Mcg Of Morphine Research Articles

Comparison of sequential and mixture injections of opioids and hyperbaric bupivacaine for subarachnoid block for lower segment caesarean section: a randomised controlled study.

Opioids are commonly added to local anaesthetic for subarachnoid block for caesarean section due to their synergistic effects. The physiochemical characteristics of opioids suggest premixing with hyperbaric bupivacaine may limit their distribution within the CSF. We studied the effect of a separate injection with a combination of bupivacaine, morphine and fentanyl on block characteristics, haemodynamic changes, postoperative pain and patient satisfaction. Following ethical approval and informed consent, a prospective double-blinded randomised controlled trial was performed in a university hospital. A total of 126 patients undergoing caesarean section were randomised to two groups. In group M, the premixed group, patients received 12mg of hyperbaric bupivacaine, 20 mcg of fentanyl and 100 mcg of morphine injected as a single mixture. In group S, the separate injection group, patients received the same drugs in separate injections. Measurements included haemodynamics, block distribution, intra- and postoperative pain, as well as patient satisfaction. Patients in both groups had similar block height, time to maximum sensory block, time to block regression and motor block. However, haemodynamics were different between the groups. The proportion of systolic hypotension episodes was greater in group S [159/1320 (12.05%)] than group M [113/1452 (7.78%)], with P = 0.0002. Moreover, a greater amount of ephedrine was administered in group S than group M, with values 12.09 (8.1) and 9.09 (8.5) mg respectively (P = 0.001). Additionally, postoperative pain, as measured by the Visual Analogue Scale (VAS), was greater in group M, with a VAS of 4.6 (1.7), vs. group S, which recorded a VAS of 3.8 (2.0) (P = 0.017). Sequential injection of intrathecal opioids and hyperbaric bupivacaine resulted in greater early haemodynamic instability and slightly better postoperative analgesia without any difference in block height or patient satisfaction. NCT04403724.

A randomized controlled trial of spinal morphine with an enhanced recovery pathway and its effect on duration of analgesia after cesarean delivery

BackgroundIntrathecal morphine is frequently administered after cesarean delivery to provide pain relief lasting up to 24 h. An enhanced recovery after cesarean pathways reduces the amount of postoperative opioids needed. The ideal dose of intrathecal morphine when combined with a pathway has not been determined. MethodsThis was a non-inferiority trial in 72 healthy women undergoing a scheduled cesarean delivery. Women were randomized to receive either 50 mcg, 150 mcg, or 250 mcg of intrathecal morphine during spinal anesthesia, with a standardized postoperative enhanced recovery pathway. The time to request supplemental opioids was the primary outcome. Secondary outcomes included pain scores, side effects, and quality of recovery at 24 h. ResultsThe duration of analgesia with 50 mcg of morphine (median 24.5 h [IQR: 3.5–34.4]) was inferior to 150 mcg (29.4 h [24.5–72]), and both doses were inferior to 250 mcg (32 h [30.5–72]). Women who received 50 mcg morphine had higher pain scores than the other doses, received more supplemental opioids, and had lower quality recovery scores. The secondary outcomes between 150 mcg and 250 mcg were similar. Side effects were similar among all groups. 63% of women who received 250 mcg remained opioid-free at 72 h, compared to 150 mcg (52%) and 50 mcg (30%). ConclusionsThe duration of analgesia using intrathecal morphine with an enhanced recovery pathway was longer with 250 mcg than with lower doses, and side effects were similar. 50 mcg provided inferior pain relief over 24 h. More than half of our patients avoided additional opioids for up to 72 h with either 150 mcg or 250 mcg doses. RegistrationClinical trial number NCT05069012

Randomized Double-Blind Trial Comparing Efficacy of Intravenous Nalbuphine vs Intrathecal Nalbuphine for Prevention of Intrathecal Morphine Induced Pruritus in Orthopaedic Surgeries

Intrathecal morphine provides excellent postoperative pain relief but results in pruritus in 30-60% of patients. Nalbuphine, an opioid agonist-antagonist prevents intrathecal morphine-induced itch when given by intravenous route. In this study, we compared efficacy of intrathecal and intravenous nalbuphine for the prevention of intrathecal morphine-induced pruritus. 90 patients were randomly divided into two groups. IT group received 100 mcg of morphine with 400 mcg of nalbuphine intrathecally. IV group received 100 mcg of morphine intrathecally and 400 mcg of nalbuphine intravenously. Incidence of itching, respiratory depression, hypotension, nausea, vomiting, sedation and analgesia were compared between the groups every 4th hourly for 24 hours. Data were analyzed with Chi-square test and Mann-Whitney test. Incidence of itching in 24 hours period was 11.6% (5 patients) in IV group and 4.8% (2 patients) in IT group which was comparable. (P= 0.250) Two patients in IV group had intractable itching requiring naloxone. Incidence of itching at all time intervals was comparable between the groups. Analgesia was prolonged in IV group (P=0.03) Incidence of nausea, vomiting, sedation and respiratory depression was comparable. We conclude that intrathecal nalbuphine and intravenous nalbuphine were equally effective in preventing intrathecal morphine induced pruritus. The duration of analgesia was more when nalbuphine was given by IV route as compared to IT route.

Randomized Clinical Trial Comparing Quadratus Lumborum Block and Intrathecal Morphine for Postcesarean Analgesia.

To compare the efficacy of quadratus lumborum (QL) block and intrathecal morphine (M) for postcesarean delivery analgesia. Thirty-one pregnant women with ≥ 37 weeks of gestation submitted to elective cesarean section were included in the study. They were randomly allocated to either the QL group (12.5 mg 0.5% bupivacaine for spinal anesthesia and 0.3 ml/kg 0.2% bupivacaine for QL block) or the M group (12.5 mg bupivacaine 0.5% and 100 mcg of morphine in spinal anesthesia). The visual analog scale of pain, consumption of morphine and tramadol for pain relief in 48 hours, and side effects were recorded. Median pain score and/or pain variation were higher in the morphine group than in the QL group (p = 0.02). There was no significant difference in the consumption of morphine or tramadol between groups over time. Side effects such as pruritus, nausea, and vomiting were observed only in the morphine group. Quadratus lumborum block and intrathecal morphine are effective for analgesia after cesarean section. Patients undergoing QL block had lower postoperative pain scores without the undesirable side effects of opioids such as nausea, vomiting, and pruritus.

A Case of Priapism After Intrathecal Morphine Injection

BACKGROUND: Data on the frequency of priapism after spinal injections is lacking. Priapism may occur as a rare complication following intrathecal narcotic administration. This report describes an uncommon adverse reaction to intrathecal morphine injection uniquely without concurrent local anesthetic. CASE REPORT: A 74-year-old male presented to the pain management office for a scheduled intrathecal bolus trial to monitor for response prior to permanent placement of an intrathecal pump. Following an intrathecal injection of a bolus dose of 100 mcg of morphine, the patient noted the development of an erection lasting 8 hours. A diagnosis of intrathecal morphine-induced priapism was made. CONCLUSION: This report presents the first case in the literature of priapism induced by noncontinuous intrathecal morphine injection in the context of an intrathecal pump trial. A specific mechanism has not yet been defined; however, we believe multiple factors play a role in the body’s response to morphine. KEY WORDS: Case report, chronic pain, intrathecal drug delivery, morphine, priapism

Determination of the ED95 of intrathecal hyperbaric prilocaine with sufentanil for scheduled cesarean delivery: a dose-finding study based on the continual reassessment method

BackgroundScheduled cesarean section is routinely performed under spinal anesthesia using hyperbaric bupivacaine. The current study was undertaken to determine the clinically relevant 95% effective dose of intrathecal 2% hyperbaric prilocaine co-administered with sufentanil for scheduled cesarean section, using continual reassessment method.MethodsWe conducted a dose-response, prospective, double-blinded study to determine the ED95 values of intrathecal hyperbaric prilocaine used with 2,5 mcg of sufentanil and 100 mcg of morphine for cesarean delivery. Each parturient enrolled in the study received an intrathecal dose of hyperbaric prilocaine determined by the CRM and the success or failure of the block was assessed as being the primary endpoint.ResultsThe doses given for each cohort varied from 35 to 50 mg of HP, according to the CRM, with a final ED95 lying between 45 and 50 mg of Prilocaine after completion of the 10 cohorts. Few side effects were reported and patients were globally satisfied.ConclusionsThe ED95 of intrathecal hyperbaric prilocaine with sufentanil 2.5 μg and morphine 100 μg for elective cesarean delivery was found to be between 45 and 50 mg. It may be an interesting alternative to other long-lasting local anesthetics in this context.Trial registrationThe study was registered on January 30, 2017 – retrospectively registered – and results posted at the public database clinicaltrials.gov (NCT03036384).

COMT val158met Polymorphism and Spinal Analgesia Efficacy of Laparoscopic Surgery for Colorectal Cancer (a Pilot Study)

The aim: To assess the effect of COMT G1947A genetic polymorphism (val158met) on the efficacy of spinal analgesia on day 1 after laparoscopic surgery for colorectal cancer.Material and methods. In a pilot study involving 100 patients with colorectal cancer, operated through laparoscopic access, using spinal analgesia (10.0–12.5 mg of bupivacaine + 200 mcg of morphine), the frequency of COMT gene G1947A (val158met) polymorphism, the intensity of pain on day 1 after surgery, the frequency and severity of nausea, vomiting, skin itching, the need for additional analgesia have been assessed.Results. The frequency distribution of alleles val/val (25%), val/met (45%) and met/met (30%) was consisted with Hardy-Weinberg equilibrium (χ2=0.96; P>0.05) and was not significantly different from the healthy donor group. In the groups of patients with various COMT alleles of val158met polymorphism, the studied parameters also did not differ significantly.Conclusion. Study did not find significant link between spinal analgesia efficacy on day 1 after laparoscopic surgery for colorectal cancer and COMT rs4680 G1947A (val158met) polymorphism. Further research to enhance the power of the study is warranted to reach the final conclusions.

Spinal analgesia increases the frequency of noradrenalin administration, but does not affect the oxygen status of patients during laparoscopic surgeries for colorectal cancer

The objective. To assess the effect of spinal analgesia on the oxygen status and the level of myocardial damage markers in patients with colorectal cancer operated by laparoscopic access.
 Subjects and methods. 60 patients with colorectal cancer operated under general anesthesia with laparoscopic access were divided into two groups. In group 1 (n=30) intraoperative analgesia was performed with fentanyl. In Group 2 (n=30) before the induction of general anesthesia was performed an intrathecal administration of 10.0-12.5 mg of bupivacaine and 200 mcg of morphine. In case of decreasing an MAP 65 mm Hg.V. a continue infusion of noradrenaline was began. The frequency of administration and the average dose of noradrenalin were estimated, as well as the levels of lactate, pH, BE, ScvO2, highly specific cardiac troponin I (hs-cTnI ) and NT-proBNP in the central venous blood.
 Results. The frequency of noradrenalin administration in group 2 was significantly higher compared to group 1 56.7% versus 26.7% (HR=2.1; 95% CI 0.86-4.16; p=0.036). Noradrenalin dose, the levels of lactate, pH, BE, ScvO2, hs-cTnI and NT-proBNP levels did not differ significantly in both groups at all stages of research.
 Conclusion. Spinal analgesia increases the frequency of noradrenalin administration but does not affect the oxygen status and the level of myocardial damage markers in patients with colorectal cancer operated by laparoscopic access.

SPINAL ANESTHESIA AS A PART OF ANAESTHESIOLOGIC SUPPORT IN FAST TRACK LAPAROSCOPIC COLON SURGERIES

The objective: to assess the efficiency of spinal analgesia as a part of anaesthesiologic support in laparoscopic colon surgeries within fast track programs. Subjects and methods: 60 patients who had laparoscopic colon surgeries within fast track programs were divided into 2 groups. In Group 1 ( n = 30), peri-operative analgesia was provided through intrathecal administration of 10.0–12.5 mg of bupivacaine and 200 mcg of morphine. In Group 2 ( n = 30), the systemic multi-modal analgesia was provided (nonsteroidal anti-inflammatory drugs, opioids). Results. The maximum intensity of pain at rest within 24 hours after surgery was assessed as 2 (2−3) scores as per the digital rating scale in Group 1 and 5 (4−6) scores in Group 2 ( p < 0.0001). The intensity of pain by the first verticalisation made 3 (2−5) scores in Group 1 and 6 (6−7) scores in Group 2 ( p < 0.0001). Intra-operative consumption of phentanyl, frequency of post-operative nausea, vomit and need for extra pain relief were much lower in Group 1. Conclusion. Intrathecal administration of 10.0−12.5 mg of bupivacaine and 200 mcg of morphine as a part of anaesthesiologic support in laparoscopic colon surgeries provides effective peri-operative analgesia and promotes the implementation of fast track programs in this type of interventions.

Incidence of Shivering after Cesarean Section under Spinal Anesthesia with or without Intrathecal Sufentanil: A Randomized Study

Shivering is a cause of discomfort and dissatisfaction in patients undergoing cesarean section. The objective of this study paper was to assess the impact of intrathecal administration of sufentanil on the incidence of shivering after cesarean section.In a prospective blinded, randomized clinical trial, pregnant women undergoing cesarean section under spinal anesthesia were enrolled. Pregnant women in labor, febrile, obese, with pregnancy-induced hypertension, anesthetic block failure or surgical complications were excluded. Patients were randomly assigned to two groups. In Group I, 10mg of 0.5% hyperbaric bupivacaine combined with 80 mcg of morphine and 2.5 mcg of sufentanil were administered. In Group II, 10mg of 0.5% hyperbaric bupivacaine combined with 80 mcg of morphine were administered. In the post-anesthesia care unit, patients were evaluated for signs of shivering by an investigator blinded to the patient's group allocation.The sample consisted of 80 patients. In both groups there was a decrease in axillary temperature of patients after cesarean section (p<0.001). This decrease was not different between groups (p<0.21). In Group I, the incidence of tremor was 32.5% (13/40) and in Group II it was 62.5% (25/40) (p<0.007); RR 0.53 (CI 95% 0.32-0.87).It has been suggested that the addition of sufentanil to hyperbaric bupivacaine and morphine during spinal anesthesia for cesarean section provides a decrease in the incidence of shivering in the immediate postoperative period.