Optimal Dose Combination of Epidural Morphine and Fentanyl for Postoperative Analgesia

Tanaka, Michiko; Watanabe, S.; Naito, Hiroshi

doi:10.1097/00000542-199209001-00831

Cited by 7 publications

(5 citation statements)

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“…Our doses in the MOF group were similar to the doses used by Tanaka et al [47]. However, no significant improvement of analgesia in the early postoperative period (30 min) was seen in the morphine/fentanyl group.…”

Section: Previous Clinical Studies With Epidural Opioidssupporting

confidence: 77%

“…This method is very simple and safe, with the only disadvantage of variable absorption rate from the epidural space. Since lipophilic opioids cross the dura more rapidly than non-lipophilic, one of our test groups received 0,1 mg phentanyl with the expectation that early postoperative analgesia would be more effective [3,12,20,30,47,49].…”

Section: Discussionmentioning

confidence: 99%

“…It was estimated that 94% of the patients had good analgesia for the first 24 postoperative hours and no other opioids were given. Tanaka et al [47] administered simultaneously 4 mg epidural morphine and 0,1 mg fentanyl in gynaecological patients. The rapid onset of fentanyl analgesia could be used to cover the latency period of epidural morphine.…”

Section: Previous Clinical Studies With Epidural Opioidsmentioning

confidence: 99%

“…A prospective, randomized, double-blind, and placebo-controlled study design was selected. The importance of fentanyl as a rapidly acting opioid bridging the delayed morphine analgesia [20,30,47], as well as the role of droperidol for attentuation of opiod side effects [ 16,21 ], was also to be tested in the same trial.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Previous Clinical Studies With Epidural Opioidssupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Previous Clinical Studies With Epidural Opioidsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…[1][2][3][4] Epidural administration of fentanyl during Caesarean section followed by morphine resulted in either inferior 1 or no improvement a in postoperative analgesia compared with epidural morphine alone. On the other hand, epidural fentanyl given after morphine improved post-hysterectomy analgesia without increasing adverse side effects.…”

mentioning

confidence: 99%

Enhanced pain management for post-gastrectomy patients with combined epidural morphine and fentanyl

et al. 1997

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Purpose: To determine whether dinical advantages could be demonstrated by epidural fentanyl given in addition to epidural morphine for postEastrectomy analgesia.Methods: One-hundred and twenty two patients undergoing elective gastrectomy were prospectively studied in a randomised, double-blind fashion. All patients received epiduraJ lidocaine 1.5% with epinephrine (I :200,000) followed by light general anaesthesia for surgical anaesthesia. They were assigned to four groups according to the combinations of each epidural opioid: 2 mg morphine alone, 2 mg morphine + 100/Jg fentanyl, 4 mg morphine alone, and 4 rng morphine + 100 ~g fentanyl. Morphine and fentanyt were given epiduraUy approximately 60 and 15 min, respectively, before the completion of surgery. Results: Addition of epidural fentanyt to both doses of morphine not only decreased intensity of pain associated with coughing during the early postoperative period, but also prolonged the time until the first analgesic request at each morphine dose studied. Of the combination doses, 4 mg morphine + 100/2g fentanyl provided the longest time to the first request for analgesic, and was associated with least amount of postoperative analgesic supplement and best patient satisfaction without increasing incidence of side effects. C_x)ndusion: The addition of 100/2g fentanyl to 2 mg or 4 mg epidural morphine provides clinical advantages over morphine alone for post-Eastrectomy analgesia.Objectif: DEterminer s'il est diniquement avantageux d'ajouter du fentanyt ~ la morphine 6pidurale pour procurer I'analg6sie aprEs une gastrectomie. S~'thodes : Cent vingt-deux patients programm6s pour une gastrectomie non urgente ont particip~ ~ cette 6tude al(~atoire en double aveugle. Pour rintervention, tousles patients ont re(;u une ~pidurale ~-la lidocaine 1,596 adr6nalin6e (1:200,000) suivie d'une anesth~sie g~nErale I~g~re. Les patients ~taient r6partis en quatre groupes d6termin6s par le mode d'administration des morphiniques : morphine seule 2 rag, morphine 2 mg + fentanyt 100/Jg, morphine 4 mg seule, et morphine 4 mg + fentanyt 100/Jg. La morphine et le fentanyl ont ~td administr6s par la voie Epidurale environ 60 et 15 min avant la completion de la chirurgie. II.&mltats : Non seulement rajout de fentanyl ~pidural aux deux doses de morphine diminualt I'intensitE de la douleur associ6e ~ la toux de la p6riode postop~ratoire imm6diate mals prolongeait de plus I'intervalle pr6c~dant la premiere demande d'analg6sique avec chacune des doses de morphine. Cette prolongation ~talt la plus marqu6e avec morphine 4 mg + fentanyl 100 gg. Cette demi~re combinalson est celle qui n6cessit~ le moins de supplement analg6sique et procurait le plus haut deE6 de satisfaction chez le patient sans auEnenter les effets secondalres. ConcluiJon : II est diniquement avanta~ux d'ajouter du fentanyl ~ la morphine ~pidurale pour ranalgEsie apr~ une gastrectomie.

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Vorteile und Risiken der periduralen Opioidapplikation bei der postoperativen Schmerztherapie

Chrubasik¹,

Chrubasik²

1996

Zur Behandlung Akuter Und Chronischer Schmerzen

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Optimal Dose Combination of Epidural Morphine and Fentanyl for Postoperative Analgesia

Cited by 7 publications

References 0 publications

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

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

Enhanced pain management for post-gastrectomy patients with combined epidural morphine and fentanyl

Vorteile und Risiken der periduralen Opioidapplikation bei der postoperativen Schmerztherapie

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