A Prospective Randomized Trial Comparing Epidural Morphine Through Intraoperatively Placed Epidural Catheter and Intravenous Morphine in Major Lumbar Spinal Surgery

Prasartritha, Thavat; Kunakornsawat, Sombat; Tungsiripat, Rachata; Jampa, Jaruat; Throngnumchai, Roongnapa

doi:10.1097/bsd.0b013e3181cd3048

Cited by 15 publications

(24 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Surgical trauma can activate peripheral and visceral nociceptors ( 8 ) to induce central pain sensory nerve sensitization and peripheral sensory nerve conduction enhancement ( 9 ), leading to a decreased threshold for those receptors and an over-threshold response enhancement, which is called hyperalgesia ( 10 ). At the same time, tissue damage caused by surgical trauma can further lead to the generation and aggregation of inflammatory mediators and pain-related factors, further aggravating pain ( 11 ). In this study, the subjects were elderly lower limb fracture patients who received open reduction and internal fixation.…”

Section: Discussionmentioning

confidence: 99%

Nalbuphine for analgesia after fracture surgery and its effect on circulating inflammatory factors

2017

View full text Add to dashboard Cite

The present study evaluated the use of nalbuphine for analgesia after fraction reduction surgery. Eighty lower limb fracture patients needing open reduction and internal fixation were selected in the First People's Hospital of Jingzhou from January 2015 to December 2015. Patients were randomly divided into observation and control groups (with 40 cases in each). After surgery, the patients in the observation group were treated with nalbuphine (2 mg/kg) for patient-controlled intravenous analgesia (PCIA), while sufentanil (2.5 µg/kg) was used for patients in the control group. The analgesia treatment lasted for 48 h after surgery. Changes in inflammatory factors and catecholamine hormones during the observation period were determined and compared between the groups. Pain, sedation scores and the number of times the analgesia pump was used were recorded at different time-points. Additionally, the life and sleep qualities and any adverse reactions were also recorded. Our results showed that after the operation, the levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), high-sensitivity CRP (hs-CRP) cortisol, adrenaline epinephrine (AD) and norepinephrine (NE) were significantly lower in the observation group than in the control group (P<0.05). Pain and sedation scores of patients in the observation group were better than those in the control group at all time-points after operation (P<0.05). Life and sleep qualities of patients in the observation group were also better than those in the control group (P<0.05). Finally, the rates of nausea, vomiting, dizziness, lethargy, urinary retention, skin itch and constipation were significantly lower in the observation group than in control group (P<0.05). Based on our findings, the application of nalbuphine for analgesia in patients with fracture surgeries can reduce the levels of inflammatory cytokines, improve the analgesic effect, bring beneficial sedative effects and reduce the occurrence of adverse reactions.

show abstract

Section: Discussionmentioning

confidence: 99%

Nalbuphine for analgesia after fracture surgery and its effect on circulating inflammatory factors

2017

View full text Add to dashboard Cite

show abstract

“…92 Pain. Among the trials that investigated combinations of epidural LA and opioids, only 3 studied effects on visual analog pain scores at discharge from PACU; of these, 2 reported reduced pain scores.…”

Section: Continuous Epidural Analgesiamentioning

confidence: 99%

“…85,93,95,96 At 48 hrs after surgery, similar results were obtained, with 4 trials reporting benefit of the regimen 90,93,94,97 and 4 others reporting no benefit. 85,92,95,96 Local anesthetic 87Y89 and opioids, 84,92 when used alone, decreased postoperative pain for 48 hrs.…”

Section: Continuous Epidural Analgesiamentioning

confidence: 99%

See 1 more Smart Citation

Beyond Opioid Patient-Controlled Analgesia

Sharma

Balireddy

Vorenkamp

et al. 2012

Regional Anesthesia and Pain Medicine

View full text Add to dashboard Cite

Postoperative pain control in patients undergoing spine surgery remains a challenge for the anesthesiologist. In addition to incisional pain, these patients experience pain arising from deeper tissues such as bones, ligaments, muscles, intervertebral disks, facet joints, and damaged nerve roots. The pain from these structures may be more severe and can lead to neural sensitization and release of mediators both peripherally and centrally. The problem is compounded by the fact that many of these patients are either opioid dependent or opioid tolerant, making them less responsive to the most commonly used therapy for postoperative pain (opioid-based intermittent or patient-controlled analgesia). The purpose of this review was to compare all published treatment options available that go beyond intravenous opiates and attempt to find the best possible treatment modality.

show abstract

“…Catheters have been placed at all moments during the procedure. In comparative studies with conventional treatment the epidural regimen (bolus, continuous infusion or PCEA) consisted mostly of the local anesthetics bupivacaine or ropivacaine 0.0625-0.3% with or without an opioid or an opioid alone [42][43][44][45][46][47][48][49][50]. Morphine is the most frequent selected opioid followed by fentanyl, sufentanil, hydomorphone, buprenorphine and tramadol.…”

Section: Epidural Analgesiamentioning

confidence: 99%

Regional Analgesia Techniques for Spine Surgery: A Review with Special Reference to Scoliosis Fusion

N-M¹,

Mb²,

Sermeus³

et al. 2015

J Spine

View full text Add to dashboard Cite

The use of regional analgesia techniques for postoperative analgesia in spine surgery is less frequently used in comparison with conventional oral and parenteral treatment. This may be explained by the fact that surgery is mostly performed under general anesthesia. Although objections of the surgeon are comprehensible, there is a growing number of studies using regional techniques for the treatment of pain after this surgery.When postoperative analgesia is the focus then regional techniques can be initiated at any time-point of the procedure while all ages and types of surgery, even extensive scoliosis fusion may benefit from it. The present overview will focus on the feasibility of (loco)regional techniques to be used for postoperative analgesia, medications used alone or in combination, as a single bolus or through persistent catheters and with special attention to pain relief following scoliosis repair.In general neuraxial techniques offer lower pain scores and/or less need for opioid rescue in comparison with systemic conventional analgesia although much less benefit may be noticed in patients operated for spinal fusion than for disc surgery, laminectomy and adolescent scoliosis correction. The actual literature provides little evidence with respect to the best timing of initiation, the best route nor the best dose in relationship to the type of surgery. Besides neuraxial techniques several alternatives have found their way in this type of intervention. As all techniques described offered variable success rates, future research is mandatory to determine their superiority over general anesthesia and conventional pain therapy modalities.

show abstract

A Prospective Randomized Trial Comparing Epidural Morphine Through Intraoperatively Placed Epidural Catheter and Intravenous Morphine in Major Lumbar Spinal Surgery

Abstract: Epidural infusion analgesia is safe and effective for posterior spinal surgery.

Cited by 15 publications

References 0 publications

Nalbuphine for analgesia after fracture surgery and its effect on circulating inflammatory factors

Nalbuphine for analgesia after fracture surgery and its effect on circulating inflammatory factors

Beyond Opioid Patient-Controlled Analgesia

Regional Analgesia Techniques for Spine Surgery: A Review with Special Reference to Scoliosis Fusion

Contact Info

Product

Resources

About