Differential Opioid Tolerance and Opioid-induced Hyperalgesia A Clinical Reality
Differential Opioid Tolerance and Opioid-induced Hyperalgesia A Clinical Reality
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DOI：
10.1097/aln.0000000000000963
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发表时间：
2016-02-01
期刊：
影响因子：
8.8
通讯作者：
Durieux, Marcel E.
中科院分区：
文献类型：
--
作者：
Hayhurst, Christina J.;Durieux, Marcel E.
目前的作者描述了不同阿片类药物耐受和OIH的临床概念，并讨论了这些实体可能对我们的围手术期管理的影响。预防或减轻OIH或急性耐受性的最佳方法是预防。因此，在可能的情况下，应大量使用保留阿片类药物的阿片类药物。大多数OIH预防策略都强调了多巴胺能系统和NMDA受体激活，氯胺酮，美沙酮和一氧化二氮已被证明可以减轻OIH。此外，已证明诸如加巴喷丁和α-2受体激动剂如可乐定等药物可减轻伤口痛觉过敏，尽管其机制尚不清楚。
The current authors describe the clinical concepts of differential opioid tolerance and OIH, and they discuss the implications these entities may have for our perioperative management. The best way to prevent or mitigate OIH or acute tolerance is likely prevention. Hence, opioid-sparing adjuncts should be used liberally when possible. Most OIH prevention strategies have highlighted the glutaminergic system and NMDA receptor activation, with ketamine, methadone, and nitrous oxide having been shown to attenuate OIH. In addition, such drugs as the gabapentinoids and α-2 receptor agonists such as clonidine have been demonstrated to mitigate wound hyperalgesia, although the mechanism is unknown.