Investigating the Role of Ultra-Low Dose Naloxone in Modulating Postoperative Pain after Laparoscopic Cholecystectomy: A Double-Blind Randomized Controlled Trial
Abstract
Background: Considering the importance of controlling post-surgical pain in individuals and the limitation in number, in addition to the variations in the results of the clinical research studies focused on pain management outcomes of very low dose naloxone, the present evaluation aims to investigate the role of ultra-low dose naloxone on the severity of pain after the procedure, nausea, vomiting and pruritic.
Methods: In this double-blind controlled randomized clinical trial, 60 patients were selected for laparoscopic cholecystectomy surgery, with class 1 and 2 anesthesia (ASA) by available method, and were allocated to the intervention and control groups using randomization. Every participant underwent general anesthesia with a specific anesthesia protocol. After the operation, PCA was implanted for all patients to control pain. The internal composition of the PCA pump included 20 mg of morphine and naloxone at a specified dosage of 0.25 μg/kg for the intervention group and 20 mg of morphine and placebo for the control arm. Pain intensity, episodes of nausea and emesis and pruritic of patients were evaluated and compared based on VAS criteria within the two groups being analysed, during the immediate postoperative period and then 2, 6, 12 and 24 hours following the surgical procedure.
Results: There was no meaningful variation between therapeutic and standard arms in terms of age, sex, BMI, duration of surgery, duration of anesthesia, and dose of intra-operative fentanyl injection. Also, with respect to the level of pain during the immediate postoperative period and 2, 6, 12, and 24 hours following the surgical procedure, and the intensity of nausea, vomiting, and pruritic during recovery, statistical analysis revealed no remarkable discrepancy between the arms. In both groups, the severity of pain showed a significant decline at each of the examined time points in comparison with the pre-intervention phase (p <0.001, for both groups). Comparing the trend of changes in pain intensity during the postoperative period between the two study groups did not show a statistically meaningful variation (p = 0.569).
Conclusion: The simultaneous prescription of naloxone and morphine in patients undergoing laparoscopic cystectomy does not demonstrate a meaningful influence on achieving relief from post-surgical pain levels, nausea and vomiting and pruritic compared to morphine alone, so the use of naloxone to reduce postoperative pain and complications of opioids is not recommended.
[1] Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW. Laparoscopic cholecystectomy the new 'gold standard'? Arch Surg. 1992;127(8):917-23.
[2] Chung F, Mezei G. Factors contributing to a prolonged stay after ambulatory surgery. Anesth Analg. 1999;89(6):1352.
[3] Pavlin DJ, Rapp SE, Polissar NL, Malmgren JA, Koerschgen M, Keyes H. Factors affecting discharge time in adult outpatients. Anesth Analg. 1998;87(4):816-26.
[4] Waddle JP, Evers AS, Piccirillo JF. Postanesthesia care unit length of stay: quantifying and assessing dependent factors. Anesth Analg. 1998;87(3):628-33.
[5] Bisgaard T, Kehlet H, Rosenberg J. Pain and convalescence after laparoscopic cholecystectomy. Eur J Surg. 2001;167(2):84-96.
[6] Sinclair DR, Chung F, Mezei G. Can postoperative nausea and vomiting be predicted? Surv Anesthesiol. 2000;44(1):3-4.
[7] Wheeler M, Oderda GM, Ashburn MA, Lipman AG. Adverse events associated with postoperative opioid analgesia: a systematic review. J Pain. 2002;3(3):159-80.
[8] Møiniche S, Jørgensen H, Wetterslev J, Dahl JB. Local anesthetic infiltration for postoperative pain relief after laparoscopy: a qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anesth Analg. 2000;90(4):899-912.
[9] Gupta A, Thörn SE, Axelsson K, Larsson LG, Ågren G, Holmström B, et al. Postoperative pain relief using intermittent injections of 0.5% ropivacaine through a catheter after laparoscopic cholecystectomy. Anesth Analg. 2002;95(2):450-6.
[10] Bisgaard T, Klarskov B, Kristiansen VB, Callesen T, Schulze S, Kehlet H, et al. Multi-regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi-modal analgesia: a randomized, double-blinded, placebo-controlled study. Anesth Analg. 1999;89(4):1017.
[11] Elhakim M, Amine H, Kamel S, Saad F. Effects of intraperitoneal lidocaine combined with intravenous or intraperitoneal tenoxicam on pain relief and bowel recovery after laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 2000;44(8):929-33.
[12] Jabbour-Khoury SI, Dabbous AS, Gerges FJ, Azar MS, Ayoub CM, Khoury GS. Intraperitoneal and intravenous routes for pain relief in laparoscopic cholecystectomy. JSLS. 2005;9(3):316.
[13] Liu J, Ding Y, White PF, Feinstein R, Shear JM. Effects of ketorolac on postoperative analgesia and ventilatory function after laparoscopic cholecystectomy. Anesth Analg. 1993;76(5):1061-6.
[14] Wilson Y, Rhodes M, Ahmed R, Daugherty M, Cawthorn S, Armstrong C. Intramuscular diclofenac sodium for postoperative analgesia after laparoscopic cholecystectomy: a randomised, controlled trial. Surg Laparosc Endosc Percutan Tech. 1994;4(5):340-4.
[15] Rawal N, Schött U, Dahlström B, Inturrisi CE, Tandon B, Sjöstrand U, et al. Influence of naloxone infusion on analgesia and respiratory depression following epidural morphine. Anesthesiology. 1986;64(2):194-201.
[16] Gueneron J, Ecoffey C, Carli P, Benhamou D, Gross J. Effect of naloxone infusion on analgesia and respiratory depression after epidural fentanyl. Anesth Analg. 1988;67(1):35-8.
[17] Johnson A, Bengtsson M, Löfström J, Rane A, Wahlström A. Influence of postoperative naloxone infusion on respiration and pain relief after intrathecal morphine. Reg Anesth Pain Med. 1988;13(4):146-51.
[18] Wright P, O'Toole D, Barron D. The influence of naloxone infusion on the action of intrathecal diamorphine: low-dose naloxone and neuroendocrine responses. Acta Anaesthesiol Scand. 1992;36(3):230-3.
[19] Kendrick WD, Woods AM, Daly MY, Birch RF, DiFazio C. Naloxone versus nalbuphine infusion for prophylaxis of epidural morphine-induced pruritus. Anesth Analg. 1996;82(3):641-7.
[20] Rebel A, Sloan P, Andrykowski M. Postoperative analgesia after radical prostatectomy with high-dose intrathecal morphine and intravenous naloxone: a retrospective review. J Opioid Manag. 2009;5(6):331-9.
[21] Gan TJ, Ginsberg B, Glass PS, Fortney J, Jhaveri R, Perno R. Opioid-sparing effects of a low-dose infusion of naloxone in patient-administered morphine sulfate. Anesthesiology. 1997;87(5):1075-81.
[22] Movafegh A, Shoeibi G, Ansari M, Sadeghi M, Azimaraghi O, Aghajani Y. Naloxone infusion and post-hysterectomy morphine consumption: a double-blind, placebo-controlled study. Acta Anaesthesiol Scand. 2012;56(10):1241-9.
[23] Woolf CJ. Analgesia and hyperalgesia produced in the rat by intrathecal naloxone. Brain Res. 1980;189(2):593-7.
[24] Levine JD, Gordon NC, Fields HL. Naloxone dose dependently produces analgesia and hyperalgesia in postoperative pain. Nature. 1979;278(5706):740-1.
[25] Ueda H, Fukushima N, Kitao T, Ge M, Takagi H. Low doses of naloxone produce analgesia in the mouse brain by blocking presynaptic autoinhibition of enkephalin release. Neurosci Lett. 1986;65(3):247-52.
[26] Miaskowski C, Taiwo YO, Levine JD. Intracerebroventricular naloxone produces a dose-dependent, monotonic increase in nociceptive threshold in the rat. Brain Res. 1990;515(1-2):323-5.
[27] Crain SM, Shen KF. Ultra-low concentrations of naloxone selectively antagonize excitatory effects of morphine on sensory neurons, thereby increasing its antinociceptive potency and attenuating tolerance/dependence during chronic cotreatment. Proc Natl Acad Sci USA. 1995;92(23):10540-4.
[28] Crain SM, Shen KF. Antagonists of excitatory opioid receptor functions enhance morphine's analgesic potency and attenuate opioid tolerance/dependence liability. Pain. 2000;84(2-3):121-31.
[29] Paronis CA, Holtzman SG. Increased analgesic potency of mu agonists after continuous naloxone infusion in rats. J Pharmacol Exp Ther. 1991;259(2):582-9.
[30] Yoburn BC, Nunes F, Adler B, Pasternak GW, Inturrisi CE. Pharmacodynamic supersensitivity and opioid receptor upregulation in the mouse. J Pharmacol Exp Ther. 1986;239(1):132-5.
[31] Cepeda MS, Africano JM, Manrique AM, Fragoso W, Carr DB. The combination of low dose of naloxone and morphine in PCA does not decrease opioid requirements in the postoperative period. Pain. 2002;96(1-2):73-9.
[32] Sartain JB, Barry JJ, Richardson CA, Branagan HC. Effect of combining naloxone and morphine for intravenous patient-controlled analgesia. Anesthesiology. 2003;99(1):148-51.
[33] Cepeda MS, Alvarez H, Morales O, Carr DB. Addition of ultralow dose naloxone to postoperative morphine PCA: unchanged analgesia and opioid requirement but decreased incidence of opioid side effects. Pain. 2004;107(1-2):41-6.
[34] Ngai S, Berkowitz BA, Yang J, Hempstead J, Spector S. Pharmacokinetics of naloxone in rats and in man: basis for its potency and short duration of action. Anesthesiology. 1976;44(5):398-401.
[35] Glass PS, Jhaveri RM, Smith LR. Comparison of potency and duration of action of nalmefene and naloxone. Anesth Analg. 1994;78(3):536-41.
[36] Bagepally BS, Haridoss M, Sasidharan A, Jagadeesh KV, Oswal NK. Systematic review and meta-analysis of gallstone disease treatment outcomes in early cholecystectomy versus conservative management/delayed cholecystectomy. BMJ Open Gastroenterol. 2021;8(1).
[37] Coccolini F, Catena F, Pisano M, Gheza F, Fagiuoli S, Di Saverio S, et al. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. Int J Surg. 2015; 18:196-204.
[38] Farda W, Tani MK, Manning RG, Fahmi MS, Barai N. Laparoscopic cholecystectomy: review of 1430 cases in cure international hospital, kabul, Afghanistan. BMC Surg. 2021;21(1).
[39] Yilmaz H, Arun O, Apiliogullari S, Acar F, Alptekin H, Calisir A, et al. Effect of laparoscopic cholecystectomy techniques on postoperative pain: a prospective randomized study. J Korean Surg Soc. 2013;85(4):149-53.
[40] Lirk P, Thiry J, Bonnet MP, Joshi GP, Bonnet F. Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations. Reg Anesth Pain Med. 2019.
[41] Barazanchi A, MacFater W, Rahiri JL, Tutone S, Hill A, Joshi G, et al. Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update. Br J Anaesth. 2018;121(4):787-803.
[42] Sjövall S, Kokki M, Kokki H. Laparoscopic surgery: a narrative review of pharmacotherapy in pain management. Drugs. 2015;75:1867-89.
[43] Small C, Laycock H. Acute postoperative pain management. Br J Surg. 2020;107(2):e70-80.
[44] Pozek JPJ, De Ruyter M, Khan TW. Comprehensive acute pain management in the perioperative surgical home. Anesthesiol Clin. 2018;36(2):295-307.
[45] Pogatzki-Zahn EM, Segelcke D, Schug SA. Postoperative pain—from mechanisms to treatment. Pain Rep. 2017;2(2).
[46] Gupta AK, Mena S, Jin Z, Gan TJ, Bergese S. Postoperative pain: a review of emerging therapeutic options. Expert Rev Aerother. 2021;21(10):1085-100.
[47] Meissner W, Huygen F, Neugebauer EA, Osterbrink J, Benhamou D, Betteridge N, et al. Management of acute pain in the postoperative setting: the importance of quality indicators. Curr Med Res Opin. 2018;34(1):187-96.
[48] Jesus RR, Leite AM, Leite SS, Vieira MC, Villela NR. Anesthetic therapy for acute pain relief after laparoscopic cholecystectomy: systematic review. Rev Col Bras Cir. 2018;45.
[49] Kim YD. Opioid: toward an effective strategy for better use. Korean J Pain. 2019;32(2):67-8.
[50] Kim KH, Seo HJ, Abdi S, Huh B. All about pain pharmacology: what pain physicians should know. Korean J Pain. 2020;33(2):108-20.
[51] Lin YS, Tsai RY, Shen CH, Chien CC, Tsai WY, Guo SL, et al. Ultra-low dose naloxone restores the antinociceptive effect of morphine in PTX-treated rats: association of IL-10 upregulation in the spinal cord. Life Sci. 2012;91(5-6):213-20.
[52] Tsai RY, Tai YH, Tzeng JI, Cherng CH, Yeh CC, Wong CS. Ultra-low dose naloxone restores the antinociceptive effect of morphine in pertussis toxin-treated rats by reversing the coupling of μ-opioid receptors from Gs-protein to coupling to Gi-protein. Neuroscience. 2009;164(2):435-43.
[53] Firouzian A, Baradari AG, Alipour A, Zeydi AE, Kiasari AZ, Emadi SA, et al. Ultra-low-dose naloxone as an adjuvant to patient controlled analgesia (PCA) with morphine for postoperative pain relief following lumber discectomy: a double-blind, randomized, placebo-controlled trial. J Neurosurg Anesthesiol. 2018;30(1):26-31.
[54] Hamann S, Sloan PA, Witt W. Low-dose intrathecal naloxone to enhance intrathecal morphine analgesia: a case report. J Opioid Manag. 2008;4(4):251-4.
[55] Maxwell LG, Kaufmann SC, Bitzer S, Jackson EV Jr, McGready J, Kost-Byerly S, et al. The effects of a small-dose naloxone infusion on opioid-induced side effects and analgesia in children and adolescents treated with intravenous patient-controlled analgesia: a double-blind, prospective, randomized, controlled study. Anesth Analg. 2005;100(4):953-8.
[56] Bijur PE, Schechter C, Esses D, Chang AK, Gallagher EJ. Intravenous bolus of ultra-low-dose naloxone added to morphine does not enhance analgesia in emergency department patients. J Pain. 2006;7(2):75-81.
[57] Ling W, Hillhouse M, Jenkins J, Miotto K, Torrington M, Chapleo C. Comparisons of analgesic potency and side effects of buprenorphine and buprenorphine with ultra-low-dose naloxone. J Addict Med. 2012;6(2):118-23.
[58] Toolabi K, Moazamipur A, Karvandian K, Dehpour AR. Effect of low-dose naloxone on pain severity and side effects of opioids on patients undergoing laparoscopic cholecystectomy. Yafteh. 2018;20(1):123-32.
[59] Zheng J, Han W, Han XD, Ma XY, Zhang P. Effect of naloxone on intravenous fentanyl patient-controlled analgesia after laparoscopic cholecystectomy. Medicine (Baltimore). 2016;95(48).
[60] Sposito JA, Habib AS. Low-dose naloxone infusion for the treatment of intractable nausea and vomiting after intrathecal morphine in a parturient. Int J Obstet Anesth. 2010;19(1):119-21.
[61] Springborg AD, Jensen EK, Taylor BK, Werner MU. Effects of target-controlled infusion of high-dose naloxone on pain and hyperalgesia in a human thermal injury model: a study protocol: A randomized, double-blind, placebo-controlled, crossover trial with an enriched design. Medicine (Baltimore). 2016;95(46):e5336.
[2] Chung F, Mezei G. Factors contributing to a prolonged stay after ambulatory surgery. Anesth Analg. 1999;89(6):1352.
[3] Pavlin DJ, Rapp SE, Polissar NL, Malmgren JA, Koerschgen M, Keyes H. Factors affecting discharge time in adult outpatients. Anesth Analg. 1998;87(4):816-26.
[4] Waddle JP, Evers AS, Piccirillo JF. Postanesthesia care unit length of stay: quantifying and assessing dependent factors. Anesth Analg. 1998;87(3):628-33.
[5] Bisgaard T, Kehlet H, Rosenberg J. Pain and convalescence after laparoscopic cholecystectomy. Eur J Surg. 2001;167(2):84-96.
[6] Sinclair DR, Chung F, Mezei G. Can postoperative nausea and vomiting be predicted? Surv Anesthesiol. 2000;44(1):3-4.
[7] Wheeler M, Oderda GM, Ashburn MA, Lipman AG. Adverse events associated with postoperative opioid analgesia: a systematic review. J Pain. 2002;3(3):159-80.
[8] Møiniche S, Jørgensen H, Wetterslev J, Dahl JB. Local anesthetic infiltration for postoperative pain relief after laparoscopy: a qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anesth Analg. 2000;90(4):899-912.
[9] Gupta A, Thörn SE, Axelsson K, Larsson LG, Ågren G, Holmström B, et al. Postoperative pain relief using intermittent injections of 0.5% ropivacaine through a catheter after laparoscopic cholecystectomy. Anesth Analg. 2002;95(2):450-6.
[10] Bisgaard T, Klarskov B, Kristiansen VB, Callesen T, Schulze S, Kehlet H, et al. Multi-regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi-modal analgesia: a randomized, double-blinded, placebo-controlled study. Anesth Analg. 1999;89(4):1017.
[11] Elhakim M, Amine H, Kamel S, Saad F. Effects of intraperitoneal lidocaine combined with intravenous or intraperitoneal tenoxicam on pain relief and bowel recovery after laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 2000;44(8):929-33.
[12] Jabbour-Khoury SI, Dabbous AS, Gerges FJ, Azar MS, Ayoub CM, Khoury GS. Intraperitoneal and intravenous routes for pain relief in laparoscopic cholecystectomy. JSLS. 2005;9(3):316.
[13] Liu J, Ding Y, White PF, Feinstein R, Shear JM. Effects of ketorolac on postoperative analgesia and ventilatory function after laparoscopic cholecystectomy. Anesth Analg. 1993;76(5):1061-6.
[14] Wilson Y, Rhodes M, Ahmed R, Daugherty M, Cawthorn S, Armstrong C. Intramuscular diclofenac sodium for postoperative analgesia after laparoscopic cholecystectomy: a randomised, controlled trial. Surg Laparosc Endosc Percutan Tech. 1994;4(5):340-4.
[15] Rawal N, Schött U, Dahlström B, Inturrisi CE, Tandon B, Sjöstrand U, et al. Influence of naloxone infusion on analgesia and respiratory depression following epidural morphine. Anesthesiology. 1986;64(2):194-201.
[16] Gueneron J, Ecoffey C, Carli P, Benhamou D, Gross J. Effect of naloxone infusion on analgesia and respiratory depression after epidural fentanyl. Anesth Analg. 1988;67(1):35-8.
[17] Johnson A, Bengtsson M, Löfström J, Rane A, Wahlström A. Influence of postoperative naloxone infusion on respiration and pain relief after intrathecal morphine. Reg Anesth Pain Med. 1988;13(4):146-51.
[18] Wright P, O'Toole D, Barron D. The influence of naloxone infusion on the action of intrathecal diamorphine: low-dose naloxone and neuroendocrine responses. Acta Anaesthesiol Scand. 1992;36(3):230-3.
[19] Kendrick WD, Woods AM, Daly MY, Birch RF, DiFazio C. Naloxone versus nalbuphine infusion for prophylaxis of epidural morphine-induced pruritus. Anesth Analg. 1996;82(3):641-7.
[20] Rebel A, Sloan P, Andrykowski M. Postoperative analgesia after radical prostatectomy with high-dose intrathecal morphine and intravenous naloxone: a retrospective review. J Opioid Manag. 2009;5(6):331-9.
[21] Gan TJ, Ginsberg B, Glass PS, Fortney J, Jhaveri R, Perno R. Opioid-sparing effects of a low-dose infusion of naloxone in patient-administered morphine sulfate. Anesthesiology. 1997;87(5):1075-81.
[22] Movafegh A, Shoeibi G, Ansari M, Sadeghi M, Azimaraghi O, Aghajani Y. Naloxone infusion and post-hysterectomy morphine consumption: a double-blind, placebo-controlled study. Acta Anaesthesiol Scand. 2012;56(10):1241-9.
[23] Woolf CJ. Analgesia and hyperalgesia produced in the rat by intrathecal naloxone. Brain Res. 1980;189(2):593-7.
[24] Levine JD, Gordon NC, Fields HL. Naloxone dose dependently produces analgesia and hyperalgesia in postoperative pain. Nature. 1979;278(5706):740-1.
[25] Ueda H, Fukushima N, Kitao T, Ge M, Takagi H. Low doses of naloxone produce analgesia in the mouse brain by blocking presynaptic autoinhibition of enkephalin release. Neurosci Lett. 1986;65(3):247-52.
[26] Miaskowski C, Taiwo YO, Levine JD. Intracerebroventricular naloxone produces a dose-dependent, monotonic increase in nociceptive threshold in the rat. Brain Res. 1990;515(1-2):323-5.
[27] Crain SM, Shen KF. Ultra-low concentrations of naloxone selectively antagonize excitatory effects of morphine on sensory neurons, thereby increasing its antinociceptive potency and attenuating tolerance/dependence during chronic cotreatment. Proc Natl Acad Sci USA. 1995;92(23):10540-4.
[28] Crain SM, Shen KF. Antagonists of excitatory opioid receptor functions enhance morphine's analgesic potency and attenuate opioid tolerance/dependence liability. Pain. 2000;84(2-3):121-31.
[29] Paronis CA, Holtzman SG. Increased analgesic potency of mu agonists after continuous naloxone infusion in rats. J Pharmacol Exp Ther. 1991;259(2):582-9.
[30] Yoburn BC, Nunes F, Adler B, Pasternak GW, Inturrisi CE. Pharmacodynamic supersensitivity and opioid receptor upregulation in the mouse. J Pharmacol Exp Ther. 1986;239(1):132-5.
[31] Cepeda MS, Africano JM, Manrique AM, Fragoso W, Carr DB. The combination of low dose of naloxone and morphine in PCA does not decrease opioid requirements in the postoperative period. Pain. 2002;96(1-2):73-9.
[32] Sartain JB, Barry JJ, Richardson CA, Branagan HC. Effect of combining naloxone and morphine for intravenous patient-controlled analgesia. Anesthesiology. 2003;99(1):148-51.
[33] Cepeda MS, Alvarez H, Morales O, Carr DB. Addition of ultralow dose naloxone to postoperative morphine PCA: unchanged analgesia and opioid requirement but decreased incidence of opioid side effects. Pain. 2004;107(1-2):41-6.
[34] Ngai S, Berkowitz BA, Yang J, Hempstead J, Spector S. Pharmacokinetics of naloxone in rats and in man: basis for its potency and short duration of action. Anesthesiology. 1976;44(5):398-401.
[35] Glass PS, Jhaveri RM, Smith LR. Comparison of potency and duration of action of nalmefene and naloxone. Anesth Analg. 1994;78(3):536-41.
[36] Bagepally BS, Haridoss M, Sasidharan A, Jagadeesh KV, Oswal NK. Systematic review and meta-analysis of gallstone disease treatment outcomes in early cholecystectomy versus conservative management/delayed cholecystectomy. BMJ Open Gastroenterol. 2021;8(1).
[37] Coccolini F, Catena F, Pisano M, Gheza F, Fagiuoli S, Di Saverio S, et al. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. Int J Surg. 2015; 18:196-204.
[38] Farda W, Tani MK, Manning RG, Fahmi MS, Barai N. Laparoscopic cholecystectomy: review of 1430 cases in cure international hospital, kabul, Afghanistan. BMC Surg. 2021;21(1).
[39] Yilmaz H, Arun O, Apiliogullari S, Acar F, Alptekin H, Calisir A, et al. Effect of laparoscopic cholecystectomy techniques on postoperative pain: a prospective randomized study. J Korean Surg Soc. 2013;85(4):149-53.
[40] Lirk P, Thiry J, Bonnet MP, Joshi GP, Bonnet F. Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations. Reg Anesth Pain Med. 2019.
[41] Barazanchi A, MacFater W, Rahiri JL, Tutone S, Hill A, Joshi G, et al. Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update. Br J Anaesth. 2018;121(4):787-803.
[42] Sjövall S, Kokki M, Kokki H. Laparoscopic surgery: a narrative review of pharmacotherapy in pain management. Drugs. 2015;75:1867-89.
[43] Small C, Laycock H. Acute postoperative pain management. Br J Surg. 2020;107(2):e70-80.
[44] Pozek JPJ, De Ruyter M, Khan TW. Comprehensive acute pain management in the perioperative surgical home. Anesthesiol Clin. 2018;36(2):295-307.
[45] Pogatzki-Zahn EM, Segelcke D, Schug SA. Postoperative pain—from mechanisms to treatment. Pain Rep. 2017;2(2).
[46] Gupta AK, Mena S, Jin Z, Gan TJ, Bergese S. Postoperative pain: a review of emerging therapeutic options. Expert Rev Aerother. 2021;21(10):1085-100.
[47] Meissner W, Huygen F, Neugebauer EA, Osterbrink J, Benhamou D, Betteridge N, et al. Management of acute pain in the postoperative setting: the importance of quality indicators. Curr Med Res Opin. 2018;34(1):187-96.
[48] Jesus RR, Leite AM, Leite SS, Vieira MC, Villela NR. Anesthetic therapy for acute pain relief after laparoscopic cholecystectomy: systematic review. Rev Col Bras Cir. 2018;45.
[49] Kim YD. Opioid: toward an effective strategy for better use. Korean J Pain. 2019;32(2):67-8.
[50] Kim KH, Seo HJ, Abdi S, Huh B. All about pain pharmacology: what pain physicians should know. Korean J Pain. 2020;33(2):108-20.
[51] Lin YS, Tsai RY, Shen CH, Chien CC, Tsai WY, Guo SL, et al. Ultra-low dose naloxone restores the antinociceptive effect of morphine in PTX-treated rats: association of IL-10 upregulation in the spinal cord. Life Sci. 2012;91(5-6):213-20.
[52] Tsai RY, Tai YH, Tzeng JI, Cherng CH, Yeh CC, Wong CS. Ultra-low dose naloxone restores the antinociceptive effect of morphine in pertussis toxin-treated rats by reversing the coupling of μ-opioid receptors from Gs-protein to coupling to Gi-protein. Neuroscience. 2009;164(2):435-43.
[53] Firouzian A, Baradari AG, Alipour A, Zeydi AE, Kiasari AZ, Emadi SA, et al. Ultra-low-dose naloxone as an adjuvant to patient controlled analgesia (PCA) with morphine for postoperative pain relief following lumber discectomy: a double-blind, randomized, placebo-controlled trial. J Neurosurg Anesthesiol. 2018;30(1):26-31.
[54] Hamann S, Sloan PA, Witt W. Low-dose intrathecal naloxone to enhance intrathecal morphine analgesia: a case report. J Opioid Manag. 2008;4(4):251-4.
[55] Maxwell LG, Kaufmann SC, Bitzer S, Jackson EV Jr, McGready J, Kost-Byerly S, et al. The effects of a small-dose naloxone infusion on opioid-induced side effects and analgesia in children and adolescents treated with intravenous patient-controlled analgesia: a double-blind, prospective, randomized, controlled study. Anesth Analg. 2005;100(4):953-8.
[56] Bijur PE, Schechter C, Esses D, Chang AK, Gallagher EJ. Intravenous bolus of ultra-low-dose naloxone added to morphine does not enhance analgesia in emergency department patients. J Pain. 2006;7(2):75-81.
[57] Ling W, Hillhouse M, Jenkins J, Miotto K, Torrington M, Chapleo C. Comparisons of analgesic potency and side effects of buprenorphine and buprenorphine with ultra-low-dose naloxone. J Addict Med. 2012;6(2):118-23.
[58] Toolabi K, Moazamipur A, Karvandian K, Dehpour AR. Effect of low-dose naloxone on pain severity and side effects of opioids on patients undergoing laparoscopic cholecystectomy. Yafteh. 2018;20(1):123-32.
[59] Zheng J, Han W, Han XD, Ma XY, Zhang P. Effect of naloxone on intravenous fentanyl patient-controlled analgesia after laparoscopic cholecystectomy. Medicine (Baltimore). 2016;95(48).
[60] Sposito JA, Habib AS. Low-dose naloxone infusion for the treatment of intractable nausea and vomiting after intrathecal morphine in a parturient. Int J Obstet Anesth. 2010;19(1):119-21.
[61] Springborg AD, Jensen EK, Taylor BK, Werner MU. Effects of target-controlled infusion of high-dose naloxone on pain and hyperalgesia in a human thermal injury model: a study protocol: A randomized, double-blind, placebo-controlled, crossover trial with an enriched design. Medicine (Baltimore). 2016;95(46):e5336.
| Files | ||
| Issue | Article in Press |
|
| Section | Research Article(s) | |
| Keywords | ||
| Laparoscopic Cholecystectomy Naloxone Pain Nausea and Vomiting Pruritic | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mohaghegh MR, Ghorbanlo M, Nouri N, Sehat S, Habibi A. Investigating the Role of Ultra-Low Dose Naloxone in Modulating Postoperative Pain after Laparoscopic Cholecystectomy: A Double-Blind Randomized Controlled Trial. Arch Anesth & Crit Care. 2025;.
