Abstract
The objective of this study is to determine whether elevated circulating plasma catecholamine levels significantly impact opioid requirements during the first 24 hours postoperative period in individuals with acute surgical pain. We retrospectively reviewed 15 electronic medical records (EMRs) from adults 18 years and older, with confirmed elevated plasma catecholamine levels (experimental) and 15 electronic health records (EHRs) from matched-controls for age, gender, race and type of surgery, with a follow up of 24 hours postoperatively. The total morphine milligram equivalents (MMEs) requirements from the experimental group were not statistically different when compared with controls [44.1 (13 to 163) mg versus 47.5 (13 to 151) mg respectively; p 0.4965]. However, the intraoperative MMEs showed a significant difference, among the two groups; [(experimental) 32.5 (13. to 130) mg, (control) 15 (6.5 to 130) mg; p 0.0734]. The intraoperative dosage of midazolam showed a highly significant positive correlation to the total MMEs (p 0.0005). The subjects with both elevated plasma catecholamines and hypertension used significantly higher intraoperative MMEs compared to controls [34.1 (13 to 130) mg versus 15 (6.5 to 130) mg, respectively; p 0.0292)]. Those 51 years and younger, with elevated circulating levels of catecholamines, required significantly higher levels of both the postoperative MMEs [29.1 (0 to 45) mg versus 12 (0 to 71.5) mg; (p 0.0553)] and total MMEs [544.05 (13 to 81) mg versus 29.42 (13 to 92.5) mg; (p 0.00018), when compared to controls with history of nicotine and alcohol use. This preliminary study evaluated a biologic factor, which have promising clinical usefulness for predicting analgesic requirements that can drive clinical decisions on acute surgical pain.
Highlights
The objective of this study is to determine whether elevated circulating plasma catecholamine levels significantly impact opioid requirements during the first 24 hours postoperative period in individuals with acute surgical pain
There was not a statistically significant difference between the two groups (total Milligram Equivalent (MME) [44.1 (13 to 163) mg versus 47.5 (13 to 151.5) p 0.1936]). (Fig. 2) It is worth mentioning that those younger than 51 years of age, with elevated circulating levels of catecholamines, required significantly higher dosage of both the postoperative MMEs and the total MMEs when compared to controls with depression and history of nicotine and alcohol use [Postop_MMEs 29.1 (0 to 45) mg versus 13 (0 to 71.5) mg, respectively, (p 0.0553) and total_MMEs 54.05 (13 to 81.1) mg versus 29.42 (13 to 92.5) mg, respectively, (p 0.00018)] (Fig. 3). The purpose of this preliminary study was to determine whether subjects with elevated circulating plasma catecholamines require higher levels of total MMEs during the first 24 hours postoperative period compared to controls
The findings in this study demonstrated that midazolam but neither propofol nor 2% lidocaine were highly correlated to higher total MMEs during the first 24 hours postoperative period
Summary
The objective of this study is to determine whether elevated circulating plasma catecholamine levels significantly impact opioid requirements during the first 24 hours postoperative period in individuals with acute surgical pain. The intraoperative dosage of midazolam showed a highly significant positive correlation to the total MMEs (p 0.0005) The subjects with both elevated plasma catecholamines and hypertension used significantly higher intraoperative MMEs compared to controls [34.1 (13 to 130) mg versus 15 (6.5 to 130) mg, respectively; p 0.0292)]. Non-genetic factors, including depression, anxiety, and pre-existing history of substance abuse, are associated with altered pain perception and higher requirements of analgesic medication for pain control [6,7,8]. The assumed role of the abnormal pool of catecholamines in adrenergic neurons in the population with genetic variants of major catecholamine enzymatic pathways is believed to predispose these individuals more often to request an analgesic drug for pain relief, receiving higher milligrams of pain medication for acute surgical pain control [11,12,13]
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have