Hydromorphone patient-controlled analgesia (PCA) after coronary artery bypass surgery

Searle, Norman R.; Roy, Micheline; Bergeron, Georges; Perrault, Jean; Roof, Jeanne; Heermans, Corrie; Courtemanche, Micheline; Derners, Christine; Cartier, Raymond

doi:10.1007/bf03009831

Cited by 48 publications

(23 citation statements)

References 23 publications

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“…In another study of PCA with morphine and hydromorphone, doses and analgesia were similar [85]. A double-blind, randomized, controlled trial of 72 patients showed that PCA with hydromorphone achieves slightly better postoperative pain relief, and minimal side-effects and sedation in cardiac surgery compared with conventional analgesic therapy [96].…”

Section: Painmentioning

confidence: 97%

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Hydromorphone: pharmacology and clinical applications in cancer patients

Sarhill

Walsh

Nelson

2001

Support Care Cancer

145

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Hydromorphone is a more potent opioid analgesic than morphine and is used for moderate to severe pain. It can be administered by injection, by infusion, by mouth, and rectally. Oral bioavailability is low. The kidney excretes hydromorphone and its metabolites. Some metabolites may have greater analgesic activity than hydromorphone itself but are unlikely to contribute to the pharmacological activity of hydromorphone. With the exception of pruritus, sedation and nausea and vomiting, which may occur less after hydromorphone than after morphine, the side-effects of these drugs are similar. On a milligram basis hydromorphone is five times as potent as morphine when given by the oral route, and 8.5 times as potent as morphine when given intravenously.

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Section: Painmentioning

confidence: 97%

“…Drowsiness and cognitive dysfunction are reported side-effects of all opioids [7,47,69,87,96]. They occur in up to 23% of patients treated with i.v.…”

Section: Sedationmentioning

confidence: 99%

Hydromorphone: pharmacology and clinical applications in cancer patients

Sarhill

Walsh

Nelson

2001

Support Care Cancer

145

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“…Opioids have been used in intravenous, patient-controlled analgesia after coronary bypass surgery (15), subcutaneous infusion (13,16) and oral administration (17) in patients suffering from severe pain due to malignant disease. In patients with unacceptable side effects of morphine, such as hyperalgesia and myoclonus (3), hydromorphone may be a beneficial alternative.…”

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confidence: 99%

Analgesic and Nonanalgesic Effects of Intravenous Hydromorphone ‐ Relation to Plasma Concentrations in Healthy Volunteers

Westerling¹,

Björk²,

Svedman³

et al. 1996

Pain Research and Management

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Analgesic and nonanalgesic effects ofintravenous hydromorphone -Relation to plasma concentrations in healthy volunteers. Pain Res Manage 1996;1(2):86-92.OBJECTIVE: To investigate the analgesic and nonanalgesic effects and the pharmacokinetics of an intravenous infusion of 2 mg hydromorphone over 20 mins. DESIGN: Open study. SUBJECTS: Twelve healthy volunteers. MEASUREMENTS: The analgesic effect of hydromorphone was evaluated serially using pressure pain thresholds (PPTs) measured on the third fingers and toes. The nonanalgesic effects of hydromorphone were measured as miosis, decrease of saliva production and central nervous effects such as euphoria/dysphoria, nausea, headache, fatigue and feeling of heaviness. Plasma concentration of hydromorphone was measured using high performance liquid chromatography. RES UL TS: PPTs were significantly increased compared with baseline levels for up to 2 h after the infusion of hydromorphone. Significant miosis and reduction of saliva production were registered up to 6 h after drug administration. Fatigue and heaviness were reported by all subjects. In the studied opioid-naive subjects, the hydromorphone-induced analgesic effect was of shorter duration than the studied nonanalgesic effects. The terminal elimination half-life of hydromorphone was 1.87±0.4 h (± SD) (95% CI 1.61 to 2.13), systemic clearance was 1.81±0.25 L/min (95% CI 1.65 to 1.97) and volume of distribution was 4.15±0.86 L/kg (95% CI 3.6 to 4.71). CONCLUSION: Analgesia and nonanalgesic effects appear to be well correlated with the plasma concentrations of the hydromorphone. MESURES : L' effet analgesique de l 'hydromorphone a ete evalue en series en utilisant les seuils de la douleur a la pression mesures sur le majeur et le gros orteil. Les effets non analgesiques de l 'hydromorphone ont ete mesures en tant que myosis, diminution de la production de salive et effets du systeme nerveux central tels I' euphorie ou la dysphorie, la nausee, les cephalees, la fatigue et la sensation de lourdeur. La concentration plasmatique d'hydromorphone a ete mesuree par chromatographie haute performance. RESULT A TS : Les seuils de la douleur a la pression augmentaient considerablement comparativement aux valeurs de base jusqu'a deux heures apres la perfusion d 'hydromorphone. Un myosis important ainsi qu'une diminution de la production de salive ont ete enregistres jusqu'a 6 h apres !'administration du medicament. La fatigue et la sensation de lourdeur ont ete rapportees par tous les sujets. Dans le groupe etudie de sujets naifs a l'opio"ide, l'effet analgesique induit par l'hydromorphone persistait moins longtemps que les effets non analgesiques etudies. La demi-vie d'elimination finale de l'hydromorphone etait de 1,87±0,4 h (±ecart-type) (IC 95 % 1,61-2,13), la clairance systemique etait de 1,81 ±0,25 L/minute (IC 95 % 1,65-1,97) et le volume de distribution de 4,15±0,86 L/kg (IC 95 % 3,71). CONCLUSION: L'analgesie et les effets non analgesiques semblent correler avec les concentrations plasmatiques de l'hydromorphone.

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“…9) In previous researches, it had been shown that patients in PCA group after CABG procedures had more rapidly decreasing VAS scores than those in conventional analgesia group. 15) The authors had also advocated that VAS scores were lower in the former group at the time of extubation and on 3rd postoperative day, and thus lower incidences of myocardial ischemia were found. 15) In the present study, continuous infusion and PCA administration methods were used on patients that have undergone sternotomy in widely accepted dosing regimens.…”

Section: Discussionmentioning

confidence: 99%

“…15) The authors had also advocated that VAS scores were lower in the former group at the time of extubation and on 3rd postoperative day, and thus lower incidences of myocardial ischemia were found. 15) In the present study, continuous infusion and PCA administration methods were used on patients that have undergone sternotomy in widely accepted dosing regimens. In addition to continuous infusion, approximately 12 times of bolus doses of the analgesics had to be used in all 4 groups except the meperidine group.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Effects of Opioid Analgesics Administered via Continuous Perfusion and Patient Controlled Analgesia after Open Heart Surgery

Öztekin

İşsever

et al. 2006

YAKUGAKU ZASSHI

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Critical care nurses and physicians are familiar with the principles of patient controlled analgesia and the opioid analgesics' regimens and observations necessary for pain control in the postoperative cardiac surgical patients. The objective of the study was to compare the eŠects of morphine, fentanyl, meperidine, remifentanil and tramadol which were administered by patient controlled analgesia and continuous intravenous infusion combination on the various parameters. This study was designed as prospective randomised trial. Fifty patients undergone open heart surgery with sternotomy were entered equally intoˆve randomized groups. Visual analog scale was used by researcher nurse to assess the patient' pain status. Respiratory rate, heart rate and blood gases (pO 2 , pCO 2 , SaO 2 ), radial arterial blood pressures were measured in theˆrst 24 hrs postoperatively. Bolus requirements were determined by physicians and side eŠects of the analgesics were documented. Fentanyl group showed statistically higher levels of mean pO 2 ( p＝0.002). Meperidine had the lowest number of bolus doses ( p＝0.001). There were no signiˆcant diŠerences between the groups for pain management except higher visual analog scales on tramadol. Headache, stomachache and, palpitations were observed in our patients. Remifentanil, meperidine, fentanyl and morphine showed similar eŠect with each other for pain relief except tramadol.

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Hydromorphone patient-controlled analgesia (PCA) after coronary artery bypass surgery

Cited by 48 publications

References 23 publications

Hydromorphone: pharmacology and clinical applications in cancer patients

Hydromorphone: pharmacology and clinical applications in cancer patients

Analgesic and Nonanalgesic Effects of Intravenous Hydromorphone ‐ Relation to Plasma Concentrations in Healthy Volunteers

Postoperative Effects of Opioid Analgesics Administered via Continuous Perfusion and Patient Controlled Analgesia after Open Heart Surgery

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