxaemia compared with groups B0 (P < 0.01) and B10 (P < 0.001). Group B10 suffered more nausea and vomiting than groups B0 (P < 0.001) and B4 (P < 0.001), but there was no significant difference in the incidence of nausea and vomiting between groups B0 and B4. Groups B4 and B10 spent more time at night asleep than group B0 (P < 0.05). There were no significant differences between the groups in the amount of time spent asleep during the day. Inclusion of a background infusion of morphine 4 micrograms kg-1 h-1 in a PCA regimen for children did not increase the incidence of side effects and was associated with less hypoxaemia and a better sleep pattern than no background infusion.
1993
Doyle E; Harper I; Morton NS
British Journal Of Anaesthesia
1993
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/10.1093/bja/71.6.818" target="_blank" rel="noreferrer">10.1093/bja/71.6.818</a>
Comparison of different bolus doses of morphine for patient-controlled analgesia in children
Child; Female; Male; Pain; Pain Measurement; Time Factors; Non-U.S. Gov't; Comparative Study; Nausea/chemically induced; Human; Support; Adolescence; Patient-Controlled; Sleep/drug effects; Vomiting/chemically induced; Appendectomy; Analgesia; Morphine/administration & dosage/adverse effects; Postoperative/prevention & control
Forty children undergoing appendicectomy were allocated randomly to receive one of two PCA regimens with morphine. Group B10 received bolus doses of 10 micrograms kg-1 and group B20 received bolus doses of 20 micrograms kg-1. In both groups there was a lockout interval of 5 min and a background infusion of 4 micrograms kg-1 h-1. Group B20 self-administered considerably more morphine (P < 0.01) than group B10. There was no difference between the pain scores of the groups at rest. Group B20 had significantly (P < 0.05) smaller pain scores during movement than group B10 and the latter group suffered significantly (P < 0.01) more hypoxaemic episodes than group B20. There were no differences between the groups in the incidence of vomiting, excess sedation or the amount of time spent asleep at night.
1994
Doyle E; Mottart KJ; Marshall C; Morton NS
British Journal Of Anaesthesia
1994
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/10.1093/bja/72.2.160" target="_blank" rel="noreferrer">10.1093/bja/72.2.160</a>
Use of methadone in the morphine-tolerant burned paediatric patient
Child; Female; Humans; Analgesics; Respiration; Methadone; Morphine; infant; Drug Tolerance; Opioid; Artificial; Burns/therapy; Conscious Sedation/methods; Intensive Care/methods
We describe the successful use of methadone in the restoration of sedation and provision of analgesia in two morphine-tolerant, paediatric patients who had suffered significant thermal injuries and were undergoing mechanical ventilation. Both patients had exhibited escalating requirements for sedative drugs while undergoing ventilation yet remained inadequately sedated. The introduction of i.v. methadone in place of i.v. morphine in the sedative regimen rapidly and effectively restored a state of sedation. Hyperalgesia and morphine tolerance appear to be associated; it is proposed that methadone acts primarily, under these circumstances, by re-establishing the analgesic state. Such use of methadone in the morphine-tolerant patient also afforded a concomitant sedative-sparing effect.
1998
Williams PI; Sarginson RE; Ratcliffe JM
British Journal Of Anaesthesia
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/10.1093/bja/80.1.92" target="_blank" rel="noreferrer">10.1093/bja/80.1.92</a>
Codeine phosphate in children: time for re-evaluation?
Child; Pain; Analgesics; Evidence-Based Medicine; infant; Human; Opioid/therapeutic use; Postoperative/drug therapy; Codeine/therapeutic use
2001
Cunliffe M
British Journal Of Anaesthesia
2001
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
Codeine phosphate in paediatric medicine
Child; Pain; Analgesics; Non-U.S. Gov't; Human; Support; Postoperative/drug therapy; Codeine/pharmacokinetics/pharmacology/therapeutic use; Opioid/pharmacokinetics/pharmacology/therapeutic use
2001
Williams DG; Hatch DJ; Howard RF
British Journal Of Anaesthesia
2001
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