A double-blind randomised trial comparing postoperative analgesia after perioperative loading doses of methadone or morphine.

This double-blind randomised study compared postoperative analgesia after a loading regimen of methadone or morphine in thirty women undergoing abdominal hysterectomy. Methadone or morphine, 0.25 mg.kg-1, was given intravenously at induction of anaesthesia with further increments in the recovery room for analgesia if required. The mean (SD) total doses of methadone and morphine required were 0.43 (0.13) mg.kg-1 and 0.45 (0.15) mg.kg-1 respectively. Patients in the methadone group had lower pain scores in the subsequent 48 hours (P less than 0.001) and required less supplementary intramuscular opioids (P less than 0.001). Ten patients in the methadone group did not request any further opioid analgesics while all patients in the morphine group made at least two requests for opioids. The overall postoperative course was remembered as less painful by patients in the methadone group (P less than 0.001). There was no significant respiratory depression or excessive sedation in either group.     

A double-blind comparison of codeine and morphine for postoperative analgesia following intracranial surgery

Codeine and morphine were compared in a double-blind study of postoperative analgesia in 40 patients after intracranial neurosurgery. Eighteen patients received codeine phosphate 60 mg and 18 morphine sulphate 10 mg, both by intramuscular injection; 4 patients (10%) required no analgesia. Both drugs provided analgesia within 20 min of injection but morphine was more effective than codeine beyond 60 min (p = 0.01). Fewer doses of morphine than codeine were required (p = 0.003). Nine patients requested one dose of morphine and 9 two doses. Seven patients required three doses of codeine and 1 patient required four doses. Neither drug caused respiratory depression, sedation, pupillary constriction or unwanted cardiovascular effects. We conclude that, in the doses used, morphine is a safe alternative to codeine for analgesia after neurosurgery and has a more persistent action.     

Peridural morphine for postoperative analgesia in patients following Milligan-Morgan surgery

Postoperative analgesia and side effects of epidural morphine (3 mg in 5 ml saline) were studied in 30 patients scheduled for Milligan-Morgan surgery. The patients were pain-free for a mean duration of 10-12 hr. Urinary retention was the most prominent side effect observed.     

A randomised controlled trial of intravenous versus inhalational analgesia during outpatient oocyte recovery

To compare the efficacy and acceptability of conventional intravenous sedation with patient-controlled inhalational isodesox, 57 women undergoing outpatient oocyte recovery were randomly allocated to receive isodesox by face mask, while 55 women were given intravenous fentanyl and midazolam. Women's satisfaction with pain relief, peroperative pain, clouding of memory and the surgeons' assessment of operating conditions were evaluated. Thirty-eight women in the inhalation group (67%) and 41 (75%) women in the intravenous group were 'very satisfied' with their analgesia (p = 0. 41). The mean (SD) pain score in women given isodesox was 46.8 (34. 7), while in the intravenous group it was 34.1 (21.3) (p = 0.02). Oxygen saturation levels < 94% were recorded in one woman using isodesox and in 16 (29%) women given intravenous analgesia. Despite higher pain scores, in comparison with the conventional analgesia, patient-controlled isodesox offers a safer method of pain relief with comparable satisfaction rates.     

Efficacy of an intravenous bolus of morphine 2.5 versus morphine 7.5 mg for procedural pain relief in postoperative cardiothoracic patients in the intensive care unit: a randomised double-blind controlled trial

As pain in the intensive care unit (ICU) is still common despite important progress in pain management, we studied the efficacy of an intravenous bolus of morphine 2.5 vs 7.5 mg for procedural pain relief in patients after cardiothoracic surgery in the ICU. In a prospective double-blind randomised study, 117 ICU patients after cardiothoracic surgery were included. All patients were treated according a pain titration protocol for pain at rest, consisting of continuous morphine infusions and paracetamol, applied during the entire ICU stay. On the first postoperative day, patients were randomised to intravenous morphine 2.5 (n=59) or 7.5 mg (n=58) 30 minutes before a painful intervention (turning of patient and/or chest drain removal). Pain scores using the numeric rating scale (Numeric Rating Scale, range 0 to 10) were rated at rest (baseline) and around the painful procedure. At rest (baseline), overall incidence of unacceptable pain (Numeric Rating Scale ≥4) was low (Numeric Rating Scale >4; 14 vs 17%, P=0.81) for patients allocated to morphine 2.5 and 7.5 mg respectively. For procedure-related pain, there was no difference in incidence of unacceptable pain (28 vs 22%, P=0.53) mean pain scores (2.6 [95% confidence interval 2.0 to 3.2] vs 2.7 [95% confidence interval 2.0 to 3.4]) between patients receiving morphine 2.5 and 7.5 mg respectively. In intensive care patients after cardiothoracic surgery with low pain levels for pain at rest, there was no difference in efficacy between intravenous morphine 2.5 mg or morphine 7.5 mg for pain relief during a painful intervention.     

Enhanced postoperative recovery pathways in emergency surgery: a randomised controlled clinical trial

Background

Enhanced recovery pathways are now widely used in elective surgical procedures. The feasibility of enhanced postoperative recovery pathways in emergency surgery for perforated peptic ulcer disease was investigated in this randomized controlled clinical trial.

Methods

Patients with perforated peptic ulcer disease who underwent laparoscopic repair were randomized into 2 groups. Group 1 patients were managed with standard postoperative care and group 2 patients with enhanced postoperative recovery pathways. The primary endpoints were the length of hospital stay and morbidity and mortality.

Results

Forty-seven patients were included in the study. There were 26 patients in group 1 and 21 in group 2. There were no significant differences in the morbidity and mortality rates, whereas the length of hospital stay was significantly shorter in group 2.

Conclusions

The application of enhanced postoperative recovery pathways in selected patients with perforated peptic ulcer disease who undergo laparoscopic Graham patch repair seems feasible.     

Double-blind randomized placebo-controlled trial of the effect of ketamine on postoperative morphine consumption in children following appendicectomy

BACKGROUND: Ketamine has an opioid sparing effect following surgery in adults. This study investigated whether a similar effect is seen following appendicectomy in paediatric patients. METHODS: Seventy-five ASA 1 or 2 children aged 7-16 years were recruited, and randomly allocated to one of three groups. Following a standard anaesthetic for appendicectomy, all were prescribed patient controlled analgesia (PCA) morphine with paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDS) as required for postoperative analgesia. In addition the control group received a saline infusion postoperatively, the ketamine bolus group received 500 micro g.kg-1 intravenous (i.v.) ketamine preincision and a saline infusion postoperatively, and the ketamine infusion group received 500 micro g.kg-1 i.v. ketamine preincision and a ketamine infusion at 4 micro g.kg-1 min-1 postoperatively. Morphine consumption, rescue analgesia requirement and side-effects were recorded postoperatively. RESULTS: There was no difference in morphine consumption between the groups. The ketamine infusion group required more doses of rescue analgesia and reported more side-effects than the control group. Five patients, all in the ketamine infusion group, reported hallucinations. CONCLUSIONS: In this paediatric population intravenous ketamine did not have a morphine sparing effect. The increased incidence of side-effects, especially hallucinations, reported by patients given a ketamine infusion may limit the further use of postoperative ketamine in children.     

The use of orbital morphine for postoperative analgesia in pterygium surgery

A prospective double-blind study compared the analgesic effectiveness of peribulbar lignocaine with peribulbar morphine and lignocaine for postoperative analgesia in pterygium surgery. Twenty patients were randomly divided to receive a peribulbar injection preoperatively of either 1% lignocaine 2 ml or 1% lignocaine 1.6 ml and 4 mg morphine. Effects on pain at injection and pain at 24 hours and 48 hours postoperatively were measured with a visual analog pain scale. Effects of the injections on sedation, pupil size and unwanted side-effects were also recorded. The groups were comparable for age, weight and surgical technique. There was a significantly lower pain score at 24 hours after operation in the morphine group (P = 0.035). There were no significant differences in sedation or side-effects between the groups. The physiological effects of morphine on the eye are reviewed. The study suggests that orbital morphine may be an effective and safe form of analgesia for corneal surgery and further investigation is warranted.     

糖尿病患者术后吗啡镇痛的效果

目的 评价糖尿病患者术后吗啡镇痛的效果.方法 下腹部手术患者20例及非糖尿病患者20例,ASA Ⅰ或Ⅱ级,分为糖尿病组和非糖尿病组,术后所有患者均采用静脉吗啡自控镇痛,记录两组患者的吗啡累积消耗量、镇痛评分、血糖水平和吗啡相关的不良反应.结果 术后4、8、24、48 h糖尿病组吗啡累积消耗量显著高于非糖尿病组(P＜0.05),术后4、8、24 h VAS评分糖尿病组亦显著高于非糖尿病组(P＜0.05),术后糖尿病组恶心发生率显著高于非糖尿病组(P＜0.05).结论 糖尿病患者术后吗啡镇痛的敏感性降低,有效的术后镇痛需要增加吗啡剂量.     

氯胺酮与吗啡超前镇痛对内脏牵拉痛及术后镇痛的影响

目的探讨氯胺酮与吗啡复合液硬膜外超前镇痛对抑制手术内脏牵拉痛的影响及术后镇痛情况的影响。方法60例ASAⅠ~Ⅱ级择期全子宫切除术患者,均于硬膜外麻醉下行全子宫切除术。随机分为两组,每组30例,即Ⅰ组(对照组):术前不施行超前镇痛;Ⅱ组(实验组):切皮前10 min将氯胺酮30 mg与吗啡2 mg用生理盐水稀释成5 ml注入硬膜外腔。所有患者术后均行自控硬膜外镇痛(PCEA)。镇痛药物为0.15%罗哌卡因+5 mg吗啡,共100 ml。观察两组患者术中牵拉反应、术后镇痛情况及并发症。结果Ⅱ组用药对抑制术中牵拉痛的效果明显优于Ⅰ组(P<0.01);Ⅱ组PCEA泵首次触发时间较Ⅰ组显著延长(P<0.01),48 h内有效触发次数显著减少(P<0.01),24 h PCEA泵总用量明显减少(P<0.05),术后并发症无明显差异。结论氯胺酮与吗啡硬膜外超前镇痛能明显抑制术中牵拉痛,提供良好的术后镇痛效果,减少阿片类药物的用量。     

Impact of the pericapsular nerve group (PENG) block on postoperative analgesia and functional recovery following total hip arthroplasty: a randomised,observer-masked,controlled trial

The pericapsular nerve group (PENG) block is a novel regional anaesthesia technique that aims to provide hip analgesia with preservation of motor function, although evidence is currently lacking. In this single-centre, observer-masked, randomised controlled trial, patients undergoing total hip arthroplasty received pericapsular nerve group block or no block (control group). Primary outcome measure was maximum pain scores (0–10 numeric rating scale) measured in the first 48 h after surgery. Secondary outcomes included postoperative opioid consumption; patient mobilisation assessments; and length of hospital stay. Sixty patients were randomly allocated equally between groups. The maximum pain score of patients receiving the pericapsular nerve group block was significantly lower than in the control group at all time-points, with a median (IQR [range]) of 2.5 (2.0–3.7 [0–7]) vs. 5.5 (5.0–7.0 [2–8]) at 12 h; 3 (2.0–4.0 [0–7]) vs. 6 (5.0–6.0 [2–8]) at 24 h; and 2.0 (2.0–4.0 [0–5]) vs. 3.0 (2.0–4.7 [0–6]) at 48 h; all p < 0.001. Moreover, the pericapsular nerve group showed a significant reduction in opioid consumption, better range of hip motion and shorter time to ambulation. Although no significant difference in hospital length of stay was detected, our results suggest improved postoperative functional recovery following total hip arthroplasty in patients who received pericapsular nerve group block.     

A double-blind comparison of morphine infusion and patient controlled analgesia in children

The analgesia provided after major abdominal surgery in 30 children by continuous morphine infusion and patient controlled analgesia, also using morphine, was compared using a double-blind, double-dummy design. The groups of children were comparable in age, weight, duration of operation and sex ratio. Pain assessment was carried out by a single observer using a visual analogue scale and the Poker Chip Tool. Assessments took place during two four-hour periods, one on the day of operation and one the following day. Children aged between nine and 15 years achieved better pain relief with patient controlled analgesia. No difference could be shown in children aged between five and eight years.     

Safety of mixture of morphine with ketamine for postoperative patient-controlled analgesia: an audit with 1026 patients

BACKGROUND: Adding ketamine to morphine for patient-controlled analgesia (PCA) may be useful. However, data on this drug combination have been collected on small sample sizes. In order to evaluate the safety of the combination morphine- ketamine, we conducted a prospective study on a large patient population. METHODS: Patient-controlled analgesia was performed with 1026 patients using morphine and ketamine in a dose ratio of 1:1. All patients were treated in the ward. Prospectively collected data included incidence of complications and side-effects, verbal pain scores at rest and during mobilization (0 = no pain to 4 = very strong pain), consumption of morphine and ketamine and patient satisfaction (0 = very un-satisfied to 3 = very satisfied). RESULTS: The study included 462 women and 564 men who underwent, on average, 71.8 h (+/-56.1) of PCA. There were 698 orthopaedic, 160 abdominal, 96 thoracic, 20 vascular, 16 plastic, 15 neurosurgical, 11 urologic and 10 other surgical procedures. No complication was observed. Incidence of side-effects was: 1.2% respiratory depression, 23.5% nausea, 6.2% vivid dreams and/or hallucinations, 21.4% sedation and 10.3% pruritus. Reasons for discontinuing the PCA were side-effects (7.0%) and other (0.5%). Mean pain scores over the whole period were 0.44 (+/-0.54) at rest and 1.36 (+/-0.62) during mobilization. Mean satisfaction score was 2.52 (+/-0.69). CONCLUSION: Patient-controlled analgesia with morphine and ketamine is safe. It produces side-effects which, however, are infrequently a reason for discontinuing the regimen. It is also associated with low pain scores and high patient satisfaction.     

Improved recovery after music and therapeutic suggestions during general anaesthesia: a double-blind randomised controlled trial

PURPOSE: This study was designed to determine whether music or music in combination with therapeutic suggestions in the intra-operative period under general anaesthesia could improve the recovery of hysterectomy patients. METHODS: In a double-blind randomised clinical investigation, 90 patients who underwent hysterectomy under general anaesthesia were intra-operatively exposed to music, music in combination with therapeutic suggestion or operation room sounds. The anaesthesia was standardised. Postoperative analgesia was provided by a patient-controlled analgesia (PCA). The pain scores were recorded by means of a visual analogue scale. Nausea, emesis, bowel function, fatigue, well-being and duration of hospital stay were studied as outcome variables. RESULTS: On the day of surgery, patients exposed to music in combination with therapeutic suggestions required less rescue analgesic compared with the controls. Patients in the music group experienced more effective analgesia the first day after surgery and could be mobilised earlier after the operation. At discharge from the hospital patients in the music and music combined with therapeutic suggestion group were less fatigued compared to the controls. No differences were noted in nausea, emesis, bowel function, well-being or length of hospital stay between the groups. CONCLUSION: This double-blind study has demonstrated that intra-operative music and music in combination with therapeutic suggestions may have some beneficial effects on postoperative recovery after hysterectomy. Further controlled studies are necessary to confirm our results.     

The effect of intrathecal bupivacaine/morphine on quality of recovery in robot-assisted radical prostatectomy: a randomised controlled trial

Robot-assisted radical prostatectomy causes discomfort in the immediate postoperative period. This randomised controlled trial investigated if intrathecal bupivacaine/morphine, in addition to general anaesthesia, could be beneficial for the postoperative quality of recovery. One hundred and fifty-five patients were randomly allocated to an intervention group that received intrathecal 12.5 mg bupivacaine/300 μg morphine (20% dose reduction in patients > 75 years) or a control group receiving a subcutaneous sham injection and an intravenous loading dose of 0.1 mg.kg⁻¹ morphine. Both groups received standardised general anaesthesia and the same postoperative analgesic regimen. The primary outcome was a decrease in the Quality of Recovery-15 (QoR-15) questionnaire score on postoperative day 1. The intervention group (n = 76) had less reduction in QoR-15 on postoperative day 1; median (IQR [range]) 10% (1–8 [−60% to 50%]) vs. 13% (5–24 [−6% to 50%]), p = 0.019, and used less morphine during the admission; 2 mg (1–7 [0–41 mg]) vs. 15 mg (12–20 [8–61 mg]), p < 0.001. Furthermore, they perceived lower pain scores during exertion; numeric rating scale (NRS) 3 (1–6 [0–9]) vs. 5 (3–7 [0–9]), p = 0.001; less bladder spasms (NRS 1 (0–2 [0–10]) vs. 2 (0–5 [0–10]), p = 0.001 and less sedation; NRS 2 (0–3 [0–10]) vs. 3 (2–6 [0–10]), p = 0.005. Moreover, the intervention group used less rescue medication. Pruritus was more severe in the intervention group; NRS 4 (1–7 [0–10]) vs. 0 (0–1 [0–10]), p = 0.000. We conclude that despite a modest increase in the incidence of pruritus, multimodal pain management with intrathecal bupivacaine/morphine remains a viable option for robot-assisted radical prostatectomy.     

静脉低剂量氯胺酮超前镇痛对腹腔镜胆囊切除术后苏醒和疼痛的影响

目的 观察氯胺酮切皮前给药对腹腔镜胆囊切除术(LC)后苏醒和疼痛的影响.方法 全麻下行LC患者80例,随机均分为两组:对照组采用雷米芬太尼复合丙泊酚麻醉;研究组在切皮前加用小剂量氯胺酮0.3 mg/kg.采用SS和VRS评分评估对苏醒时间和苏醒期躁动情况.结果 两组呼吸恢复时间、睁眼时间、拔管时间差异无统计学意义.研究组苏醒期躁动、镇痛、镇静效果显著优于对照组(P<0.05).结论 静脉低剂量氯胺酮超前镇痛用于LC术后苏醒快,术后疼痛轻,苏醒期躁动少.     

The elective use of oxytocin infusion during labour in nulliparous women using epidural analgesia: a randomised double-blind placebo-controlled trial

The obstetric outcome following the elective use of oxytocin infusion was determined in a randomised, double-blind placebo-controlled trial. 93 nulliparous women in a London hospital, who had requested epidural analgesia in labour (相似文献   

Plasma catecholamine levels following continuous epidural infusion of morphine for postoperative analgesia in surgical patients

Plasma catecholamine levels were measured to evaluate postoperative pain relief either with epidural morphine or systemic analgesics in sixteen patients who underwent gastrectomy. Eight patients (epidural morphine group) obtained postoperative analgesia with continuous epidural morphine with a pump (CADD-PCA, Model 5200P, Pharmacia). A bolus of morphine was administered through an indwelling thoracic (Th8 X 9) epidural catheter 3 hrs prior to the proposed end of the surgery, which was followed with continuous epidural infusion of morphine at a rate of 0.167-0.042mg.hr-1 by the pump during and after anesthesia and surgery with gradual decrease in dose until the third postoperative day. The remaining eight patients (systemic analgesics group) received repeatedly intravenous or intramuscular pentazocine and buprenorphine when needed. Plasma epinephrine levels increased significantly at the end of surgery in both groups, and were higher in the systemic analgesics group than those in the epidural morphine group. In the epidural morphine group, the catecholamine levels decreased to the previous day's levels on the first postoperative day and afterward, but remained high during three postoperative days in the systemic analgesics group. Plasma norepinephrine levels increased significantly at the end of surgery and afterward in both groups. However, they were significantly higher in the systemic analgesics group than in the epidural morphine group. Plasma dopamine levels were unchanged in the epidural morphine group during the surgical procedures, but they increased significantly on the first postoperative day and thereafter in the systemic analgesics group. Our study suggests that continuous epidural infusion of morphine is adequate for postoperative pain relief and exerts a suppressing effect on plasma catecholamine levels as compared with systemic analgesics regimen.