Morphine For Postoperative Pain Control Research Articles

Opioid-Sparing Effect of Intrathecal Morphine for Postoperative Pain Control.

Opioid-Sparing Effect of Intrathecal Morphine for Postoperative Pain Control.

Intraoperative Dexmedetomidine Decreases Postoperative Pain after Gastric Endoscopic Submucosal Dissection: A Prospective Randomized Controlled Trial

Postoperative pain is one of the most common complications after gastric endoscopic submucosal dissection (ESD); however, there have been only a few studies assessing the efficacy of interventions on postoperative pain after gastric ESD. This prospective randomized controlled trial was designed to assess the effect of intraoperative dexmedetomidine (DEX) on postoperative pain after gastric ESD. A total of 60 patients undergoing elective gastric ESD under general anesthesia were randomly divided into the DEX group receiving DEX with a loading dose of 1 μg/kg, followed by a maintenance dose of 0.6 μg/kg/h until 30 min before the end of the endoscopic procedure, and the control group receiving normal saline. The primary outcome was the visual analog scale (VAS) score of postoperative pain. Secondary outcomes were the dosage of morphine for postoperative pain control, hemodynamic changes during the observable period, the occurrence of adverse events, lengths of postanesthesia care unit (PACU) and hospital stays, and patient satisfaction. The incidence of postoperative moderate to severe pain was 27% and 53% in the DEX and control groups, respectively, with a significant difference. Compared to the control group, VAS pain scores at 1 h, 2 h, and 4 h postoperatively, the dosage of morphine in the PACU, and the total dosage of morphine within 24 h postoperatively were significantly decreased in the DEX group. Both incidences of hypotension and use of ephedrine in the DEX group were significantly decreased during surgery, but they were significantly increased in the postoperative period. Postoperative nausea and vomiting scores were decreased in the DEX group; however, the length of PACU stay, patient satisfaction, and duration of hospital stay were not significantly different between groups. Intraoperative DEX can significantly decrease postoperative pain level, with a slightly reduced dosage of morphine and a decreased severity of postoperative nausea and vomiting after gastric ESD.

Efficacy and safety of intrathecal morphine for pain control after spinal surgery: a systematic review and meta-analysis.

This study aimed to assess the efficacy and safety of intrathecal (IT) morphine for postoperative pain control in adults undergoing spinal surgeries. We searched the electronic databases of PubMed, Embase, and CENTRAL up to 1st January 2021 for randomized controlled trials (RCTs) or controlled clinical trials (CCTs) comparing IT morphine with placebo or other analgesics. Twelve studies were included. Eleven were RCTs and one was a CCT. Our meta-analysis indicated a statistically significant reduction of pain scores with IT morphine at 2 hours, 4 hours, 6 hours, 8 hours, 12 hours, and 24 hours; but no significant difference at 48 hours. Meta-analysis indicated a statistically significant reduction in analgesic consumption with IT morphine as compared to control. Pooled analysis indicated that IT morphine had no statistically significant effect on length of hospital stay. Our analysis indicated no statistically significant difference in the risk of nausea, vomiting, sedation, respiratory depression, headache, and urinary retention between IT morphine and control groups. The incidence of pruritis was significantly increased in the IT morphine group. The certainty of the evidence was judged to be "moderate" for pain scores at 12 hours, 24 hours, and analgesic consumption. To conclude, our review indicates that IT morphine results in significantly better pain control in the first 24 hours after spinal surgery. The risk of pruritis is significantly increased with the use of IT morphine but not for other opioid-related adverse events. Future RCTs should focus on finding the most optimal dose of IT morphine for spinal surgeries.

Midazolam as an antiemetic in patients receiving epidural morphine for postoperative pain relief

Epidural morphine has been associated with a significant incidence of postoperative nausea and vomiting (PONV). The authors have evaluated the prophylactic effects of midazolam in preventing nausea and vomiting following epidural morphine for postoperative pain control. The authors studied 80 women (n = 40 in each group) undergoing total abdominal hysterectomy under epidural anesthesia, in a randomized, double-blind, placebo-controlled study. At the end of the surgery, all patients received epidural morphine 3 mg for postoperative pain. Before morphine injection, the midazolam group received low-dose midazolam infusion (1 mg bolus followed by 1 mg h(-1)), while the placebo group received i.v. saline. Patients in the midazolam group reported a lower incidence of total PONV, and a lower frequency of rescue antiemetic request than those in the placebo group (p < 0.05). In addition, midazolam was associated with a reduced incidence of pruritus following epidural morphine (p < 0.05). The authors conclude that low-dose midazolam infusion is effective in the prevention of nausea, vomiting, and pruritus following epidural morphine for postoperative pain control.

Intrathecal morphine for postoperative pain control following robot-assisted prostatectomy: a prospective randomized trial.

Robot-assisted laparoscopic prostatectomy (RALP) is minimally invasive surgery, but also causes moderate to severe pain during the immediate postoperative period. We evaluated the efficacy and safety of intrathecal morphine (ITM) for postoperative pain control in patients undergoing RALP. Thirty patients scheduled for RALP were randomly assigned into one of two groups. In the ITM group (n=15), postoperative pain was managed using 300µg intrathecal morphine with intravenous patient-controlled analgesia (IV-PCA). In the IV-PCA group (n=15), only intravenous patient-controlled analgesia was used. The numerical pain score (NPS; 0=no pain, 100=worst pain imaginable), postoperative IV-PCA requirements and opioid-related complications including nausea, vomiting, dizziness, headache and pruritus were compared between the two groups. The NPSs on coughing were 20 (IQR 10-50) in the ITM group and 60 (IQR 40-80) in the IV-PCA group at postoperative 24h (p=0.001). The NPSs were significantly lower in the ITM group up to postoperative 24h. The ITM group showed less morphine consumption at postoperative 24h in the ITM group than in the IV-PCA group [5 (IQR 3-15) mg vs 17 (IQR 11-24) mg, p=0.001]. Complications associated with morphine were comparable between the two groups and respiratory depression was not reported in either group. Intrathecal morphine provided more satisfactory analgesia without serious complications during the early postoperative period in patients undergoing RALP.

Comparison of intravenous tramadol and ketamine for prevention of catheter-related bladder discomfort after laparoscopic surgery: a randomized, placebo-controlled, double-blind study

Background: Catheter-related bladder discomfort (CRBD) is a distressing symptom after anesthesia. Objectives: To compare the efficacy of tramadol and ketamine to prevent CRBD after laparoscopic surgery. Methods: After registration with the Thai Clinical Trial Registry (TCTR20140220001), we conducted a randomized controlled trial in 210 patients aged 18–70 years with American Society of Anesthesiologists physical status I or II undergoing elective laparoscopic surgery requiring bladder catheterization. These patients were randomly allocated into 1 of 3 groups: Group T received intravenous (i.v.) tramadol 1.5 mg/kg, Group K received i.v. ketamine 0.5 mg/kg, and Group P received i.v. saline as a placebo before catheterization. Patients received i.v. morphine for postoperative pain control. An anesthesiologist blinded to the randomization evaluated postoperative and CRBD pain severity using visual analog scales (VAS). The cumulative postoperative and CRBD pain was calculated by multiplying mean VAS scores by the hours of assessment. Results: Groups T and K had significantly less cumulative CRBD pain compared with placebo (P = 0.04 and 0.001, respectively). Cumulative postoperative pain, total 24-h morphine consumption, and adverse effects were comparable between groups. Group T had a significantly lower incidence of shoulder pain (7/67, 10%) than Group K (21/70, 30%), and Group P (24/70, 34%) 24 h after surgery (P = 0.006 and 0.001, respectively). Conclusions: Tramadol 1.5 mg/kg and ketamine 0.5 mg/kg administered i.v. before bladder catheterization are both effective in reducing the 24-h cumulative postoperative CRBD after laparoscopic surgery without significant adverse effects. Tramadol also decreases the incidence of postlaparoscopy shoulder pain. Keywords: Catheter-related bladder discomfort, ketamine, laparoscopic surgery, laparoscopy, pain, prevention, tramadol

Transdermal fentanyl patch for postoperative analgesia in total knee arthroplasty: a randomized double-blind controlled trial.

PurposeTo assess the efficacy of a transdermal fentanyl patch (TFP) (50 μg/hour) applied 10–12 hours before surgery versus placebo for postoperative pain control of total knee arthroplasty (TKA).Materials and methodsWe enrolled 40 patients undergoing elective TKA under spinal anesthesia using isobaric or hyperbaric bupivacaine. Subjects were randomized to receive a TFP (Duragesic® 50 μg/hour) or placebo patch applied with a self-adhesive to the anterior chest wall 10–12 hours before spinal anesthesia. Every patient was given patient-controlled morphine for postoperative pain control. Patients were evaluated every 4 hours until 48 hours.ResultsMorphine consumption at 24 and 48 hours in the TFP group versus the placebo group was 15.40±12.65 and 24.90±20.11 mg versus 33.60±19.06 and 57.80±12.65 mg (P≤0.001). Numeric rating scale scores at rest and during movement over 48 hours were lower in the TFP group. Ambulation and nausea/vomiting scores were statistically greater, but not clinically significant in the TFP group. Sedation scores were low and not statistically significantly different between groups. There was no severe respiratory depression.ConclusionTFP (50 μg/hour) applied 10–12 hours before surgery can effectively and safely decrease morphine consumption and pain scores during the first 48 hours after TKA surgery.

Morphine at “sub-analgesic” background infusion rate plus low-dose PCA bolus control pain better and is as safe as twice a bolus-only PCA regimen: A randomized, double blind study

Morphine for postoperative pain control is commonly titrated via intravenous patient-controlled analgesia (IV-PCA). An IV morphine background infusion is rarely used. We investigated whether analgesia is effectively attained and morphine consumption is reduced if PCA titration is coadjuvated by a continuous infusion protocol. Following colorectal cancer surgery, consenting patients were randomized to receive a minimal (“sub-analgesic”) dose of morphine 0.01mg/kg/h background infusion plus a 0.01mg/kg bolus (BI), or a 1.5mg bolus-only morphine (B0) (bolus ratio ∼1:2). Bolus lockout time was 7min in either case. All patients received 0.1mg/kg morphine before protocol initiation, and diclofenac 75mg intramuscularly b.i.d. during the study period, lasting 48h. Eighty-six patients (51 males, age 26–95 years) participated in the study. The total mean morphine consumption during the 48h was 25% lower in the BI than in the B0 group (P<0.05). Although the former applied the PCA device for boluses 19% less than the latter (P<0.05), their pain score was lower (P<0.05) most of the time, and they reported greater satisfaction (P<0.05) on a 10-scale numerical rating score. Pre- and postoperative vital signs were similar for both groups. No patient depicted hypoxemia or lapsed into deep sedation. Four BI and three B0 patients required treatment for postoperative nausea and vomiting. One BI patient had transient pruritus and one B0 69-year individual became disoriented 24h into treatment; either event subsided soon after stopping their respective regimen without the need for treatment. The main conclusions of the results are that very-low-dose background morphine infusion combined with small-dose PCA boluses may provide better pain relief, lower morphine consumption, and minimal complication rate as a 1.5mg PCA bolus-only protocol.

Continuous epidural infusion of morphine versus single epidural injection of extended-release morphine for postoperative pain control after arthroplasty: a retrospective analysis

This study retrospectively compared the continuous epidural infusion of morphine with a single epidural injection of extended-release morphine for postoperative pain control after arthroplasty. Medical records were reviewed for subjects who had total knee or hip arthroplasty (THA) under spinal anesthesia and received either a continuous epidural infusion of morphine (Group EPID; n = 101) or an extended-release epidural morphine (Group EREM; n = 109) for postoperative pain. Data were collected for three postoperative days (POD) on: pain scores; supplemental opioids; medications for respiratory depression, nausea, and pruritus, and distance ambulated during physical therapy. Pain scores were similar until subjects were transitioned to another analgesic approach on POD 2; after that time, pain scores increased in Group EPID, although they decreased in Group EREM. Supplemental opioids were used more on POD1 in Group EREM than in Group EPID, although time to first opioid and total daily morphine equivalents were similar. Naloxone and antiemetics, not antipruritics, were used more in Group EREM. Distance ambulated after THA was greater in Group EREM than in Group EPID. These results suggest that EREM is associated with better postoperative ambulation and analgesia during the transition to oral or intravenous analgesics, although a higher incidence of side-effects was evident.

Continuous epidural infusion of morphine versus single epidural injection of extended-release morphine for postoperative pain control after arthroplasty: a retrospective analysis

Continuous epidural infusion of morphine versus single epidural injection of extended-release morphine for postoperative pain control after arthroplasty: a retrospective analysis

Continuous epidural infusion of morphine versus single epidural injection of extended-release morphine for postoperative pain control after arthroplasty: a retrospective analysis

Continuous epidural infusion of morphine versus single epidural injection of extended-release morphine for postoperative pain control after arthroplasty: a retrospective analysis

Therapeutic Effect of Intrathecal Morphine After Posterior Lumbar Interbody Fusion Surgery

Prospective, double-blind, randomized, placebo-controlled study. To assess the efficacy and safety of 0.4 mg intrathecal morphine for postoperative pain control after posterior lumbar interbody fusion (PLIF) surgery. Multiple studies have established the technique of intrathecal morphine analgesia in a wide variety of clinical settings. Several trials were conducted in patients undergoing spine surgery, generally supporting the efficacy for this type of surgery. Many exhibit methodologic problems with dosing regimes or study design. After the institutional review board-approval and written informed consent, 52 patients scheduled for PLIF-surgery were enrolled, of whom 46 could be analyzed. Patients were randomized to receive 0.4 mg morphine (M-group) or normal saline (P-group) intrathecally under direct vision before the end of surgery. Additionally, all patients received a piritramide patient-controlled-analgesia for individual pain control. Measures included visual analog scale-scores and blood-gas analysis over 20 hours after surgery. Morphine associated side effects and complications were recorded. Visual analog scale-scores at rest and when the patients bent their legs were comparable between groups throughout the observation period, only being significantly lower in the M-group at rest 4 and 8 hours after surgery. Cumulative piritramide patient-controlled-analgesia requirements were significantly lower in the M-group throughout the observed 20 hours after surgery. Patients of the M-group were experiencing mild respiratory depression 4 hours after surgery not demanding any intervention, though. With respect to other morphine associated side effects or complications, there was no difference between the study groups. We demonstrated the efficacy of 0.4 mg intrathecal morphine after PLIF-surgery as indicated by a significantly lower cumulative piritramide requirement without any serious increase of opioid associated side effects. Therefore, morphine in a dose of 0.4 mg administered intrathecally seems to be a viable alternative therapeutic option to provide postoperative analgesia with PLIF-surgery.

Single-dose haloperidol does not reduce nausea and vomiting following epidural morphine for postoperative pain control

Single-dose haloperidol does not reduce nausea and vomiting following epidural morphine for postoperative pain control

Bowel function after bowel surgery: morphine with ketamine or placebo; a randomized controlled trial pilot study

Morphine decreases gut peristalsis, and ketamine decreases morphine use after surgery, and does not slow peristalsis. Thus, the combination should result in faster return of bowel function after surgery than morphine alone. A double-blind randomized controlled trial of saline vs. ketamine with intravenous patient-controlled-analgesia morphine for post-operative pain control was conducted on 42 patients having bowel resection. Bowel function was assessed by auscultation, time to passage of flatus and stool, and time to first retained oral intake; pain by visual analog scale. Time to return of all four measures of bowel function was the primary outcome. Despite a ketamine dose that in other studies had decreased morphine use without side-effects, there was no difference in bowel function, pain control, or morphine use between the two groups. Ketamine resulted in hallucinations in six out of 19 patients, with none in the placebo group (P =0.018). Low-dose ketamine was not efficacious for hastening return of bowel function, or for decreasing post-operative pain after surgery for bowel resection. It resulted in hallucinations in some patients. Those reporting hallucinations all wished to remain in the study.

Association of μ‐opioid receptor gene polymorphism (A118G) with variations in morphine consumption for analgesia after total knee arthroplasty

Morphine consumption after a given surgical procedure can vary considerably. Studies show that single nucleotide polymorphism involving the nucleotide position 118 at exon 1 of the mu-opioid receptor gene (OPRM1) may play a role in mediating the effects of opioids. This study was performed to correlate the A118G polymorphism at OPRM1 with morphine consumption in patients undergoing total knee arthroplasty. Post-operative pain was relieved by patient-controlled analgesia (PCA). The analgesic effect was evaluated using a visual analogue scale. Side-effects, such as sedation, nausea and vomiting, and pruritus, were recorded systematically. The genotypes were determined by sequencing polymerase chain reaction-amplified DNA. The differences in demographics and consumed morphine from the PCA device between the different genotypes were tested using one-way analysis of variance. The prevalence of side-effects from morphine and sex distribution were compared using the Kruskal-Wallis test. One hundred and forty-seven patients were included in the study. Twenty-seven patients who required rescue analgesia were excluded; these patients did not differ demographically or genetically from the 120 who completed the study. Of the latter, 74 were A118 homozygous (AA), 33 were heterozygous (AG) and 13 were G118 homozygous (GG). Group GG consumed significantly more morphine (40.4 +/- 22.0 mg) than group AA (25.3 +/- 15.5 mg) and group AG (25.6 +/- 11.7 mg) during the first 48 h post-operatively. The groups did not differ with respect to reported pain, age, sex, weight and adverse effects. G118 homozygotes have a poorer response to morphine for post-operative pain control than A118 homozygotes or heterozygotes. The genotype may thus influence the post-operative response to pain and cause differences in the amounts of analgesic consumed by patients after total knee arthroplasty.

Peroperative ketamine and morphine for postoperative pain control after lumbar disk surgery

Background Ketamine, a N-methyl- d-aspartate receptor antagonist, may reduce postoperative opioid demand and improve postoperative analgesia. Methods Sixty-nine patients scheduled for lumbar disk surgery under general anaesthesia were enrolled in a randomised, double-blind study comparing three analgesic combinations that were started before surgical incision: morphine 0.1 mg kg −1 alone (group M; n = 23); ketamine 0.15 mg kg −1 alone (group K; n = 22); and a combination of morphine 0.1 mg kg −1 with ketamine 0.15 mg kg −1 (group KM; n = 23). Postoperatively patient-controlled analgesia was provided with intravenous morphine. Morphine consumption was assessed during 24 H, and pain scores were measured using a visual analogue scale (VAS) at rest and on mobilisation, during the first two postoperative days. Results In group KM, less i.v. morphine was administered in the post anaesthesia care unit than in group M (median [range]: 0 mg [0–2] vs. 7 mg [6–9], P = 0.009). Cumulative 24 H morphine consumption was reduced by 57% in group KM vs. group M, and by 48% in group KM vs. group K. Postoperative VAS scores were lower in group KM vs. groups K and M. Maximal VAS score on mobilization was reduced in group KM compared to groups K and M (38 mm [35–45] vs. 52 mm [48–59] and vs. 59 mm [55–64], in groups KM, K and M, respectively, P = 0.05 and P = 0.002). The incidence of postoperative nausea and vomiting was decreased in group KM compared to group M (21.7% vs. 43.5%, P = 0.001). Conclusion Ketamine small-dose, combined with morphine improves postoperative analgesia and reduces opioid-related side effects in lumbar disk surgery.

Preventive Effect of Intravenous Ondansetron on Postoperative Nausea and Vomiting related to Epidural Morphine after Abdominal Surgery

Background: A prospective study was performed to evaluate the preventive effect of intravenous (IV) ondansetron on postoperative nausea and vomiting (PONV) due to epidural morphine for postoperative pain control after major abdominal surgery. Methods: One hundred patients undergoing elective major abdominal surgery were randomly devided into two groups, group O (n = 50) receiving IV ondansetron and group C (n = 50) receiving IV saline. After bolus epidural morphine were injected to all patients thirty minutes before the end of surgery, group O received ondansetron 8 mg and group C received normal saline intravenously. Incidence and severity of nausea, episodes of vomiting, patient´s satisfaction, side effects such as pruritus, headache, dizziness related to epidural morphine were checked at 6, 24 hours after operation. Results: The incidence and severity of nausea were significantly decreased in group O than group C during the first 24 hours after surgery. There were no significant differences in postoperative pain scores and patient´s satisfaction between groups. The patients who didn´t experienced PONV were significantly more satisfied than those who experienced PONV after surgery. Conclusions: Ondansetron decrease the incidence and severity of nausea in patients receiving epidural morphine for postoperative pain control after major abdominal surgery.

Subacromial and intra-articular morphine versus bupivacaine after shoulder arthroscopy

Purpose: Multiple studies have compared the effects of intra-articular bupivacaine and morphine for postoperative pain control after arthroscopy of the knee. To date, these agents have not been compared in the shoulder. The purpose of this study was to compare intra-articular (IA)/subacromial (SA) morphine, bupivacaine, and placebo after shoulder arthroscopy. Type of Study: Prospective, double-blind, randomized clinical trial. Methods: The effectiveness of each drug was measured by comparing the amount of supplemental analgesics required as well as the evaluation of each patient’s level of pain after surgery. A visual analog scale was used to record each patient’s level of pain before surgery and at various time intervals after surgery. The amount of supplemental analgesic was likewise recorded for 24 hours after surgery. Sixty-four patients were randomized into 3 groups and injected with morphine (n = 22), bupivacaine (n = 22), or saline (n = 20) at the conclusion of shoulder arthroscopy. The injection was directed intra-articular as well as subacromial if surgical dissection had been performed in this area. Statistical significance was determined at P <.05. Results: There were no differences between groups before surgery. A statistically significant difference in pain level at 30 and 60 minutes was found. At 30 and 60 minutes, patients who were administered IA/SA bupivacaine reported average pain levels less than those administered morphine or saline. Morphine was not statistically different from saline at reducing postarthroscopy pain at any time interval. Despite differences in pain level, there were no significant differences in the amount of supplemental analgesics requested at any time interval among these 3 groups. Conclusions: IA/SA morphine does not contribute to postoperative pain control after shoulder arthroscopy, whereas IA/SA bupivacaine improves pain control during the first 60 minutes after surgery.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 5 (May-June), 2002: pp 464–468

Comparison of Epidural Buprenorphine and Morphine for Postoperative Pain Control in Combined Spinal Epidural Anesthesia for Cesarean Section

Comparison of Epidural Buprenorphine and Morphine for Postoperative Pain Control in Combined Spinal Epidural Anesthesia for Cesarean Section

Comparison of Continuous Epidural Analgesia with Fentanyl-Bupivacaine Versus Intravenous Patient-Controlled Analgesia with Morphine for Postoperative Pain Control

Comparison of Continuous Epidural Analgesia with Fentanyl-Bupivacaine Versus Intravenous Patient-Controlled Analgesia with Morphine for Postoperative Pain Control