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首页> 外文期刊>The Lancet >Perioperative opioid analgesia-when is enough too much? A review of opioid-induced tolerance and hyperalgesia
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Perioperative opioid analgesia-when is enough too much? A review of opioid-induced tolerance and hyperalgesia

机译：围手术期阿片类镇痛 - 什么时候足够？ 对阿片类药物诱导的耐受性和痛觉过敏症综述

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摘要

Opioids are a mainstay of acute pain management but can have many adverse effects, contributing to problematic long-term use. Opioid tolerance (increased dose needed for analgesia) and opioid-induced hyperalgesia (paradoxical increase in pain with opioid administration) can contribute to both poorly controlled pain and dose escalation. Hyperalgesia is particularly problematic as further opioid prescribing is largely futile. The mechanisms of opioid tolerance and hyperalgesia are complex, involving mu opioid receptor signalling pathways that offer opportunities for novel analgesic alternatives. The intracellular scaffold protein beta-arrestin-2 is implicated in tolerance, hyperalgesia, and other opioid side-effects. Development of agonists biased against recruitment of beta-arrestin-2 could provide analgesic efficacy with fewer side-effects. Alternative approaches include inhibition of peripheral mu opioid receptors and blockade of downstream signalling mechanisms, such as the non-receptor tyrosine kinase Src or N-methyl-D-aspartate receptors. Furthermore, it is prudent to use multimodal analgesic regimens to reduce reliance on opioids during the perioperative period. In the third paper in this Series we focus on clinical and mechanism-based understanding of tolerance and opioid-induced hyperalgesia, and discuss current and future strategies for pain management.
机译：阿片类药物是急性疼痛管理的主干，但可能具有许多不利影响，有助于有问题的长期使用。阿片类耐受性（镇痛所需的剂量增加）和阿片类药物诱导的痛觉疗程（阿片类药物施用的矛盾的痛苦）可以有助于受到痛苦的疼痛和剂量升级。由于进一步的阿片类药物规定在很大程度上，痛觉过敏症是尤其问题的。阿片类耐耐受性和痛觉过敏的机制是复杂的，涉及Mu阿片类受体信号传导途径，为新的镇痛替代品提供了机会。细胞内支架蛋白β-insction-2涉及耐受性，痛觉过敏和其他阿片类药物副作用。激动剂的发展偏向于诱捕β-instrin-2，可以提供镇痛效果，副作用较少。替代方法包括抑制外周MU阿片受体和阻断下游信号传导机制，例如非受体酪氨酸激酶SRC或N-甲基-D-天冬氨酸受体。此外，使用多式镇痛方案是谨慎的，以减少围手术期间对阿片类药物的依赖性。在本系列中的第三篇论文中，我们专注于基于临床和机制的对耐受性和阿片类药物诱导的痛觉过敏症的理解，并讨论了止痛药的目前和未来的策略。

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  • 来源
    《The Lancet》 |2019年第10180期|共11页
  • 作者

    Colvin Lesley A.; Bull Fiona; Hales Tim G.;

  • 作者单位

    Univ Dundee Div Populat Hlth &

    Genom Ninewells Hosp &

    Med Sch Dundee DD2 4RB Scotland;

    Univ Dundee Inst Acad Anaesthesia Div Syst Med Sch Med Ninewells Hosp Dundee Scotland;

    Univ Dundee Inst Acad Anaesthesia Div Syst Med Sch Med Ninewells Hosp Dundee Scotland;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 医药、卫生;
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