Extradural Diamorphine for Postoperative Analgesia: Audit of a Nurse-Administered Service to 800 Patients in a District General Hospital

Abstract

We report the use of extradural diamorphine for postoperative analgesia as a nurse-based service on selected surgical wards in a district general hospital. Eight hundred patients received lumbar or thoracic extradural diamorphine analgesia for postoperative or traumatic pain. Diamorphine was administered in bolus form by suitably trained nursing staff. Satisfactory analgesia, recorded on a verbal rating scale at the conclusion of the service, was achieved in 94.6% of patients. The technique was considered by medical and nursing staff to be a safe and acceptable method of analgesia. Respiratory depression, defined as a ventilatory frequency of less than 10 b.p.m., occurred in seven patients (incidence of 0.9%). All occurred in the theatre recovery area or in the intensive care unit. Retrospectively, each was predictable and all responded to naloxone 0.4 mg.

A comparative study of patient-controlled epidural diamorphine, subcutaneous diamorphine and an epidural diamorphine/bupivacaine combination for postoperative pain

“…The reason for this disparity between the epidural groups is not clear as the mean diamorphine consumption was similar in the two epidural groups. The incidence of nausea and vomiting was higher than that of previous reports where diamorphine was used [16].…”

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

“…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.…”

“…First reports on extradural morphine were published more than 15 years ago [46]. Meanwhile, many studies accumulated and reported on some controversial results.…”

“…It was proposed that epidural morphine is a favourable method for relieving postoperative pain after bone surgery of the extremities and chest [2,7,9,13,28,33,36,37,50,51]. On the other hand, some authors stated that extradural opioids cannot be given safely unless the patient is monitored on an intensive care unit [10,22,29,32,41,43,46,52]. However, not very much is known about the benefits and risks of intra-operatively given single doses of epidural morphine in spinal surgery.…”