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Analgesic Control During Acute Pain to Protect Heart Function

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Brain and Heart Dynamics

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Abstract

Pain activates a general hormonal and inflammatory reaction is a main determinant in postsurgical patient’s recovery that may negatively affect the CV system, especially in high-risk patients. Pain can also become chronic, increasing the risk for CV dysfunctions.

Epidural analgesia has various beneficial effects on patient’s outcome, including the reduction of stress response and sympathetic activation after surgery. Some data suggest a protective role of EA on CV morbidity, especially on ischemia and dysrhythmias. However, serious CV complications may be expected with neuraxial anesthesia.

Traditional CV drugs such as alpha-2 agonists and beta-blockers display important role in pain treatment. Clonidine may also protect from CV morbidity perioperatively, by improving hemodynamic and sympathetic stabilities and reducing stress response, while beta-blockers display beneficial effects in cardiac surgery but may be deleterious in noncardiac surgery.

On the other hand, common drugs that are effective for analgesia may also improve the risk for CV morbidity. COX-2 inhibitors are contraindicated for chronic use in pain patients; however, they may not be unsafe in the perioperative setting. Available data are sparse to conclude that short-time administration of COX-2 inhibitors in the perioperative setting is associated to higher risk of CV morbidity, except for patients at higher risk for cardiac events. As well, new data suggest that acetaminophen, which is traditionally considered safe in terms of CV risk, may not be as safe as believed. Opioids are safe, but can harm CV homeostasis in specific cases or when associated with other drugs; neuraxial opioids may protect from hemodynamic impairment and positively affect analgesia.

Protecting heart function during pain flares means acting on nociceptive stimulus and on the organic response to pain; the concept should be to stabilize and bring homeostasis to a pain patient’s CV system, always balancing beneficial and detrimental effects of any treatment.

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Authors and Affiliations

  1. Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, Bergamo, Italy

    Dario Bugada & Luca F. Lorini

  2. Department of Anesthesia, ICU and Pain Therapy, University Hospital of Parma, Parma, Italy

    Valentina Bellini

  3. Department of Medicine and Surgery, University of Parma, Parma, Italy

    Elena G. Bignami

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  1. Dario Bugada
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  2. Valentina Bellini
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  3. Elena G. Bignami
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  4. Luca F. Lorini
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Corresponding author

Correspondence to Dario Bugada .

Editor information

Editors and Affiliations

  1. Dept of Drug Sciences, Pharmacology Sect, University of Pavia, Dept of Drug Sciences, Pharmacology Sect, Pavia, Pavia, Italy

    Stefano Govoni

  2. Dept of Brain and Behavioural Sciences, University of Pavia Dept of Brain and Behavioural Sciences, Pavia, Pavia, Italy

    Pierluigi Politi

  3. Department of Molecular Medicine, University of Pavia, Department of Molecular Medicine, Pavia, Pavia, Italy

    Emilio Vanoli

Section Editor information

  1. Anesthesia Intensive Care Department, Multimedica IRCCS Hospital, Sesto san Giovanni (MI, Italy

    Massimo Allegri

  2. Italian Pain Group, Milan, Italy

    Massimo Allegri

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Bugada, D., Bellini, V., Bignami, E.G., Lorini, L.F. (2019). Analgesic Control During Acute Pain to Protect Heart Function. In: Govoni, S., Politi, P., Vanoli, E. (eds) Brain and Heart Dynamics. Springer, Cham. https://doi.org/10.1007/978-3-319-90305-7_42-1

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