Mahinda Tania B, Lovell Blaise M, Taylor Bradley K
*Division of Pharmacology, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri; and †Department of Pharmacology, School of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana.
Anesth Analg. 2004 Jun;98(6):1698-1704. doi: 10.1213/01.ANE.0000115148.03515.56.
Several studies have emphasized an opioidergic link between the central regulation of cardiovascular function and acute noninflammatory pain. By contrast, relatively few studies have investigated the relationships between opioids, hypertension, and inflammatory pain. We used the formalin model of acute inflammatory pain to compare morphine antinociception among spontaneously hypertensive (SHR) rats, their genetic normotensive controls, Wistar-Kyoto (WKY) rats, and Sprague-Dawley (SD) rats. Measures of nociception included both behavioral and cardiovascular end-points (increased mean arterial blood pressure and heart rate). Morphine (3.0 mg/kg subcutaneously) produced greater hypotension and bradycardia in SHR than in WKY or SD rats. We next administered formalin (5%; 50 microL) and observed greater nociception during both Phase 1 and Phase 2 in SHR controls than in WKY controls. The morphine-treated groups did not differ, suggesting that morphine attenuates hypersensitivity to formalin pain in the SHR. Morphine inhibited edema but not paw hyperthermia to a greater degree in SHR, whereas Phase 1 remifentanil produced a relatively shorter delay in the onset of Phase 2 in SHR. We suggest that the presentation of essential hypertension be considered when opioid regimens are planned both during surgery (to minimize cardiovascular complications) and during the postoperative period (to optimize analgesic effects).
Presentation of essential hypertension should be considered when opioid regimens are planned both during surgery (to minimize cardiovascular complications) and during the postoperative period (to optimize analgesic effects).
多项研究强调了心血管功能的中枢调节与急性非炎性疼痛之间的阿片能联系。相比之下,研究阿片类药物、高血压和炎性疼痛之间关系的研究相对较少。我们使用急性炎性疼痛的福尔马林模型,比较自发性高血压(SHR)大鼠、其基因正常血压对照品系Wistar-Kyoto(WKY)大鼠和Sprague-Dawley(SD)大鼠对吗啡的镇痛作用。伤害感受的测量包括行为和心血管终点指标(平均动脉血压和心率升高)。皮下注射3.0mg/kg吗啡时,SHR大鼠比WKY或SD大鼠产生更大程度的低血压和心动过缓。接下来,我们注射福尔马林(5%;50μL),并观察到SHR对照品系在第1阶段和第2阶段的伤害感受均比WKY对照品系更强。吗啡治疗组之间没有差异,这表明吗啡可减轻SHR大鼠对福尔马林疼痛的超敏反应。吗啡对SHR大鼠水肿的抑制作用大于对爪部体温过高的抑制作用,而第1阶段瑞芬太尼使SHR大鼠第2阶段的发作延迟相对较短。我们建议,在手术期间(以尽量减少心血管并发症)和术后阶段(以优化镇痛效果)制定阿片类药物方案时,应考虑原发性高血压的情况。
在手术期间(以尽量减少心血管并发症)和术后阶段(以优化镇痛效果)制定阿片类药物方案时,应考虑原发性高血压的情况。