Oral Morphine Equivalent Consumption Research Articles

Analgesia after Cesarean delivery: a retrospective comparison of intrathecal hydromorphone and morphine

Study ObjectiveTo compare analgesia and opioid-related side effects of intrathecal morphine and intrathecal hydromorphone after elective Cesarean delivery. DesignRetrospective, comparative study. SettingLabor and delivery unit of an academic hospital. Patients114 parturients age ≥ 18 years, presenting for elective Cesarean delivery. InterventionsPatients who received 0.04 mg intrathecal hydromorphone were compared to a random sample of patients who received 0.1 mg intrathecal morphine for postoperative analgesia. MeasurementsThe primary outcome was the presence of any opioid-related complication (pruritus, nausea or vomiting, respiratory depression) requiring treatment within 24 hours of intrathecal opioid administration. Secondary outcomes included total opioid consumption (in oral morphine equivalents) within 24 hours of intrathecal opioid administration and verbal pain score (0 = none, 10 = worst) at 4, 8, 12, 18, and 24 hours after intrathecal opioid administration. Main Results38 patients who received intrathecal hydromorphone 0.04 mg were compared with 76 patients given 0.1 mg of intrathecal morphine for elective Cesarean delivery. No significant differences in demographics were noted between groups. There were no statistically significant differences between the intrathecal hydromorphone and intrathecal morphine groups in overall frequency of opioid-related complications (50% vs 34.2%; P = 0.11), 24-hour opioid consumption (33 mg oral morphine equivalent [OME] vs 8 mg OME; P = 0.27), or pain scores at any time point up to 24 hours. ConclusionsOverall, analgesia and incidence of opioid-related side effects after 0.04 mg of intrathecal hydromorphone did not differ statistically from 0.1 mg of intrathecal morphine.

The role of integrated treatments for patients with cancer with bone metastases: The quarterback study.

e19655 Background: Palliative radiotherapy has been shown to improve quality of life in some patients affected by advanced incurable cancers, being also able to reduce major skeletal events and prolonge overall survivall. The integration of radiotherapy and palliative care, such as bisphosphonates and opioid drugs, may lead to further clinical benefit. Our study aimed at evaluating the pain relief score on day 3 and 14 in cancer patients with bone metastases, with particular emphasis to backbone localization. Methods: Sixty patients were evaluated, M/F ratio 22/38, median age 68 years (range 40-78), median ECOG PS 3. The metastases involved bone (100% of cases), backbone (50%), liver (33.3%), lung (30%), lymph nodes (30%), brain (10%), peritoneum (10%), and pleura (3.33%). The primary tumor was breast (40% of cases), lung (NSCLC 23.3%; SCLC 3.33%), prostate (10%), unknown primitive origin (6.72%), colon (6.66%), sarcoma (3.33%), ovary (3.33%), non-Hodgkin’s lymphoma (3.33%). Radiotherapy was administered in 5 fractions with total dose of 20 Gy. The patients were treated with opioids (70%) and bisphosphonates too. Results: The median pain intensity measured by Numerical Rating Scale (NRS) was 6 (range 3-9) before the treatment start. The median Oral Morphine Equivalent Doses consumption was 80 mg (range 30-240). The integrated treatment tested in the study led to quick and considerable pain relief. In fact, the median NRS pain intensity was 4 (± 1.5) on day 3 and 2 (± 1) on day 14. Conclusions: The present data confirm the high prevalence of breast, lung and prostate cancer in patients with bone metastases and support the synergistic use of radiotherapy and palliative care in order to improve the quality of life in our setting of patients.

Intraoperative Ketamine and Chronic Opioid Use: Less Pain, More Morphine?

Christchurch Hospital, Christchurch, New Zealand. richard.seigne@cdhb.govt.nzThe recent paper by Loftus et al. ,1“Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery,” was of interest to me because I occasionally use the technique described. This group of patients is very complex and I congratulate the authors for undertaking this study.There are four points that warrant clarification. First, the primary outcome of the study was based on data derived from a review of medical records (i.e. , mean [SD] 48-h postoperative oral morphine equivalent consumption of 500 [300] mg). However, the placebo group consumed only 309 (341) mg of this substance. Can the authors comment on this large difference and its possible relevance?Second, the term “morphine equivalents” requires further explication. This terminology was confusing because it was applied to oral and intravenous formulations. Which formulation was used was not always immediately clear. For example, in their table 1,1were “median preoperative morphine equivalents” delivered orally or intravenously? The text implies that these equivalents are intravenous morphine. If this supposition is correct, then it appears to me that both groups of patients may be consuming more morphine equivalents at 6-week follow-up (data presented as mean [SD]) than they did preoperatively (data presented as median [interquartile range]). In fact, the placebo group appears to have much higher rates of morphine consumption at 6 weeks compared with their own preoperative consumption levels and the treatment group's consumption at 6-week follow-up. There is a possibility that the treatment group's 6-week follow-up consumption has also increased from the preoperative period, which is concerning. Can the authors clarify and comment on these points?Third, the treatment group had more spinal levels operated on than did the control group. In fact, this difference reached statistical significance. However, this feature of the study was not addressed by the authors. Do the authors believe this difference was clinically significant?Finally, with regard to these observations, specifically with respect to possible increases in morphine consumption among both groups at 6-week follow-up and the chronic nature of back pain, I believe that a more extended follow-up period is warranted. Do the authors plan to do this?Christchurch Hospital, Christchurch, New Zealand. richard.seigne@cdhb.govt.nz

Use of antibiotics and chemotherapeutics in surgery

Enhanced recovery pathways aim to reduce postoperative opioid use and opioid-related complications. These pathways often include epidural analgesia (EA). This study examines postoperative opioid use after elective laparotomy with and without EA.Retrospective chart review of elective laparotomies performed by General Surgery at a tertiary academic center during 2017 was completed. Primary outcome was postoperative opioid usage. Secondary outcomes were time to mobilization, duration of urinary catheterization and postoperative ileus.Among 236 patients, 213 (90%) received EA. There was no significant difference in mean total oral morphine equivalent (OME) usage between EA and non-EA groups. Mean OME use on postoperative day three was higher in the EA group (38.0 vs 22.4 mg, p = 0.02). On multivariate analysis, preoperative opioid use was associated with increased postoperative OME consumption (regression coefficient 147.5, p < 0.001).In this cohort, epidural analgesia did not reduce postoperative opioid consumption.