Safety in cardiovascular profile for the use of Propranolol as co-analgesic treatment in non-cardiac surgery, a pilot study
Notice bibliographique
Résumé
Background: Perioperative alternatives to treat pain are still mostly limited to the delivery of systemic opioids. Recently animal and clinical studies have suggested β2-receptors as a possible target to back up analgesia performed by opioids. Co-administration of opioid agonists with β-blockers resulted in substantial synergetic analgesia in animal pain behavioral models. Thus, co-administration of β2-blockers with opioids might be a resourceful synergic combination able to maximize opioids analgesia while minimizing their adverse effects. Despite encouraging results from preclinical studies, a clear understanding of the role of β2-receptor role in human analgesia is still lacking. Thus a randomized controlled trial to clarify the role of β2-blockers as co-analgesic adjuvants was designed and initiated at the McGill University Health Centre (NCT02511483). The hypothesis of the study was that Propranolol would be able to reduce Morphine consumption after surgery without impacting the hemodynamic stability of the patients. However, particularly, concerns related to the hemodynamic effects of β2-receptor blockage prevent their usage. To address this concern, we performed a planned interim-analysis from data of the ongoning randomized control trial to determine the hemodynamic safety of β2-adrenergic antagonist administration in the perioperative setting. Methods: Data from patients recruited in this ongoing, randomized controlled trial were analyzed. Patients undergoing abdominal and gynecological laparoscopic surgery were randomized to receive either Propranolol (Propranolol group) or Placebo (Placebo group) in combination with Morphine as co-analgesic adjuvants. Perioperative blood pressure and heart rate were recorded. Postoperative analgesia, morphine consumption, opioid side-effects, were also measured. Results: Systolic blood pressure (SBP) during the induction and emergency from anesthesia was higher in Propranolol Group versus the Placebo Group (induction of anesthesia: 121 mmHg ±21.5 vs 110 mmHg ±23.7; p-value: 0.04; emergence of anesthesia 117 mmHg ±12.5 vs 108 mmHg ±10.8; p-value: <0.01). No significant difference was find for diastolic blood pressure (DBP). Heart rate (HR) was lower in patients treated with Propranolol at the emergence from anesthesia (61 ±7.4 bpm vs 74 ±6.5 bpm, p-value: <0.01) and continued to be lower during the stay in PACU (67 ±7.1 bpm vs 90 ±21.9 bpm; p-value: 0.05) and on the surgical ward (66 ±6.4 bpm vs. 86 ±12.3 bpm, p-value: 0.02) on the day of the surgery (day 0). Conclusions: The results of this interim analysis suggest that perioperative administration of propranolol as co-analgesic adjuvant at this dosage and regimen is feasible, and does not significantly affect blood pressure and heart rate. Although, few statistically significant differences were observed between the 2 groups, the clinical relevance of these findings is questionable as blood pressure and heart rate always remained within the safety range in the first 24 hours after surgery. On the other side, analgesic benefits related to the administration of Propranolol were not observed. Recruitment of future patients will to better define the analgesic role of administering Propranolol as co-analgesic adjuvant in the context of multimodal analgesia.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».