Evidence map›Paper›PMID 30983591›Full record

ReviewLancet (London, England)2019

Perioperative opioid analgesia-when is enough too much? A review of opioid-induced tolerance and hyperalgesia.

Lesley A Colvin, Fiona Bull, Tim G Hales

6 registry-linked trialsOpen access · bronzeAbstract readReview
PubMed Publisher
In one paragraph

Review in Lancet (London, England), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 6 registered trials, which are not on this map. Cited by 261 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
261citing papers in PubMed, 6 pooled it
30.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06291363 phase4unknown statusnot on this mapstarted 2024, after this paper: background citation

Impact of Continuous Intraoperative Administration of Esmolol on Nociception Level-guided Control of Nociception. The EsmoNOL Randomized Controlled Trial

TypeinterventionalSponsorCiusss de L'Est de l'Île de MontréalRan2024 to 2025Enrolled64ConditionsOpioid Use, Unspecified, Anesthesia, Nociceptive PainArmsEsmolol Hydrochloride, Saline
NCT06693427 completednot on this mapstarted 2021, after this paper: background citation

Effect of Femoral and Sciatic Nerve Blocks, Combined with General Anesthesia, in Postoperative Pain Levels and Phantom Limb Pain Development in Patients Undergoing Lower Limb Amputation

TypeobservationalSponsorDIMITRIOS KATSAROSRan2021 to 2023Enrolled72ConditionsPhantom Limb Pain, Amputation, Anesthesia, LocalArmsPeripheral Nerve Block
NCT07221786 narecruitingnot on this mapstarted 2025, after this paper: background citation

A Pilot Study of the Feasibility of Preoperative Opioid Tapering Before Spine Surgery Using Cognitive Behavioral Therapy and Measuring Postoperative Outcomes

TypeinterventionalSponsorThomas Jefferson UniversityRan2025 to 2026Enrolled45ConditionsOpioid Consumption, Postoperative, Pain After Surgery, Opioid DependencyArmsOpioid tapering with CBT and education, Opioid tapering with education alone
NCT07370129 naenrolling by invitationnot on this mapstarted 2025, after this paper: background citation

Impact of Transnasal Sphenopalatine Ganglion Block on Pain Relief and Recovery Following Tonsillectomy

TypeinterventionalSponsorAnkara UniversityRan2025 to 2026Enrolled28ConditionsPost Tonsillectomy Pain, Post Operative Analgesia, Opioid Consumption, Sphenopalatine Ganglion BlockArmsTransnasal Transmucosal Sphenopalatine Ganglion Block, Lidocaine %5, Saline (0.9% NaCl)
NCT07510373 narecruitingnot on this mapstarted 2026, after this paper: background citation

Opioid Tapering After Hospital Discharge: Testing an Intervention to Improve Post-operative

TypeinterventionalSponsorMontefiore Medical CenterRan2026 to 2028Enrolled42ConditionsOpioid TaperingArmsTreatment as Usual (TAU), Telephonic Support (TS) Providers, DOTS Intervention
NCT07747142 nanot yet recruitingnot on this mapstarted 2026, after this paper: background citation

Comparaison Entre anesthésie Avec épargne Morphinique guidée Par l'Index CARDEAN® et anesthésie Sans Morphinique au Cours Des Arthroplasties Totales de Hanche : étude randomisée

TypeinterventionalSponsorPole Sante Oreliance, Polyclinique des Longues AlleesRan2026 to 2027Enrolled140ConditionsTotal Hip Arthroplasty (THA)ArmsTitrated Opioid Sparing Anesthesia, opioid free anesthesia
3 · Its place in the literature

Who cites it

261 citing papers in PubMed, 6 syntheses or guidelines pooled it, 531 citations in OpenAlex.

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201 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

3 authors at 2 institutions in 1 country.

Lesley A ColvinDivision of Population Health and Genomics, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK. Electronic address: l.a.colvin@dundee.ac.uk.
Fiona BullInstitute for Academic Anaesthesia, Division of Systems Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK.
Tim G HalesInstitute for Academic Anaesthesia, Division of Systems Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK.
University of Dundee · GBNinewells Hospital · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Opioids are a mainstay of acute pain management but can have many adverse effects, contributing to problematic long-term use. Opioid tolerance (increased dose needed for analgesia) and opioid-induced hyperalgesia (paradoxical increase in pain with opioid administration) can contribute to both poorly controlled pain and dose escalation. Hyperalgesia is particularly problematic as further opioid prescribing is largely futile. The mechanisms of opioid tolerance and hyperalgesia are complex, involving μ opioid receptor signalling pathways that offer opportunities for novel analgesic alternatives. The intracellular scaffold protein β-arrestin-2 is implicated in tolerance, hyperalgesia, and other opioid side-effects. Development of agonists biased against recruitment of β-arrestin-2 could provide analgesic efficacy with fewer side-effects. Alternative approaches include inhibition of peripheral μ opioid receptors and blockade of downstream signalling mechanisms, such as the non-receptor tyrosine kinase Src or N-methyl-D-aspartate receptors. Furthermore, it is prudent to use multimodal analgesic regimens to reduce reliance on opioids during the perioperative period. In the third paper in this Series we focus on clinical and mechanism-based understanding of tolerance and opioid-induced hyperalgesia, and discuss current and future strategies for pain management.

Indexed as

Analgesics, OpioidDrug ToleranceHumansHyperalgesiaPerioperative CarePostoperative PainAnalgesics, Opioid

Identifiers

PMID30983591
OpenAlexW2940404939

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.