Epidural morphine prophylaxis of postoperative pain: report of a double-blind multicentre study

Writer, W. D. R.; Hurtig, J. B.; Edelist, Gerald; Evans, David P.; Fox, Gordon S.; Needs, R. E.; Hope, Charles E.; Forrest, James B.

doi:10.1007/bf03011336

Cited by 41 publications

(10 citation statements)

References 33 publications

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“…Respiratory depression is the complication which has the greatest risk, its frequency being proportional to the dose administered. In the study by Writer et al in 1985, respiratory depression was observed in 7% of patients who received 5 mg of morphine by the epidural route, which imposes prolonged monitoring of ventilation up to 24 hours after the injection [31]. Some hospitals cannot provide such surveillance, and so the use of this technique is limited.…”

Section: Discussionmentioning

confidence: 99%

Analgesic Efficacy of Pfannenstiel Incision Infiltration with Ropivacaine 7.5 mg/mL for Caesarean Section

Nguyen

Landais

Barbaryan

et al. 2010

Anesthesiology Research and Practice

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Background. Pain after Caesarean delivery is partly related to Pfannenstiel incision, which can be infiltrated with local anaesthetic solutions. Methods. A double- blind randomized control trial was designed to assess the analgesic efficacy of 7.5 mg/mL ropivacaine solution compared to control group, in two groups of one hundred and forty four parturients for each group, who underwent Caesarean section under spinal anaesthesia: group R (ropivacaine group) and group C (control group). All parturients also received spinal sufentanil (2.5 μg). Results. Ropivacaine infiltration in the Pfannenstiel incision for Caesarean delivery before wound closure leads to a reduction of 30% in the overall consumption of analgesics (348 550 mg for group R versus 504 426 mg for group C with P < .05), especially opioids in the first 24 hours, but also significantly increases the time interval until the first request for an analgesic (4 h 20 min ± 2 h 26 for group R versus 2 h 42 ± 1 h 30 for group C). The P values for the two groups were: P < .0001 for paracetamol, P < .0001 for ketoprofen and P for nalbuphine which was the most significant. There is no significant difference in the threshold of VAS in the two series. Conclusion. This technique can contribute towards a programme of early rehabilitation in sectioned mothers, with earlier discharge from the post-labour suite.

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Section: Discussionmentioning

confidence: 99%

Analgesic Efficacy of Pfannenstiel Incision Infiltration with Ropivacaine 7.5 mg/mL for Caesarean Section

Nguyen

Landais

Barbaryan

et al. 2010

Anesthesiology Research and Practice

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show abstract

“…In two large retrospective surveys and one prospective study of epidural opioid treatment, the frequency of respiratory depression was 0.09–0.9% (2, 34, 35), and elderly patients are especially prone to respiratory depression (36). In a double blind multicentre study the incidence was as high as 2–7% (37), which also may reflect differences in epidural opioid dosage. Rarely, the incidence of respiratory depression is reported for parenteral opioid treatment, but it is important to remember when considering dosage and optimal choice of postoperative pain relief.…”

Section: Discussionmentioning

confidence: 99%

Pain relief and safety after major surgery A prospective study of epidural and intravenous analgesia in 2696 patients

Flisberg

Rudin

Linnér

et al. 2003

Acta Anaesthesiol Scand

105

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Pain relief and safety after major surgery A prospective study of epidural and intravenous analgesia in 2696 patients. Link to publication Citation for published version (APA): Flisberg, P., Rudin, Å., Linnér, R., & Lundberg, C. J. F. (2003). Pain relief and safety after major surgery A prospective study of epidural and intravenous analgesia in 2696 patients. Acta Anaesthesiologica Scandinavica, 47(4), 457-465. DOI: 10.1034457-465. DOI: 10. /j.1399457-465. DOI: 10. -6576.2003 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Background: Adverse effects may still limit the use of continuous epidural and intravenous analgesia in surgical wards. This study postulated that postoperative epidural analgesia was more efficient, and had fewer side-effects than intravenous morphine. The aim was to investigate efficacy, adverse effects and safety of the treatments in a large patient population. Methods: During a five-year period 2696 patients undergoing major surgery, received either epidural or intravenous analgesia for postoperative pain relief. The patients were prospectively monitored in surgical wards. Pain was evaluated with a numeric rating scale (0Ð10) at rest/mobilization. Treatment duration, respiratory depression, sedation/hallucinations/ nightmares/confusion, nausea/vomiting, pruritus, orthostatism/ leg weakness, and insufficient pain relief were registered. Pain relief for all patients aimed at a pain scoring of less than 4 at rest. Results: Epidural analgesia was used in 1670 patients, and intravenous morphine in 1026 patients. Patients with epidural analgesia experienced less pain both at rest and during mobilization. Insufficient treatment effects such as dose adjustments, orthostatism/leg weakness, and pruritus were more common in the epidural group. Respiratory depression and sedation/hallucinations/nightmares/confusion occurred more often in the intravenous group. Thoracic epidural catheters caused a lower incidence of motor blockade compared to lumbar catheter placements. Conclusion:In a large patient population the use of epidural and intravenous postoperative analgesia was considered safe in surgical wards, and the incidence of adverse effects was low.Patients with epidural analgesia experienced overall less pain, while opioid related side-effects were more common with intravenous morphine analgesia.

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“…Despite higher doses necessary to achieve adequate analgesia, epidural application of morphine carries a lower risk of respiratory depression as compared to intrathecal injection [35,44,53,54]. However, the amount of opioid injected epidurally has to be great enough to be pharmacologically effective, since the resorption rate is variable [3].…”

Section: Discussionmentioning

confidence: 98%

“…The level of drug concentration in the infusion is higher than the plasma level, thus allowing selective analgesia and avoiding major complications due to systemic drug actions [46,53]. However, placement of epidural catheters in neurosurgical patients with disc herniation is not recommended due to discogenic radicular compression and risk of injury in the affected spinal segment.…”

Section: Discussionmentioning

confidence: 98%

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Intra-operative epidural morphine, fentanyl, and droperidol for control of pain after spinal surgery A prospective, randomized, placebo-controlled, and double-blind trial

1996

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The present study was conducted to investigate the analgesic effects of intra-operatively administered epidural morphine in patients undergoing surgery for lumbar disc disease. Three treatment groups were constituted: one with 5.0 mg morphine and 2.5 mg dehydrobenzperidol (DHB) in 10 ml physiological saline, one with 5.0 mg morphine and 0.1 mg fentanyl in the same amount of saline, and one placebo group with saline only. The test solution was injected epidurally via catheter after haemostasis and before closure of the wound. Sixty eight patients were randomly assigned to each of the three groups and subjected to a double-blind evaluation. In the morphine/fentanyl and morphine/droperidol groups, significantly better analgesia was found as compared to the placebo group. No significant difference was found between the morphine/fentanyl and morphine/droperidol groups considering side effects of therapy, as well as duration and quality of analgesia. The side effects in the treatment groups were only slight and not significantly different from the placebo group. It was shown that additional epidural fentanyl offers no significant improvement of postoperative analgesia. No significant reduction of adverse effects could be found in the morphine/droperidol group compared to the morphine/fentanyl group. In conclusion, the intra-operative epidural application of morphine is a safe, effective and simple method for achieving sufficient analgesia in the first 24 hours after lumbar spinal surgery for disc disease.

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Epidural morphine prophylaxis of postoperative pain: report of a double-blind multicentre study

Cited by 41 publications

References 33 publications

Analgesic Efficacy of Pfannenstiel Incision Infiltration with Ropivacaine 7.5 mg/mL for Caesarean Section

Analgesic Efficacy of Pfannenstiel Incision Infiltration with Ropivacaine 7.5 mg/mL for Caesarean Section

Pain relief and safety after major surgery A prospective study of epidural and intravenous analgesia in 2696 patients

Intra-operative epidural morphine, fentanyl, and droperidol for control of pain after spinal surgery A prospective, randomized, placebo-controlled, and double-blind trial

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