Pain Neuropeptides Plasma Levels’ Measurement as Biomarkers of Opioids Effectiveness in Critically ill Children
Introduction: Effective analgesia and sedation, which often involve the administration of opioid analgesics, are essential for the physiological and psychological comfort in paediatric patients hospitalized in intensive care units (PICU). The behavioral pain scale, Comfort B, is one of the most common and widely used tools in assessing the pain management in critically ill children. However, objective biomarkers in pain assessment require further evaluation in critically ill children. Aim: Aim of the study was the use of two pain neuropeptides [Neurokinin A (NKA) and neuropeptide Y (NPY)] as biomarkers of the administrated opioid analgesia effectiveness in children who are hospitalized in PICU. Material and Method: A prospective correlational study with repeated measurements and cross-sectional comparisons was conducted from July 2015 to January 2016. A convenience sample of 20 paediatric patients was consisted. Pain levels were estimated with the use of Comfort B scale and the VASobs. Blood samples were collected (a) during the administration of opioids analgesics and, (b) at 4 or more hours after the analgesics had been suspended. NKA and NPY plasma levels were detected by ELISA. Non-parametric statistic tests were performed with the use of the statistical package SPSSver.24. The significant statistical level was set at p≤0.05. Results: Patients’ mean age was 8.40 (±5.4) years and the mean length of stay was 3.75(±2) days. Decreased mean levels of NKA and increased mean levels of NPY were observed after the opioid infusion was suspended. Median values of NKA (U=10, p=0.023), and NPY (U=4, p=0.007) found elevated when fentanyl was administering. Decreased mean levels of NKA and increased mean levels of NPY were noted while sedation was combined with the opioid analgesics. Conclusions: This research presents one of the first attempts to identify pain neuropeptides as opioids effectiveness biomarkers and as objective indicators of pain management in human species and more specific in children. The results are encouraging further research for more accurate conclusions and suggest the use of alternative pharmaceutical methods for pain management through the investigation of pain neuropeptides physiology.
|Volume 57, N 4
|Eleni Tamvaki , Evangelos Bozas , Maria Kalafati , Maria Kapritsou , Vassiliki Matziou , Margarita Giannakopoulou