μ-Opioid Receptor Agonists: Do They Have Utility in the Treatment of Acute Pain?
μ-Opioid Receptor Agonists: Do They Have Utility in the Treatment of Acute Pain?
复制标题
μ-阿片受体激动剂：它们在治疗急性疼痛中有用吗？
DOI：
10.1097/aln.0000000000002177
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发表时间：
2018
期刊：
影响因子：
8.8
通讯作者：
Mikulich-Gilbertson,SusanK
中科院分区：
文献类型：
--
作者：
Henthorn,ThomasK;Mikulich-Gilbertson,SusanK
在这一期的《麻醉学》中，Roozekrans等人1重新审视了效用函数，强调阿片类药物疗效和毒性之间的平衡。他们重新分析了三项先前发表的关于阿芬太尼镇痛和呼吸抑制作用的研究数据，以确定从产生镇痛而不产生显著呼吸抑制的角度来看的“效用”。考虑到阿片类药物引起的呼吸抑制死亡数量不断增加5，6以及Roozekrans等人1的药代动力学-药效学分析的最显著发现：阿芬太尼镇痛的EC 50超过呼吸抑制的EC 50，进一步探索阿片类药物效用的理论基础尤其值得推荐。这远远不是一个令人鼓舞的治疗指数。因此，值得将这项新工作与阿片类药物效用的先前操作化进行比较，同时反思效用函数如何演变并成为临床医生，药理学家和公共卫生官员的更核心概念。莱顿小组于2013年首次将效用函数引入麻醉学文献7。该出版物促使Kharasch和Rosow 8深入讨论效用函数的起源以及这一重要新工具“增强剂量-反应关系评价活力”的潜力。
In this issue of Anesthesiology, Roozekrans et al. 1, have revisited the utility function to emphasize the balance between therapeutic efficacy and toxicity of opioids. They reanalyze data from three previously published studies of the analgesic and respiratory depressant effects of alfentanil2–4 to determine ‘utility’from the perspective of producing analgesia without significant respiratory depression. Further exploration of the theoretical underpinnings of opioid utility is particularly a propos given the escalating number of respiratory depression deaths due to the opioid epidemic5, 6 coupled with the most salient finding of the pharmacokinetic-pharmacodynamic analysis of Roozekrans et al. 1: that the EC50 for alfentanil analgesia exceeds the EC50 for respiratory depression. This is far from an encouraging therapeutic index. It is, therefore, worth comparing this new work with prior operationalizations of opioid utility while reflecting on how the utility function can evolve and become a more central concept to clinicians, pharmacologists and public health officials.The Leiden group first introduced the utility function to the anesthesiology literature in 20137. This publication prompted an in-depth discussion by Kharasch and Rosow8 of the origins of the utility function and the potential of this important new tool to ‘intensify the vigor’of the evaluation of the dose-response relationship.