Letson Hayley L, Dobson Geoffrey P
Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, Queensland, Australia.
Shock. 2021 Mar 1;55(3):379-387. doi: 10.1097/SHK.0000000000001630.
The effect of analgesia on physiological systems has received little attention in trauma research. Our aim was to examine the effect of two different analgesics, buprenorphine and carprofen, on adenosine, lidocaine, and magnesium (ALM) resuscitation in a rat model of laparotomy and non-compressible hemorrhage. Male Sprague-Dawley rats were randomly assigned to Saline Carprieve, ALM Carprieve, Saline Buprenorphine, or ALM Buprenorphine (all n = 10). Anesthetized animals underwent surgical placement of chronic catheters and laparotomy, then hemorrhage was induced by liver resection (60% left lateral lobe). After 15 min, animals received 0.7 mL/kg 3% NaCl ± ALM bolus, and after 60 min, 4 h 0.5 mL/kg/h 0.9% NaCl±ALM drip with 72 h monitoring. Carprieve groups received 5 mg/kg s.c. every 24 h and Buprenorphine groups received 0.05 mg/kg Temgesic every 6 to 12 h. Survival, hemodynamics, blood chemistry, and hematology were measured. ALM Carprieve led to 100% survival compared to 40% survival in ALM Buprenorphine group (P = 0.004). In Saline-treated rats, buprenorphine reduced median survival time by 91% (22 h to 2 h). Recovery of mean arterial pressure (MAP) at 60 min was lower in the buprenorphine versus Carprieve groups (83% vs. 101% for ALM and 62% vs. 95% for Saline groups). Buprenorphine was also associated with higher blood lactates and potassium. No analgesic-related differences were found in total white cells, lymphocytes, platelet count, hyperthermia, weight loss, or pica. We conclude that reduced survival and MAP recovery appears to a buprenorphine effect on cardiovascular function. Until the underlying mechanisms can be elucidated, buprenorphine should be used with caution in small and possibly large models of trauma and shock.
镇痛对生理系统的影响在创伤研究中很少受到关注。我们的目的是在大鼠剖腹术和不可压缩性出血模型中，研究两种不同的镇痛药丁丙诺啡和卡洛芬对腺苷、利多卡因和镁（ALM）复苏的影响。将雄性Sprague-Dawley大鼠随机分为生理盐水卡洛芬组、ALM卡洛芬组、生理盐水丁丙诺啡组或ALM丁丙诺啡组（每组n = 10）。对麻醉的动物进行慢性导管的手术放置和剖腹术，然后通过肝切除术（左外侧叶60%）诱导出血。15分钟后，动物接受0.7 mL/kg 3%氯化钠±ALM推注，60分钟后，4小时内以0.5 mL/kg/h的速度输注0.9%氯化钠±ALM，并持续监测72小时。卡洛芬组每24小时皮下注射5 mg/kg，丁丙诺啡组每6至12小时皮下注射0.05 mg/kg替利定。测量生存率、血流动力学、血液化学和血液学指标。ALM卡洛芬组的生存率为100%，而ALM丁丙诺啡组的生存率为40%（P = 0.004）。在生理盐水处理的大鼠中，丁丙诺啡使中位生存时间缩短了91%（从22小时降至2小时）。丁丙诺啡组60分钟时平均动脉压（MAP）的恢复低于卡洛芬组（ALM组分别为83%对101%，生理盐水组分别为62%对95%）。丁丙诺啡还与更高的血乳酸和血钾相关。在白细胞总数、淋巴细胞、血小板计数、体温过高、体重减轻或异食癖方面未发现与镇痛相关的差异。我们得出结论，生存率降低和MAP恢复似乎是丁丙诺啡对心血管功能的影响。在阐明其潜在机制之前，在小型和可能的大型创伤和休克模型中应谨慎使用丁丙诺啡。
