Postoperative Analgesia and Recovery Course After Major Colorectal Surgery in Elderly Patients: A Randomized Comparison Between Intrathecal Morphine and Intravenous PCA Morphine

Beaussier, Marc; Weickmans, Henri; Parc, Yann; Delpierre, Eric; Camus, Y.; Funck‐Brentano, Christian; Schiffer, Eduardo; Delva, E.; Lienhart, A.

doi:10.1016/j.rapm.2006.06.250

Cited by 39 publications

(51 citation statements)

References 28 publications

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“…27 The multicomponent interventions appeared to be effective in preventing delirium among patients admitted to hospital with hip fracture (summary RR 0.75, 95% CI 0.64-0.88; p for heterogeneity = 0.58). The number needed to treat to prevent 1 case of delirium was 7 (95% CI [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. In one of the trials, there were nonsignificant (p > 0.1) differences in baseline characteristics, including prefracture dementia and impairment in activities of daily living.…”

Section: Multicomponent Interventionsmentioning

confidence: 99%

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How can delirium best be prevented and managed in older patients in hospital?

Holroyd‐Leduc¹,

Khandwala²,

Sink³

2009

Canadian Medical Association Journal

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Section: Multicomponent Interventionsmentioning

confidence: 99%

“…16 The intervention group received preoperative intrathecal morphine at L4-L5 (n = 29); the control group received a preoperative subcutaneous injection of saline at L4-L5 (n = 30). Postoperatively both groups received propacetamol intravenously and patient-controlled morphine intravenously for breakthrough pain.…”

Section: Reviewmentioning

confidence: 99%

How can delirium best be prevented and managed in older patients in hospital?

Holroyd‐Leduc¹,

Khandwala²,

Sink³

2009

Canadian Medical Association Journal

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“…Pain accelerates recovery of consciousness from anaesthesia, 12 hence patients in severe abdominal pain recover more rapidly than volunteers. Pain would also influence recovery in both groups in the present study, however whether one group might be more affected is not known.…”

Section: Discussionmentioning

confidence: 99%

The Effect on the Recovery Profile of a Change from Enflurane to Desflurane during the Latter Part of Anaesthesia

et al. 2008

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This study compared emergence and recovery characteristics after either enflurane anaesthesia or crossover from enflurane to desflurane anaesthesia. At an estimated 1 h prior to the end of operation, enflurane was either reduced (group E, n = 23) or replaced with desflurane (group X, n = 23). At the end of the operation, emergence and recovery characteristics of the two groups were compared. The crossover technique accelerated recovery compared with enflurane anaesthesia. The time taken for the eyes to open in response to painful pinching or a verbal command, and to regain awareness of age and name, were significantly shorter after crossover anaesthesia than after enflurane anaesthesia. The digit symbol substitution test and serial seven test scores were significantly better in patients subjected to crossover anaesthesia than in those subjected to enflurane anaesthesia. We conclude that, during surgery, the substitution of enflurane with desflurane in the latter part of anaesthesia can improve recovery.

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“…5,28,29 However, in contrast to orthopedic or obstetrical procedures, the optimal dose of ITM for major abdominal surgery has not yet been determined, although others have successfully used ITM doses in the range that we have studied. 6,7 It is possible that had we used a lower dose of ITM, then the analgesic benefit of ITS may have been unveiled. Although this combination may appear attractive at institutions unable to closely monitor patients overnight, this hypothesis needs to be formally tested.…”

Section: Discussionmentioning

confidence: 99%

“…5 In major abdominal surgery, ITM (0.3-0.4 mg) combined with patient controlled analgesia (PCA) improves perioperative analgesia compared to PCA alone during the first 24 hr after surgery. 6,7 Intrathecal morphine has the advantage of providing long-lasting analgesia after a single injection. However, because morphine is a hydrophilic opioid, its peak analgesic effect is delayed (six to seven hours after injection) and its rostral spread carries the risk of late respiratory depression especially at high doses.…”

mentioning

confidence: 99%

Low-dose sufentanil dœs not potentiate intra-thecal morphine for perioperative analgesia after major colorectal surgery

et al. 2007

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Purpose: Both intrathecal sufentanil (ITS) and intrathecal morphine (ITM) improve analgesia in obstetrical or cardiac procedures. From a pharmacokinetic standpoint, combining these two opioids may improve perioperative analgesia. We performed a prospective randomized double-blind study to compare the analgesic efficacy of ITM alone vs a mixture of a low dose of ITS plus ITM for perioperative pain relief in colorectal surgery. Methods:Eighty adult patients undergoing colorectal surgery were randomly allocated to receive either 0.4 mg ITM alone or 10 µg ITS plus 0.4 mg ITM before general anesthesia. Intraoperative intravenous sufentanil consumption, postoperative morphine consumption delivered with a patient controlled analgesia device, pain scores, patient satisfaction and adverse effects were recorded for the first 48 hr postoperatively. Results:No differences were observed between groups with respect to intraoperative sufentanil consumption (39 ± 23 µg in group ITM and 40 ± 25 µg in group ITS plus ITM, P = 0.85) and in postoperative morphine consumption in postanesthesia care unit (6 ± 5 mg vs 6 ± 5 mg, P = 0.59), at 24 hr (26 ± 17 vs 24 ± 15 mg, P = 0.59) and at 48 hr (47 ± 31 vs 44 ± 22 mg, P = 0.58). Similarly, no differences were observed in regards to pain relief, patient satisfaction and incidence of adverse effects. Conclusions:These results do not support the addition of 10 µg ITS to 0.4 mg ITM for colorectal surgery, as low dose sufentanil does not improve intraoperative and postoperative analgesia in this setting. post-anesthésiques (6 ± 5 mg vs 6 ± 5 mg, P = 0,59), à 24 h (26 ± 17 vs 24 ± 15 mg, P = 0,59) et à 48 h (47 ± 31 vs 44 ± 22 mg, P = 0,58

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Postoperative Analgesia and Recovery Course After Major Colorectal Surgery in Elderly Patients: A Randomized Comparison Between Intrathecal Morphine and Intravenous PCA Morphine

Abstract: Intrathecal morphine, as compared with intravenous PCA morphine alone, improves immediate postoperative pain and reduces parenteral morphine consumption but does not improve postoperative recovery in elderly patients after major colorectal surgery.

Cited by 39 publications

References 28 publications

How can delirium best be prevented and managed in older patients in hospital?

How can delirium best be prevented and managed in older patients in hospital?

The Effect on the Recovery Profile of a Change from Enflurane to Desflurane during the Latter Part of Anaesthesia

Low-dose sufentanil dœs not potentiate intra-thecal morphine for perioperative analgesia after major colorectal surgery

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