A Comparison of Regularly Administered Sustained Release Oral Morphine with Intramuscular Morphine for Control of Postoperative Pain

“…Morphine, a narcotic analgesic, is used frequently and administered intravenously, 1) epidurally, 2) subarachnoidally, 3) subcutaneously, 4) and intramuscularly. 5) Continuous intravenous injection of morphine by patient-controlled analgesia (PCA) is often used in many countries and rated favorably. 6) Morphine is used to obtain a favorable analgesic eŠect for any dosing method, but it may increase the incidence of Postoperative nausea and vomiting (PONV) or make food intake di‹cult, which leads to the discontinuance of its administration.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Effective Drugs for the Prevention of Nausea and Vomiting Induced by Morphine Used for Postoperative Pain: A Quantitative Systematic Review

et al. 2001

View full text Add to dashboard Cite

Postoperative nausea and vomiting (PONV) with morphine therapy develops in more than 60％ of patients after surgery, markedly reducing patient QOL. The prophylactic eŠect of several antiemetics has already been studied, but evaluations, and even those using the same drug, are not uniform. The present research involved a meta-analysis of randomized controlled trials on prophylactic drug therapy for PONV in patients receiving morphine for the treatment of postoperative pain. The e‹cacy of the prophylactic administration of the drugs was examined.As a result, meta-analysis ofˆve drugs was possible and the evidence of e‹cacy was shown for three drugs ranked in order of an increasing odds ratio (OR) and conˆdence interval (CI): dexamethasone (OR: 0.23, 95％ CI: 0.15-0.35, p＜ 0.00001), droperidol (OR: 0.27, 95％ CI: 0.21-0.34, p＜0.00001), and metoclopramide (OR: 0.48, 95％ CI: 0.30-0.75, p＜0.001). These results suggest that the three drugs are eŠective in prophylactic treatment for PONV. Of them, dexamethasone used as a prophylactic drug for PONV provided the best results. Dexamethasone was shown to reduce the incidence of PONV from 66-80％ to 16-50％ with a dose of 1.25 to 10 mg and to be suitable as aˆrst drug of choice.

show abstract

“…8 The most common of these ORADEs include gastrointestinal (GI) effects such as constipation, ileus, nausea, and vomiting; central nervous system effects including sedation, euphoria, and delirium; pruritus; urinary retention; and more serious adverse effects such as respiratory depression. [8][9][10] Several patient clinical and demographic characteristics have been demonstrated to play a role in increased ORADE risk. Perioperative and intraoperative treatment factors associated with ADE incidence include specific procedure type, longer duration of surgery, use of volatile intraoperative anesthetics, general versus regional anesthesia, and postoperative opioid dose and route of administration.…”

mentioning

confidence: 99%

Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

Minkowitz¹,

Scranton

Gruschkus

et al. 2014

JMCP

View full text Add to dashboard Cite

BACKGROUND: Opioid-related adverse drug events (ORADEs) are common causes of hospitalization and increased health care costs. OBJECTIVES: To (a) estimate rates of specific adverse drug events (ADEs) among gastrointestinal (GI) surgery patients receiving postoperative opioids; (b) examine the utility of a risk-scoring model in categorizing patients at high risk of experiencing ORADEs; and (c) quantify potential clinical/economic benefits of targeting high-risk GI surgical patients for opioid-sparing regimens in terms of hospitalization cost, length of stay (LOS), and 30-day readmission rates. METHODS: Using a retrospective design based on an administrative database, patients with an inpatient surgical procedure between January 1, 2010, and December 31, 2010, were included. GI surgical patients aged > 18 years followed from admission through 30 days postdischarge were characterized as high or low risk using clinical/demographic characteristics and were evaluated for several outcomes. Using multivariate logistic regression, the ORADE incidence, total hospitalization cost, LOS, and 30-day readmissions were compared for high-risk and low-risk patients. RESULTS: In 87.8% (n = 3,235) of the surgical population, there was a strong concordance between risk assignment and ORADE incidence. Among the remaining 12.2% (n = 449) of patients, 5.5% (n = 202) were low risk with an ORADE, and 6.7% (n = 247) were high risk without an ORADE. Overall, 20.6% (n = 344) of high-risk patients experienced ≥ 1 ORADE (mean cost: $31,988; LOS: 12.1 days) compared with only 5.3% (n = 107) of lowrisk patients (mean cost: $25,216; LOS: 8.0 days). High-risk patients had higher hospitalization costs and longer LOS than low-risk patients, respectively (mean cost: $19,234 vs. $13,036; mean LOS: 6.8 days vs. 3.3 days). These differences correspond to 47.0% higher costs for high-risk patients and an LOS approximately twice as long compared with low-risk patients. CONCLUSIONS: Patient clinical/demographic characteristics influence the risk of developing ORADEs. Risk assessment tools can effectively identify high-risk patients, thereby enabling interventions that can reduce ORADEs, decrease hospital costs, and improve postsurgical experiences for patients.

show abstract

A Comparison of Regularly Administered Sustained Release Oral Morphine with Intramuscular Morphine for Control of Postoperative Pain

Cited by 18 publications

References 9 publications

Orthopaedic Postoperative Pain Management

Orthopaedic Postoperative Pain Management

Evaluation of the Effective Drugs for the Prevention of Nausea and Vomiting Induced by Morphine Used for Postoperative Pain: A Quantitative Systematic Review

Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

Contact Info

Product

Resources

About