Morphine blood concentrations in elderly postoperative patients following administration via an indwelling subcutaneous cannula

Semple, T.J.; Upton, Richard N.; Macintyre, Pamela E.; Runciman, William B.; Mather, Laurence E.

doi:10.1111/j.1365-2044.1997.83-az0081.x

Cited by 23 publications

(6 citation statements)

References 10 publications

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Section: Discussionmentioning

confidence: 99%

“…The common perception that subcutaneous diamorphine is absorbed slowly and erratically may be attributed to early clinical experiences with military casualties and hypovolaemia (Semple et al 1997). Contemporary anaesthetic and recovery management results in patients being discharged from recovery with body temperature and¯uid balance within the normal range.…”

Section: Discussionmentioning

confidence: 99%

“…Advantages such as patient satisfaction with PCA compared to intramuscular opioids make this a popular method of analgesia delivery with patients (Gould et al 1992). Most studies evaluating the ef®cacy of PCA use the intravenous route yet the use of the subcutaneous route for patient controlled analgesia is not new (Urquhart et al 1989, Doyle et al 1994, Semple et al 1997 ). Disturbance of sleep due to pain has been a signi®cant ®nding from interviews with surgical patients (Closs 1988).…”

mentioning

confidence: 99%

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Improving patients’ postoperative sleep: a randomized control study comparing subcutaneous with intravenous patient‐controlled analgesia

Dawson

Brockbank

Carr

et al. 1999

Journal of Advanced Nursing

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One hundred female patients undergoing major reconstructive plastic or gynaecological surgery were randomized to either receive subcutaneous patient-controlled analgesia (PCA) (bolus dose 2.5 mg diamorphine in 1 ml with a 20-minute lockout) or intravenous PCA (bolus dose 0.5 mg diamorphine in 1 ml with a 5-minute lockout). Data were collected by questionnaire and interview to evaluate the intervention on pain scores, quality of sleep on the first postoperative night, postoperative nausea and vomiting (PONV) and overall patient acceptability. The subcutaneous PCA group experienced less 'worse pain' (P < 0.01) and less sleep disturbance due to pain (P < 0.001). Subcutaneous PCA would appear to offer patients a safe and effective means of analgesia and may offer significant advantages over the intravenous route of administration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Improving patients’ postoperative sleep: a randomized control study comparing subcutaneous with intravenous patient‐controlled analgesia

Dawson

Brockbank

Carr

et al. 1999

Journal of Advanced Nursing

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“…Gades et al (24) conducted a study in mice and stated that sc morphine showed peak analgesic effect within 2-3 hours and that dose interval was 2-3 hours. Semple et al (25) reported that peak serum morphine concentration was achieved in 16±7 minutes after subcutaneous administration. Administration of sc morphine provides earlier postoperative pain control as compared to intramuscular (im) administration; because morphine reaches to peak plasma concentration in 17.5-27.8 minutes after im administration (26,27).…”

Section: Discussionmentioning

confidence: 99%

Evaluation Of Multimodal Approach For Postoperative Pain At The patients Who Underwent Flank Incision In The Urology Operating Room

Deni̇z¹,

Erakgün²,

Sergi̇n³

et al. 2014

Turk J Anesth Reanim

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Objective: In this study, we evaluated subcutaneous (sc) morphine in combination with multimodal analgesia for postoperative pain control after radical nephrectomy and pyeloplasty with flank incision. Methods:Forty-nine patients under The American Society of Anesthesiologists Physical Status classification (ASA) I-III aged 18-85 years undergoing radical nephrectomy and pyeloplasty with flank incision were included in this prospective, randomised study. The patients were divided into two groups (Group O [n=25] and Group M [n=24]) and received standard general anaesthesia. Tramadol (100 mg) and paracetamol (100 mg) were given intravenously before fascia closure and 20 mL of 0.25% levobupivacaine was injected locally at surgical incisions in all patients. Patients in Group M also received 0.1 mg kg -1 morphine subcutaneously. Patient-controlled analgesia (PCA) with tramadol was used for postoperative pain control in both groups. Postoperative pain scores (VAS), vital parameters, side effects, the need for rescue analgesia during 24 hours postoperatively, and patient satisfaction were recorded.Results: Groups were comparable with respect to demographic data, ASA status, and duration of surgery. There were no significant differences between the groups in postoperative PCA tramadol consumption, rescue analgesia, side effects, or vital parameters. Postoperative pain scores (VAS) in Group M were significantly lower at 30, 45, 60, and 120 minutes compared to Group O (p<0.05). Conclusion:In patients undergoing radical nephrectomy and pyeloplasty with flank incision, subcutaneous morphine in combination with multimodal analgesia decreases early postoperative pain scores compared to multimodal analgesia alone.Key Words: Subcutaneous, morphine, postoperative pain, flank incision Abstract O (n=24). Anaesthesia induction in the patients that did not undergo premedication was performed with intravenous (iv) 0.5 mg atropine, iv 2 mg kg -1 propofol, iv 1 µg kg -1 remifentanil for 30-60 seconds (sec) and iv 0.6 mg kg -1 rocuronium, and maintenance was provided by O 2 , air, and sevoflurane and iv infusion of 0.25 µg kg -1 min -1 remifentanil. Before the closure of fascia after the procedure, sc 0.1 mg kg -1 morphine was administered through the deltoid muscle in the patients in Group M. No additional procedure was performed in the patients in Group O. Then, during the closure of the fascia at the end of surgery, 100 mg tramadol and 1 g/100 mL paracetamol was administered in all patients by slow infusion (not shorter than 20 min.). During skin closure, incision line was infiltrated by 20 mL of 0.25% levobupivacaine. Decurarization was provided by iv 0.5 mg atropine and iv 1.0 mg neostigmine. Postoperative pain was controlled in all patients by patient-controlled analgesia (PCA) (tramadol PCA; 4 amp tramadol 100 mg/100 mL in 0.9% NaCl, bolus 20 mg, lock time 15 min., 4-hour limit: 200 mg). In the postoperative period, iv 1 g/100 mL paracetamol was administered by slow infusion (not shorter than 20 min) within the first 24 hours rep...

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“…To the contrary, it is a popular route of administration for the management of chronic conditions, such as cancer pain [46].…”

Section: Subcutaneousmentioning

confidence: 99%

Highlights in postoperative pain treatment

Leykin¹,

Pellis²,

Ambrosio³

2007

Expert Review of Neurotherapeutics

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Acute pain is a symptom that originates from actual ongoing or impending tissue damage. Pain is an individual subjective experience and varies markedly among individuals. For this reason, patient involvement is essential, with the most reliable indicator of severity being patient self-report. The main objective of postoperative pain management is the achievement of fast rehabilitation, recovery of all normal functions and reduction of postoperative morbidity. Sufficient evidence supports the hypothesis that effective analgesia modifies many of the adverse sequelae that accompany acute pain and assists in recovery. Nevertheless, despite the availability of drugs and techniques for its effective management, postoperative pain remains undertreated. It is now accepted that the solution to the problem of inadequate pain relief lies not only in the development of new analgesic drugs or technologies but also in the development of an appropriate organization to utilize existing expertise. Methods used to control postoperative pain are numerous; this review focuses on pharmacological and anesthetic methods.

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Morphine blood concentrations in elderly postoperative patients following administration via an indwelling subcutaneous cannula

Cited by 23 publications

References 10 publications

Improving patients’ postoperative sleep: a randomized control study comparing subcutaneous with intravenous patient‐controlled analgesia

Improving patients’ postoperative sleep: a randomized control study comparing subcutaneous with intravenous patient‐controlled analgesia

Evaluation Of Multimodal Approach For Postoperative Pain At The patients Who Underwent Flank Incision In The Urology Operating Room

Highlights in postoperative pain treatment

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