A comparison of morphine, pethidine and fentanyl in the postsurgical patient-controlled analgesia environment

Abstract

This study was designed to evaluate whether there is any scientific basis for clinicians' preferences for selecting opioids for use in patient-controlled analgesia (PCA) and to determine whether there are any patients' preferences for being treated with any of these opioids. Results were obtained for 55 postoperative patients recruited to investigate putatively equivalent doses of 3 commonly used opioids--morphine, pethidine and fentanyl--when self-administered postoperatively. No significant differences in the incidence of side effects between groups were found with the exception of more pruritus reported in the group given morphine. Patients who experienced vomiting or pruritus reported a greater intensity of these side effects if receiving morphine and fentanyl than if receiving pethidine. The majority of patients reported being very satisfied with their postoperative pain management and with PCA, with no differences in satisfaction between the 3 opioid-treated groups. A senior consultant anaesthetist, when asked to make a judgement, was not able to identify which agent each patient was receiving with a better than chance accuracy. These findings suggest that while there may be subtle differences in patient response to these 3 commonly used opioids, none was obviously superior when used for postoperative PCA.

Nausea and vomiting in the postoperative patient‐controlled analgesia environment

“…Lerman [2] and Watcha & White [3] suggest that the incidence of postoperative nausea and vomiting has remained fairly constant for decades with Ϸ20-30% of patients suffering from these unpleasant side-effects. However, it is common to find reports of a much higher incidence in a variety of surgical populations [4][5][6][7][8][9][10]. Differentiation of opioidinduced nausea and vomiting from that of other perioperative factors, including those associated with uncontrolled pain [11], is difficult enough without complications introduced by patient-controlled analgesia (PCA) which allows patients to medicate on irregular and inconsistent bases.…”

“…His findings suggested that there were few differences in the incidence of nausea and emesis reported between most agents, with the exceptions of nalbuphine, nefopam and pethidine [29]. While Lehmann [29] found only 8% of patients experienced nausea and only 5% reported emesis while receiving pethidine, others have found a much higher incidence of postoperative nausea and vomiting associated with this opioid [30,10]. A study conducted at the authors' institution found no notable differences in the incidence of nausea and vomiting of patients receiving morphine, pethidine or fentanyl for postoperative pain, with Ϸ 60% of patients experiencing nausea and 40% reporting vomiting.…”

A randomized clinical study comparing the analgesic efficacy of intra venous patient- controlled analgesia of morphine with fentanyl in post-operative pain management of major surgery patients

“…In another study by Woodhouse et al, [14] the mean VAS was similar in both groups, but total drug consumed by fentanyl group was significantly more (143 ± 86 mg) than morphine group (82 ± 50 mg). In our study, it also has shown similar results by 72 h.…”

“…In a study by Claxton et al, [14,15] they found that nausea was more in morphine group than in fentanyl group. In another study by Niiyama et al, [9] they observed that there was no significant difference in the incident of nausea between the groups.…”

Drug Choices for Intravenous and Spinal Analgesia

“…The effective dose range of some full agonists is limited by side effects (e.g., pethidine and its metabolite, norpethidine, is a convulsant). Most studies on the use of different opioids administered by patient-controlled alagesia (PCA) suggest that there is little to choose between opioids [2,3].…”