Efficacy and safety of an extended-release sebacoyl dinalbuphine ester for laparoscopic cholecystectomy: A randomized controlled trial.

BACKGROUND: A long-acting κreceptor agonist parenteral analgesic may theoretically improve acute pain and reduce incidence of chronic postsurgical pain (CPSP) after laparoscopic cholecystectomy with minimal drug-related side effects of the traditional µreceptor opioids. METHODS: Eighty adult patients undergoing elective laparoscopic cholecystectomy were randomly assigned to receive single intramuscular injection of an extended-release sebacoyl dinalbuphine ester (SDE, Naldebain 150 mg; n = 40) or placebo (n = 40) after anesthesia induction. Standard multimodal analgesia (MMA) was administered for postoperative pain control. The primary endpoint was pain intensity within 7 days after surgery. The secondary endpoints were incidence CPSP at 3 months and adverse reactions up to 7 days after surgery. RESULTS: The highest visual analogue scale (VAS) and area under the curve of VAS 0 to 48 hours after operation were not different between the two groups and a similar proportion of patients requested rescue parenteral analgesics. Average pain intensities were also not different at 72 hours and 7 days after surgery. Incidence of CPSP was 22.5% and 13.1% in patients who received placebo and SDE treatment, respectively (P = .379). Significantly higher incidence of drug-related adverse events, including dizziness, nausea and injection site reactions, were recorded in the SDE group. CONCLUSION: A single dose of extended-release analgesic SDE given intraoperatively did not provide sufficient add-on effect for acute and chronic pain management after laparoscopic cholecystectomies in patients who received standard postoperative MMA. Intramuscular injection of 150 mg SDE in patients with average body mass causes adverse events that could have been overlooked. More clinical studies are warranted to determine the target populations who may benefit from SDE injections for improvement of acute and chronic postsurgical pain management.

[Effect of electroacupuncture on 5-HT7R in gastric antrum and colon tissues of functional diarrhea rats].

OBJECTIVE: To observe the effect of electroacupuncture(EA) at "Zusanli"(ST36), "Yinlingquan" (SP9) or "Yingu"(KI10) on the expression of 5-hydroxytryptamine type 7 receptor (5-HT7R) in the gastric antrum and colon tissues in functional diarrhea (FD) model rats, so as to explore its mechanisms underlying improving FD. METHODS: Forty male SD rats were randomly divided into control, model, ST36, SP9 and KI10 groups，with 8 rats in each group. The FD model was established by combined administration of restriction (four-limbs' banding) + abdominal cold stimulation + feeding every other day, for 14 days. EA (2 Hz, 0.5 mA) was applied to bilateral ST36 or bilateral SP9 or bilateral KI10 in the 3 corresponding groups for 30 min, once a day for 7 days after successful modeling. Rats of the control group received restriction only. The fecal water content was calculated and the stool form score was given according to the Bristol's methods. The gastric residual rate (GRR) and small intestine propulsion rate (SIPR) were determined to assess the motility of the gastrointestinal tract. Immunohistochemical and real-time fluorescent quantitative PCR were used to detect the expression of 5-HT7R protein and mRNA of the gastric antrum and colon tissues, respectively. RESULTS: Compared with the control group, the fecal water content, the stool form score, the SIPR and the expression levels of 5-HT7R protein and 5-HT7R mRNA were significantly increased (P<0.01,P<0.05) and the GRR was considerably decreased in the model group (P<0.01). The fecal water content, stool form score and SIPR, and expression level of 5-HT7R protein and mRNA in the gastric antrum and colon were significantly lower in both the ST36 and SP9 groups (not in the KI10 group) than in the model group (P<0.01, P<0.05), but the GRR was significantly higher in the ST36 and SP9 groups (not in the KI10 group) than in the model group (P<0.01). The effects of both ST36 and SP9 were significantly superior to those of KI10 in improving all the indexes mentioned above （except SIPR and the mRNA level of 5-HT7R in the colon in SP9 group）(P<0.01, P<0.05). No significant differences were found between the ST36 and SP9 groups in lowering the levels of fecal water content, stool form score, SIPR, and the expression of 5-HT7R protein and mRNA, as well as in up-regulating GRR (P>0.05). CONCLUSION: EA of ST36 and SP9 can improve the motility of gastrointestinal tract in FD rats, which may be related to its functions in down-regulating the expression of 5-HT7R protein and mRNA in gastric antrum and colon tissues. The effects of ST36 and SP9 were obviously better than those of KI10 in ameliorating the gastric and intestinal motility (except GRR) and in lowering the expression of 5-HT7R protein and mRNA.