Laprairie Jamie L, Johns Malcolm E, Murphy Anne Z
Department of Biology, Georgia State University, Atlanta, Georgia 30303-3088, USA.
Pediatr Res. 2008 Dec;64(6):625-30. doi: 10.1203/PDR.0b013e31818702d4.
Despite mounting evidence on the importance of pain management in preterm infants, clinical use of analgesics in this population is limited. Our previous studies have shown that neonatal inflammation results in long-term alterations in adult somatosensory thresholds, characterized by decreased baseline nociceptive sensitivity, and enhanced hyperalgesia after a subsequent inflammatory insult. The present studies were conducted to determine whether preemptive morphine attenuates these negative consequences. At P0, pups received an injection of morphine sulfate before an intraplantar injection of 1% carrageenan. Control pups received either saline (SAL) followed by intraplantar carrageenan, morphine sulfate followed by intraplantar SAL, or SAL followed by intraplantar SAL. Preemptive morphine significantly attenuated neonatal injury-induced hypoalgesia in adolescence and adulthood. Similarly, morphine pretreated animals displayed significantly less hyperalgesia and recovered faster from a subsequent inflammatory insult compared with controls. Neonatal morphine had no significant effect on morphine analgesia in adulthood. Interestingly, neonatally injured animals that did not receive morphine displayed a significant rightward shift in the morphine dose-response curve in the absence of peripheral inflammation. Together, these results demonstrate that preemptive morphine significantly attenuates the long-term behavioral impact of neonatal inflammatory injury.
尽管有越来越多的证据表明疼痛管理对早产儿很重要,但镇痛药在这一人群中的临床应用仍然有限。我们之前的研究表明,新生儿炎症会导致成年后躯体感觉阈值的长期改变,其特征是基线伤害性感受敏感性降低,以及在随后的炎症刺激后痛觉过敏增强。本研究旨在确定预防性使用吗啡是否能减轻这些负面后果。在出生后第0天,幼崽在足底注射1%角叉菜胶之前接受硫酸吗啡注射。对照幼崽接受生理盐水(SAL)随后足底注射角叉菜胶、硫酸吗啡随后足底注射SAL或SAL随后足底注射SAL。预防性使用吗啡显著减轻了青春期和成年期新生儿损伤诱导的痛觉减退。同样,与对照组相比,吗啡预处理的动物表现出明显较轻的痛觉过敏,并且从随后的炎症刺激中恢复得更快。新生儿期使用吗啡对成年期的吗啡镇痛没有显著影响。有趣的是,未接受吗啡的新生儿期受伤动物在没有外周炎症的情况下,吗啡剂量-反应曲线显著右移。总之,这些结果表明,预防性使用吗啡能显著减轻新生儿炎症损伤的长期行为影响。