PCA Morphine Research Articles

Effect of spinal opioids on PCA morphine requirements following major abdominal surgery

Effect of spinal opioids on PCA morphine requirements following major abdominal surgery

Efficacy and side effects of small versus large bolus size morphine patient controlled analgesia combined with paracetamol

IntroductionPatient controlled analgesia (PCA) provides a better analgesia over conventional opioid treatment. The reduction of bolus size and its efficacy on pain relief and associated side effects were not enormously studied. This study was constructed to evaluate small versus traditional bolus size PCA, including pain relief, and side effects of both regimens.MethodsSeventy-seven patients were included in the study. All patients received general anesthesia. Patients were randomly distributed between two groups; traditional group (M1) received a bolus dose of Morphine as 0.02 mg/kg body weight to a maximum of 1.5 mg, and group (M2) where 0.01 mg/kg body weight to a maximum of 0.75 mg is the bolus dose. PCA machines were set up at 6 min lockout interval and a maximum dose of 0.15 mg/kg/h to a maximum of 10 mg/h. Rescue doses were given according to pain scores and reported. 1000 mg Paracetamol every 6 h were given. Morphine consumption at 24 and 48 h, VAS at 1, 2 then every 4 h for 48 h were measured. Reported complications as respiratory depression, over sedation, constipation, pruritus, nausea and vomiting were analyzed.ResultsMorphine consumption in small bolus size group M2 during the first (36.38 ± 17.75) and second 24 h (30.22 ± 17.15) were less when compared to large bolus size group M1 (39.20 ± 17.97 and 36.38 ± 17.75), the change was insignificant. In spite of using small bolus size Morphine in group M2, pain scores were close to group M1 and statistically insignificant. The frequency of occurrence of side effects was statistically insignificant when comparing the two groups.ConclusionsSmall bolus size of Morphine PCA produces efficient pain relief but does not reduce total morphine consumption nor did morphine associate side effects.

Silent myocardial ischaemia in diabetic patients after general anaesthesia with 24 h intravenous opioids or with epidural analgesia

ObjectiveTo evaluate the effect of general anaesthesia with either continuous i.v. opioids (G/O) or thoracic epidural analgesia (G/EP) on postoperative transient myocardial ischaemia (TMI) in type 2 diabetic patients undergoing open cholecystectomy.MethodologyThis randomised controlled study was conducted on 50 patients with D.M. Patients were divided into G/O group or G/EP group. All patients had negative stress exercise test and at least two cardiac risks preoperatively. Epidural analgesia was established by 15 ml of ropivacaine 0.2% with fentanyl 2 μg/ml followed by 5–8 ml/h of ropivacaine 0.1% with fentanyl 1 μg for 24 h postoperatively. Both studied groups received same general anaesthesia. Continuous i.v. fentanyl 100 μg/h was given intraoperatively in group G/O followed by i.v. morphine PCA. Primary outcome measured postoperative TMI using 24 h continuous ST segment analysis, endothelin-1(ET-1), troponin T, creatine kinase MB (CK-MB), and CKMB/CK preoperatively, 8 h and 24 h postoperatively. Second outcome measured dynamic stress (perioperative heart rate, blood pressure and postoperative pain).ResultsEndothelin-1 was above cutoff level preoperatively and rose up dramatically postoperatively in both studied groups. G/EP attenuated ET-1 elevation than G/O. Troponin T and CK-MB did not rise postoperatively in both studied groups. Postoperative CK-MB/ CK ratio was higher than 10% in 12 and eight patients in group G/O and G/EP, respectively. Twelve cardiac ischaemic events were noticed in four patients in group G/O and four events in two patients in group G/EP without significant difference in total duration of ischaemia between groups. G/EP lowered HR more significantly intraoperatively and gave better pain control for 4 h postoperatively. In conclusion, D.M was associated with high ET-1 level. Upper abdominal surgery increased ET-1 release. G/EP attenuated ET-1 release more than G/O and produced more stable haemodynamic parameters and less postoperative pain. No superior cardioprotective effect was noticed in G/EP over G/O.

48 A PROSPECTIVE AUDIT OF ONE-HUNDRED PATIENTS PRESENTING FOR THORACIC EPIDURAL PAIN RELIEF FOR HEPATOBILIARY SURGERY

Background: There is a perception that epidurals provide the best pain relief for major abdominal surgery. Prospective trials comparing epidural anesthesia with i.v. narcotics have failed to show differences in complications. Using an epidural, however, is associated with significantly less pain during the first 3 postoperative days, decreases respiratory complications, and facilitates early ambulation. Aim: This was a prospective audit of 100 patients to assess the effectiveness of epidural analgesia for hepatobiliary surgery and review complications. Method: We prospectively audited 100 patients undergoing hepatobiliary surgery where thoracic epidural pain relief was offered as combined general and neuraxial anesthesia and continued for postoperative pain relief. Result: Four patients refused epidural and preferred morphine patient-controlled analgesia PCA. Two cases failed epidural placement and morphine PCA was given as an alternative. Ninety-four patients received thoracic epidural between T6 and T10. There was difficulty in placement in 8% of patients. Postoperatively, 2 patients had no sensory block and were given PCA morphine. All patients were followed up for 24 h postoperatively. There were significant interventions in the epidural management; 92% required at least one intervention. PCA morphine was added in 6 patients. Referred shoulder tip pain and discomfort from central venous neck lines required additional analgesia NSAIDs and paracetamol in 50% of patients. Patient satisfaction of analgesia was good, 92%. Hypotension requiring additional i.v. fluids occurred in 68% of patients. Conclusion: Thoracic epidural pain relief may be considered as the gold standard but it has significant failures in our series and additional pain relief was required. 47

Remifentanil patient-controlled analgesia effect-site target-controlled infusion compared with morphine patient-controlled analgesia for treatment of acute pain after uterine artery embolization

Post-procedural pain control after uterine artery embolization (UAE) of urethral leiomyomata remains a major problem. This double-blind, randomized study tested the possibility to obtain a quicker onset of analgesia by using effect-compartment controlled remifentanil patient-controlled analgesia (remifentanil TCI-PCA) than by using i.v. morphine PCA. Both systems were connected to an i.v. catheter. Active drug or matching placebo administration was activated by a single push-button. Pain was assessed using a numerical rating scale (NRS) from 0 to 10. NRS values were lower in the remifentanil group (with a possible difference from two to seven points on the scale) during the initial 4 h post-embolization. After the fourth hour, the NRS values were identical between the groups. No major respiratory or haemodynamic side-effect was observed. Remifentanil PCA-TCI with a slow and progressive adapted algorithm without any associated premedication or co-medication is feasible in young healthy women undergoing UAE.

Effect of bupivacaine concentration on the efficacy of ultrasound-guided interscalene brachial plexus block

Background:Interscalene brachial plexus block (ISBPB) is an effective technique for shoulder surgery and postoperative pain control. The aim of this study is to compare the analgesic efficacy of 0.1% vs 0.2% bupivacaine for continuous postoperative pain control following arthroscopic shoulder surgery.Methods:A total of 40 adult patients divided into two groups (each 20 patients) undergoing arthroscopic shoulder surgery were randomized to receive an ultrasound-guided ISBPB of either 0.1% or 0.2% bupivacaine 10 ml bolus plus 5 ml/h infusion through interscalene catheter. Standard general anesthesia was given. Both groups received rescue postoperative PCA morphine. Pain, sensory, and motor power were assessed before for all patients, 20 minute after the block, postoperatively in the recovery room, and at 2, 6, 12, and 24 hours thereafter. The patient and surgeon satisfaction and the analgesic consumption of morphine were recorded in the first 24 hours postoperatively. A nonparametric Mann-Whitney was used to compare between the two groups for numerical rating scale, morphine consumption in different time interval.Results:Group 1 (0.1% bupivacaine) patients had significantly received more intraoperative fentanyl and postoperative morphine with higher pain scores at 24 hours postoperatively vs group 2 (0.2% bupivacaine) patients.Conclusions:The use of ultrasound-guided ISBPB with 0.2% bupivacaine provided better intra- and post-operative pain relief vs 0.1% bupivacaine in arthroscopic shoulder surgery.

Comparative randomized study on the analgesic efficacy and side effects of iv PCA morphine versus a continuous infusion of a multimodal combination for cardiac surgery

Comparative randomized study on the analgesic efficacy and side effects of iv PCA morphine versus a continuous infusion of a multimodal combination for cardiac surgery

Addition of ketamine to morphine PCA in patients suffering severe postoperative pain: Effect of a preoperative intake of opioids

Addition of ketamine to morphine PCA in patients suffering severe postoperative pain: Effect of a preoperative intake of opioids

Opioid-sparing properties of intranasal ketorolac: a pooled analysis of patients experiencing moderate-to-severe acute pain

Ketorolac is a nonopioid mixed COX1/2 inhibitor used for short-term (up to 5 days) management of moderate-to-severe acute pain. An intranasal (IN) formulation of ketorolac is in development as a self-administered alternative to injectable ketorolac and opioids for pain management. The pharmacokinetics of IN ketorolac are similar to those of ketorolac administered intramuscularly. The efficacy and tolerability of IN ketorolac were assessed in phase 2/3 clinical trials in 705 patients (men and women, ≥18 yr). Abdominal and orthopedic surgery models were used to assess IN ketorolac efficacy in managing moderate-to-severe acute pain. Patients received IN ketorolac (31.5 mg) (n=455) or placebo (n=250) 3 or 4 times a day for up to 5 days. Statistically significantly greater reductions in the summed pain intensity difference over 48 hr occurred in patients receiving IN ketorolac compared to placebo (P<0.05). The most common adverse events in the IN ketorolac group were transient nasal discomfort (15% vs. 2% placebo) and rhinalgia (12% vs <1% placebo). Most patients received concurrent opioid analgesics for the first 48 hr. Morphine use (mg) was calculated by adding all PCA morphine and morphine equivalents (using American Pain Society guidelines for other analgesic medications). Patients in the IN ketorolac group used 34% less morphine over 48 hours after surgery compared to the placebo group (P<0.001). In the first 8 hr after surgery, patients receiving IN ketorolac undergoing orthopedic surgery had greater decreases in opioid use relative to placebo than did abdominal surgery patients. Reductions in opioid use were similar when stratified by age and sex. Efficacy in this clinical model indicates that IN ketorolac provides a noninjection parenteral option for management of acute moderate-to-severe pain that may be particularly useful for ambulatory patients, particularly where avoidance of, or reductions in, opioid use are desirable. (Supported by ROXRO PHARMA). Ketorolac is a nonopioid mixed COX1/2 inhibitor used for short-term (up to 5 days) management of moderate-to-severe acute pain. An intranasal (IN) formulation of ketorolac is in development as a self-administered alternative to injectable ketorolac and opioids for pain management. The pharmacokinetics of IN ketorolac are similar to those of ketorolac administered intramuscularly. The efficacy and tolerability of IN ketorolac were assessed in phase 2/3 clinical trials in 705 patients (men and women, ≥18 yr). Abdominal and orthopedic surgery models were used to assess IN ketorolac efficacy in managing moderate-to-severe acute pain. Patients received IN ketorolac (31.5 mg) (n=455) or placebo (n=250) 3 or 4 times a day for up to 5 days. Statistically significantly greater reductions in the summed pain intensity difference over 48 hr occurred in patients receiving IN ketorolac compared to placebo (P<0.05). The most common adverse events in the IN ketorolac group were transient nasal discomfort (15% vs. 2% placebo) and rhinalgia (12% vs <1% placebo). Most patients received concurrent opioid analgesics for the first 48 hr. Morphine use (mg) was calculated by adding all PCA morphine and morphine equivalents (using American Pain Society guidelines for other analgesic medications). Patients in the IN ketorolac group used 34% less morphine over 48 hours after surgery compared to the placebo group (P<0.001). In the first 8 hr after surgery, patients receiving IN ketorolac undergoing orthopedic surgery had greater decreases in opioid use relative to placebo than did abdominal surgery patients. Reductions in opioid use were similar when stratified by age and sex. Efficacy in this clinical model indicates that IN ketorolac provides a noninjection parenteral option for management of acute moderate-to-severe pain that may be particularly useful for ambulatory patients, particularly where avoidance of, or reductions in, opioid use are desirable. (Supported by ROXRO PHARMA).

The addition of metamizole to morphine and paracetamol improves early postoperative analgesia and patient satisfaction after lumbar disc surgery

Combined analgesic regimens produce sufficient analgesia by additive or synergistic effects, and reduce the total dose of analgesics and minimise adverse effects. We investigated the metamizole, paracetamol and morphine combination with respect to postoperative pain treatment in lumbar disc surgery. After Ethics Committee approval and informed consent, 63 patients were allocated to three treatment groups; as Group paracetamol: paracetamol (1 g), Group paracetamol-metamizole: paracetamol (1 g) and metamizole (1 g), and Group placebo: no analgesic. All the patients received intravenous (i.v.) morphine with a patient-controlled analgesia device (PCA) as the rescue analgesic. Pain was assessed by the numerical pain rating scale (NRS, 0-3). Total morphine consumption at 24 hours, patient satisfaction and side effects were investigated. NRS of Group paracetamol-metamizole was low at 15th min, 30th min and 1st hour, and the difference reached statistical significance at 30th min (p=0.033). Patient satisfaction at the same measurement times was high in this group. Total morphine consumption and side effects were not statistically different between the three groups. Addition of metamizole to paracetamol along with iv morphine PCA offers an advantage over single iv morphine PCA and paracetamol, with respect to early postoperative pain treatment and patient satisfaction.

Patient-controlled analgesia in orthognathic surgery: evaluation of the relationship to anxiety and anxiolytics

Although patient-controlled analgesia' (PCA) use has been reported in oral and maxillofacial surgery,(8) it has not been evaluated for use in orthognathic surgery. In this study, we evaluated the relationship between age, gender, and preoperative anxiety and postoperative morphine intake after orthognathic surgery in the PCA environment. Fifty-one patients (34 female, 17 male) underwent orthognathic surgery. Patients' anxiety was evaluated preoperatively. All patients received morphine-based postoperative PCA. Relationship between preoperative anxiety and postoperative visual analog scale (VAS) and 24 hour morphine intake was evaluated. Patients were randomly grouped according to whether preoperative oral anxiolytics were prescribed. Age and VAS were correlated, as well as preoperative anxiety score and postoperative morphine intake (P < .05). Female patients receiving anxiolytics before surgery had less morphine consumption than those who did not. Preoperative anxiety directly influences postoperative PCA morphine intake. Anxiolytics preoperatively seem to reduce the need for postoperative analgesics.

Adding Gabapentin to a multimodal regimen does not reduce acute pain, opioid consumption or chronic pain after total hip arthroplasty

Gabapentin (GPN) is effective in reducing post-operative pain and opioid consumption, but its effects with regional anesthesia for total hip arthroplasty (THA) are not known. We designed this study to determine whether (1) gabapentin administration reduces pain and opioid use after THA using a multimodal analgesic regimen including spinal anesthesia; (2) pre-operative administration of gabapentin is more effective than post-operative administration. After REB approval and informed consent, 126 patients were enrolled in a double-blinded, randomized-controlled study. Patients received acetaminophen 1 g per os (p.o.), celecoxib 400 mg p.o. and dexamethasone 8 mg intravenously, 1-2 h pre-operatively. Patients were randomly assigned to one of three treatment groups (G1: Placebo/Placebo; G2: GPN/Placebo; G3: Placebo/GPN). Patients received gabapentin 600 mg (G2) or placebo (G1 and G3) 2 h before surgery. All patients had spinal anesthesia [15 mg (3cc) of 0.5% hypobaric bupivacaine with 10 microg of fentanyl]. In the post-anesthetic care unit, patients received gabapentin 600 mg (G3) or placebo (G1 and G2). On the ward, patients received acetaminophen 1000 mg p.o. q6h, celecoxib 200 mg p.o. q12h and a morphine PCA device. Patients were interviewed 6 months post-surgery to determine the incidence and severity of chronic post-surgical pain. Mean+/-SD cumulative morphine (mg) consumption (G1=49.4+/-24.8, G2=47.2+/-30.1 and G3=56.1+/-38.2) at 48 h and pain scores at 12, 24, 36 and 48 h post-surgery were not significantly different among the groups [G1 (n=38), G2 (n=38) and G3 (n=38)]. Side effect profiles were similar across groups. Six months after surgery, the number of patients who reported chronic post-surgical pain (G1=10, G2=12 and G3=9) and the severity of the pain (G1=4.2+/-2.9, G2=4.1+/-2.2 and G3=4.9+/-2.2) did not differ significantly among the groups (P>0.05). A single 600 mg dose of gabapentin given pre-operatively or post-operatively does not reduce morphine consumption or pain scores in hospital or at 6 months after hip arthroplasty within the context of spinal anesthesia and a robust multimodal analgesia regimen.

Efficacy and safety of morphine-6-glucuronide (M6G) for postoperative pain relief: A randomized, double-blind study

Aims The aim of the study was to assess analgesia and safety effects of a range of intravenous doses of M6G (10, 20 and 30 mg/70 kg), compared to placebo, in postoperative patients. Methods In a randomized, multicentre, double-blind study, patients undergoing knee replacement surgery under spinal anaesthesia were administered one of three doses of M6G, or placebo, 150 min after spinal nerve block. Morphine rescue medication was available via a PCA pump. The key index of analgesic activity was determined as the amount of morphine consumed by the patient over 12 and 24 h after M6G administration. Time to first use of rescue medication, VAS and global pain assessment scales were also recorded. Safety was assessed by monitoring supine blood pressure, heart rate, respiratory rate and body temperature and typical opioid side-effects of PONV and sedation. Results A total of 170 patients were dosed with study medication. M6G induced a dose-related reduction in morphine use over 24-h that reached statistical significance compared to placebo at M6G 30 mg/70 kg. There was no clear relationship between M6G dose and time to first use of PCA morphine. Pain relief was similar in all groups. M6G showed small, but inconsistent effects on the cardiovascular system and on sedation and no effects were observed on respiration or PONV. Conclusion M6G induced long-lasting dose-related analgesic effects in postoperative patients with limited effects on cardiorespiratory systems or of opioid-like side-effects. M6G is an effective opioid for the treatment of moderate to severe postoperative pain.

IONSYS™ versus morphine PCA: Analysis of the current literature using a Bayesian approach

Summary Background The IONSYS™ device, providing transdermal fentanyl, has been found as non-inferior to intravenous morphine PCA in four non-inferiority studies; the accepted loss of efficacy had to be lower than a 10% decrease of therapeutic success. Bayesian analysis allows to compute likelihoods pertaining to any chosen difference in therapeutic rate of success, and is not limited to conclusions based on arbitrary thresholds. Methods We try to show the superiority of intravenous morphine PCA, using the data of the four comparative studies. We have subjected the four studies to a Bayesian analysis, with respect to the common primary outcome reported in the four studies, in a sequence that parallels their dates of publication. In a first analysis we used an uninformative prior, and in a second analysis a moderately sceptical prior. Results With an uninformative prior probability, there is a 75% probability that some (>0%) increased rate of success exists with morphine PCA. With a moderately sceptical prior the probability is still around 69%. The probability of a relative risk reduction of treatment failure >10% of difference, is 14.8% with an initial uninformative prior and 3.7% with a sceptical prior. The probability of a relative risk reduction >20% is virtually non-existent. Conclusions Although, some decrease in the rate of therapeutic success can be expected, the fentanyl transdermal system seems a viable substitute to intravenous morphine PCA, as a large difference in the rate of therapeutic success is unlikely.

Comparison of remifentanil PCA effect site TCI versus morphine PCA for treatment of acute pain after uterine artery embolization

Comparison of remifentanil PCA effect site TCI versus morphine PCA for treatment of acute pain after uterine artery embolization

Correlates of Postoperative Pain and Intravenous Patient-Controlled Analgesia Use in Younger and Older Surgical Patients

Age-related patterns in postoperative pain are unclear with reports of no age differences and less pain with age. The objective of this study was to identify correlates of pain and intravenous patient-controlled analgesia (i.v. PCA) morphine use in younger and older patients. 24 hours after surgery, patients completed measures of pain intensity and pain qualities. Surgical factors, i.v. PCA morphine intake, anticholinergic load, polypharmacy, physical status, previous chronic and postoperative pain, and PCA experience were measured. Two academic general hospitals. PATIENTS. Two hundred forty-six general surgery patients ranging in age from 18 to 82 years old. In older patients, higher pain scores were associated with female gender and previous experience of postoperative PCA. In younger patients, higher pain scores were associated with female gender, previous surgery without PCA, and greater morphine intake. Lower pain was associated with being male, and no previous surgical experience in older patients, and lower morphine intake in younger patients. Morphine intake was higher in patients who were younger, had better physical status, higher anticholinergic load, and experience with PCA. Among younger patients, increased morphine use also was associated with surgical procedure and duration. Higher pain scores were more strongly associated with morphine use among younger than older patients. The correlates of postoperative pain and morphine use may differ with age, and the same factor may have different effects across age groups. Research is needed into the mechanisms of these age-specific profiles.

Effect of Parecoxib on Postoperative Pain After Lumbar Spine Surgery

A bicenter randomized, patients, healthcare providers, and data collectors blind placebo-controlled trial in multimodal analgesia for postoperative lumbar spine surgery was conducted. To assess the efficacy and safety of parecoxib on postoperative pain management after posterior lumbar spine surgery. Systematic reviews suggest that cyclo-oxygenase-2 inhibitors are an effective treatment for acute postoperative pain. However, previous trials on lumbar spine surgery showed equivocal efficacy of cyclo-oxygenase-2 inhibitors for postoperative pain relief. In this study, 120 patients undergoing posterior lumbar discectomy, spinal decompression, or spinal fusion were stratified based on the surgical procedure to 3 groups (n = 40) and randomly allocated to receive multidoses of parecoxib 40 mg/dose or placebo. Efficacy was assessed by total morphine used from patient-controlled analgesic pump, pain intensity, pain relief, and the patient's subjective rating of the medication. Parecoxib 40 mg reduced the total amount of morphine required over 48 hours by 39% relative morphine reduction compared with placebo (P = 0.0001). Pain at rest was reduced by 30% (P = 0.0001). Ninety percent of patients given parecoxib experienced at least 50% maximum total pain relief compared with 58% treated with placebo. The number-needed-to-treat for 1 patient to have at least half pain relief was 3.1 (2.0-4.6). Patients' subjective rating of the medication was described as "excellent, good, and fair" by 48%, 43%, and 8% in the parecoxib group, respectively, compared with 21%, 50%, and 28% of placebo patients (P = 0.004). Overall adverse effects of patients receiving parecoxib and morphine were comparable to those receiving morphine alone. The present study demonstrates that the perioperative administration of parecoxib with patient-controlled analgesic morphine after lumber spine surgery resulted in significantly improved postoperative analgesic management as defined by reduction in opioid requirement, lower pain scores, and higher patients' subjective rating of the medication.

Do patients after off-pump coronary artery bypass grafting need the intensive care unit? A prospective audit of 85 patients

With limited resources, cardiac surgery is frequently cancelled due to lack of ICU beds. Immediate postoperative extubation (UFT) is performed in our hospital setting. The aim of the present study is to report patients undergoing off-pump aortocoronary bypass grafting (OPCABG) with immediate extubation and no ICU stay. Eighty-five patients undergoing OPCABG were included. UFT analgesia consisted of high thoracic epidural analgesia (n=65), or PCA morphine (n=20). Discharge criteria from PACU to cardiac ward were: alert, cooperative patient, respiratory rate <25/min, PaO(2)>80 mmHg and PaCO(2)<45 mmHg, temperature >36 degrees C, hemodynamic stability, no bleeding, no ischemia, and sufficient analgesia. More males (71/14) were included. Mean age was 63.4 years, NYHA class III, ejection fraction 59.4. Three grafts were performed in 119 min. Patients were extubated 12+/-2 min after closure. After 428 min in PACU, four patients did not meet ward criteria; three bradycardia requiring pacing, one elevated CK-MB. Two patients returned to the ICU, one for hypertension, and one for hypovolemia. Cardiac complications were: atrial fibrillation (29%), MI=2, bradycardia=3. During the same period, 304 OR-extubated patients spent 21+/-6 h in the ICU. The cost from leaving the OR until the patient reached the cardiac ward was 1265$ for ICU bypass patients vs. 6405$ for ICU patients, the difference representing 5140$ per patient. ICU bypass after OPCABG is safe. By avoiding ICU, this protocol reduces costs, improves resource utilization and may reduce OR cancellation due to ICU bed shortages.

Antiemetic effect of ondansetron 0.2 mg mL−1 in PCA morphine solution

To study the effect of 0.2 mg mL-1 of ondansetron added to morphine patient-controlled analgesia solution after a 4 mg loading dose on the incidence and severity of postoperative nausea and vomiting. One hundred and sixty patients scheduled for elective surgery, between 18 and 65 yr old, were studied. Patients who smoked, received antiemetics and hormonal therapy, had a history of motion sickness or gastrointestinal disease, a body mass index >35 or menstruation at the time of the study were excluded. Patients were assigned to the ondansetron and control groups by block randomization. At the end of anaesthesia, all patients received 4 mg of ondansetron intravenously and the same patient-controlled analgesia regimen of morphine. The ondansetron group (n = 80) received 0.2 mg of ondansetron per 1 mg of morphine. The nausea score, vomiting score and the requested ondansetron dose were evaluated at 1, 2, 6, 12 and 24 h. Patient-satisfaction for nausea/vomiting was recorded at the end of the study. Patient characteristics and cumulative morphine consumption were similar but ondansetron group had higher pain scores (P = 0.006). The ondansetron group had a lower nausea and vomiting scores, and more patients were free from nausea and vomiting than the control group (41 vs. 26, respectively, P = 0.025). The ondansetron group had fewer cumulative ondansetron doses than the control group and better patient satisfaction than the control group (P < 0.05). Ondansetron 4 mg plus 0.2 mg mL-1 given with PCA morphine can reduce nausea and vomiting thus improving patient satisfaction.

Évaluation de l'analgésie postopératoire par bloc continu iliofascial après chirurgie pour remplacement de prothèse totale de hanche : étude pilote

Objective To assess the analgesic efficiency of a continuous iliofascial nerve sheath block after total hip arthroplasty replacement (RPTH). Study design open and prospective pilot study. Patients and methods Before induction of general anaesthesia (GA), an iliofascial catheter was inserted (group KT, n = 11) or not (group NKT, n = 10). In the KT group, 30 ml of ropivacaïne 4,75 mg/ml (maximum dose) were injected, and 14 mg/h of ropivacaïne 2 mg/ml were infused during the first 48 postoperative hours. All patients underwent a standardized GA and a multimodal postoperative analgesia with a intravenous PCA morphine, paracetamol and tramadol during the first 48 hours. Postoperative pain assessment which was achieved using visual analogic scores (VAS) at rest (EVAr) and on movement (EVAm), total morphine consumption, and side effects were collected during the first 48 hours. Statistical analysis was performed using a Mann and Whitney test for the quantitative values and a chi 2 exact test for the qualitative values. Data are expressed as median [interquartile range]. Results Total morphine consumption was lower in the KT group with a total amount of 26 mg [11–48] versus 77.5 mg [55–91] ( p = 0.007) at h48. EVAr and EVAm were lower in the KT group at h4, h8, h24, h36 for the EVAr and during the 48 postoperative hours for EVAm. Three patients experienced nausea and/or vomiting in the KT group versus 6 in the NKT group ( p = 0.05). Conclusion After RPTH surgery, continuous iliofascial block reduces morphine consumption; provide a better pain relief at rest and on movement than IV multimodal analgesia alone.