Hyperalgesia induced by low-dose opioid treatment before orthopaedic surgery. Issue 4 (April 2015)

• Record Type: Journal Article
• Authors: Hina, Nabil; Fletcher, Dominique; Poindessous-Jazat, Frédérique; Martinez, Valéria
• Is Part Of: European journal of anaesthesiology. Volume 32:Issue 4(2015:Apr.)
• Publication Date: 2015-04
• Subjects: Anesthesiology -- Periodicals; Anesthesiology -- Periodicals; Anesthésiologie -- Périodiques; Anesthesiology; Periodicals; Electronic journals; 617.96
• DOI: 10.1097/EJA.0000000000000197
• Languages: English
• ISSNs: 0265-0215

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>BACKGROUND</title> <p>Chronic pain and opioid consumption may trigger diffuse hyperalgesia, but their relative contributions to pain vulnerability remain unclear.</p> </sec> <sec> <title>OBJECTIVES</title> <p>To assess preoperative opioid-induced hyperalgesia and its postoperative clinical consequences in patients with chronic pain scheduled for orthopaedic surgery.</p> </sec> <sec> <title>DESIGN</title> <p>A prospective observational study.</p> </sec> <sec> <title>SETTINGS</title> <p>Raymond Poincare teaching hospital.</p> </sec> <sec> <title>PATIENTS</title> <p>Adults with or without long-term opioid treatment, scheduled for orthopaedic surgery.</p> </sec> <sec> <title>PRIMARY OUTCOME MEASURE</title> <p>Preoperative hyperalgesia was assessed with eight quantitative sensory tests, in a pain-free zone.</p> </sec> <sec> <title>SECONDARY OUTCOME MEASURES</title> <p>Postoperative morphine consumption and pain intensity were evaluated using a numerical rating scale (NRS) in the recovery room and during the first 72 h.</p> </sec> <sec> <title>RESULTS</title> <p>We analysed results from 68 patients (28 opioid-treated patients and 40 controls). Mean daily opioid consumption was 42 ± 25 mg of morphine equivalent. The opioid-treated group displayed significantly higher levels of preoperative hyperalgesia in three tests: heat tolerance threshold (47.1°C vs. 48.4°C; <italic>P</italic> <italic>=</italic> 0.045), duration of tolerance to a 47°C stimulus (40.2 vs. 51.1 s; <italic>P</italic> = 0.03) and mechanical temporal summation [1.79 vs. 1.02 (ΔNRS<sub>10–1</sub>); <italic>P</italic> = 0.036]. Patients in the opioid-treated group consumed more morphine (19.1 vs. 9.38 mg; <italic>P</italic> = 0.001), had a higher pain intensity (7.6 vs. 5.5; <italic>P</italic> = 0.001) in the recovery room and a higher cumulative morphine dose at 72 h (39.8 vs. 25.6 mg; <italic>P</italic> = 0.02).</p> </sec> <sec> <title>CONCLUSION</title> <p>Chronic pain patients treated with low doses of opioid had hyperalgesia before surgery. These results highlight the need to personalise the management of patients treated with opioids before surgery.</p> </sec> <sec> <title>TRIAL REGISTRATION</title> <p>ID-RCB 2011-A00304-37.</p> </sec> </abstract>