Endogenous morphine levels increase following cardiac surgery as part of the antiinflammatory response?

被引:85
作者
Brix-Christensen, V [1 ]
Tonnesen, E
Sanchez, RG
Bilfinger, TV
Stefano, GB
机构
[1] Aarhus Univ Hosp, Dept Anaesthesia & Intens Care, DK-8000 Aarhus C, Denmark
[2] Copenhagen Heart Ctr, Copenhagen, Denmark
[3] SUNY Stony Brook, Univ Med Ctr, Cardiac Res Program, Long Isl, NY 11798 USA
[4] SUNY Coll Old Westbury, Neurosci Res Inst, Long Isl, NY 11568 USA
关键词
immune response; endogenous morphine; surgery; cardiac; anaesthetics; epidural; high-dose fentanyl; intravenous;
D O I
10.1016/S0167-5273(97)00229-5
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Exogenous morphine downregulates the activity of immunocompetent cells such as lymphocytes, granulocytes and macrophages. Furthermore, morphine increases the secretion of CRH, ACTH and glucocorticoids, i.e. substances with inhibitory effects on the immune system. In the present study we tested the hypothesis that endogenous morphine production is increased as part of the antiinflammatory response to cardiac surgery. Sixteen patients submitted to elective coronary artery bypass grafting (CABG) surgery were randomized to either thoracic epidural analgesia combined with general anaesthesia (group I) or high-dose fentanyl anaesthesia (group II). Patients in group I did not receive morphine while patients in group II received systemic morphine for postoperative pain relief. From each patient 18 blood samples were taken perioperatively and tested for morphine. Furthermore, monocyte function with respect to motility and shape was determined by computer-assisted image analysis. A steep increase in plasma morphine concentrations was demonstrated on the first postoperative day in patients in group I (not given morphine). Plasma morphine levels remained significantly elevated during the following five postoperative days. Patients in group II given morphine as pain treatment showed a larger and earlier morphine peak related to the morphine administration. Computer-assisted image analysis of leukocyte behaviour revealed a biphasic increase in cell motility. In conclusion, we demonstrate for the first time that endogenous morphine levels increase after the trauma of surgery. We surmise that morphine is part of the antiinflammatory response to cardiac surgery. (C) 1997 Elsevier Science Ireland Ltd.
引用
收藏
页码:191 / 197
页数:7
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