Pre-emptive lumbar epidural anaesthesia reduces postoperative pain and patient-controlled morphine consumption after lower abdominal surgery (original) (raw)
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Anesthesiology, 2003
The aim of this study was to evaluate the postoperative morphine-sparing effects and reduction in pain and secondary mechanical hyperalgesia after preincisional or postincisional epidural administration of a local anesthetic and an opioid compared with a sham epidural control. Patients undergoing major gynecologic surgery by laparotomy were randomly assigned to three groups and studied in a double-blinded manner. Group 1 received epidural lidocaine and fentanyl before incision and epidural saline 40 min after incision. Group 2 received epidural saline before incision and epidural lidocaine and fentanyl 40 min after incision. Group 3 received a sham epidural control (with saline injected into a catheter taped to the back) before and 40 min after incision. All patients underwent surgery with general anesthesia. One hundred forty-one patients completed the study (group 1, n = 45; group 2, n = 49; group 3, n = 47). Cumulative patient-controlled analgesia morphine consumption at 48 h was significantly lower (P = 0.04) in group 1 (89.8 +/- 43.3 mg) than group 3 (112.5 +/- 71.5 mg) but not group 2 (95.4 +/- 60.2 mg), although the hourly rate of morphine consumption between 24 and 48 h after surgery was significantly lower (P < 0.0009) in group 1 (1.25 +/- 0.02 mg/h) than group 2 (1.41 +/- 0.02 mg/h). Twenty-four hours after surgery, the visual analog scale pain score on movement was significantly less intense (P = 0.005) in group 1 (4.9 +/- 2.2 cm) than group 3 (6.0 +/- 2.6 cm) but not group 2 (5.3 +/- 2.5 cm), and the von Frey pain threshold near the wound was significantly higher (P = 0.03) in group 1 (6.4 +/- 0.6 log mg) than in group 3 (6.1 +/- 0.8 log mg) but not group 2 (6.2 +/- 0.7 log mg). Preincisional administration of epidural lidocaine and fentanyl was associated with a significantly lower rate of morphine use, lower cumulative morphine consumption, and reduced hyperalgesia compared with a sham epidural condition. These results highlight the importance of including a standard treatment control group to avoid the problems of interpretation that arise when two-group studies of preemptive analgesia (preincisional vs. postsurgery) fail to find the anticipated effects.
Epidural Morphine for Postoperative Pain: Experience with 1085 Patients
Acta Anaesthesiologica Scandinavica, 1985
A prospective study of the effect and side-effects of epidural morphine for pain relief in 1085 patients after thoracic, abdominal, urologic, or orthopaedic surgery was performed. Morphine chloride was diluted in saline or bupivacaine and administered through an epidural catheter placed at a srgmrntal level appropriate for the type of surgery. The initial dose was 4 or 6 mg morphine and supplemrntary doses were givcn when needed to obtain complete freedom from pain during deep breathing or nursing care. The cotal dose of epidural morphine from end of surgery until the next morning vaned from 4 t o 18 mg. 97":, of hip arthroplasty patients, 91 yo of prostatectomy patients and thoracotomy patients, 90y0 of paticnta after major lower extremity surgery and 88: / , of patients after laparotomy were completely satisfied with thr postoperativr course. For hip arthroplasty and major extremity surgery, an initial dose o f 4 mg of epidural morphinr was as effective as 6 mg. After prostatectomy, laparotomy, and thoracotomy, an initial dose of 6 mg gave significantly better effect than 4 mg. Pruritus occurred in 1 I%, nausea or vomiting in 34?;,, and respiratory depression in 0,9yo of the total patient population. Urinary retention occurred in 42U,;, of patients not having urinary catheters in place. Postoperative nausea or vomiting was more frrquent in women than in mrn (P< 0.001). There was a higher incidence of nausea or vomiting in men experiencing pain than in men who were completely pain-free after abdominal surgery (P < 0.001). Respiratory depression was rare and occurred as a gradually decreasing respiratory rate. Treatment with naloxone was effective without pain-brrakthrough. Naloxone relieved pruritus in 9O"/b of patients in whom it was attempted, but was not rfrertivc. in trtating nausea, vomiting, or urinary retention. After this study our dosage regimen for postoperative epidural morphine is: for major surgery of the lower limb or hip arthroplasty 4 mg; after prostatrctomy. lap;trotomy, and thoracotomy 6 mg. No later than 12 h before the patients leave the postoperative care unit, half the initial dose of epidural morphine is usually repeated. Morphine is diluted in bupivacaine if pain is alrcady present, otherwise in saline.
Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences., 2008
Effects of Different Epidural Analgesic Compositions on Postoperative Pain Relief and Systemic Response to Surgery Despite many achievements during the last decade, postoperative pain remains the dominant complaint after major surgery and has great potential to be influenced by the anaesthesiologist. Reports suggest that short-term effective anaesthesia and analgesia can have long-lasting beneficial effects on recovery from surgery. The aim of our study is to compare the effect of epidural analgesia, using different compositions, including glucocorticoids (methylprednisolone), and habitual composition of bupivacaine-morphine, in regard to analgesic and anti-inflammatory properties. A total of 129 patients participated in the study in four different treatment groups: patients from Group I received glucocorticoid methylprednisolone succinate and long-acting opioid morphine hydrochloride, Group II received local anaesthetic bupivacaine hydrochloride and morphine hydrochloride, Group II...
Acta Anaesthesiologica Scandinavica, 2000
Background: Previous studies have shown that N-methyl-Dasparate (NMDA) receptor antagonists provide a pre-emptive analgesic effect in humans. This study investigated the benefits of pre-emptive analgesia for upper abdominal surgery, using pre-incisional epidural ketamine π morphine π bupivacaine (KπMπB) treatment for achieving postoperative pain relief. Methods: Sixty ASA 1-2 patients scheduled for upper abdominal surgery were allocated to three groups in a randomized, single-blinded study. Patients in the control group (I) received general anaesthesia followed by an infusion of normal saline. Group II and III patients received general anaesthesia with a continuous epidural infusion of 2% lidocaine. Thirty minutes after the incision in groups I and II, an epidural pain control regimen was administered using ketamine (10 mg) and morphine (1 mg) in 10 ml of 0.085% bupivacaine (KπMπB). Group III patients also received KπMπB, but it was administered 10 min after the 2% lidocaine injection and 30 min before skin incision. All patients received an epidural pain control regimen (q12 h) for 3 days after their first injection. Patient-controlled analgesia (PCA) with morphine was used to control subsequent postoperative pain. During the 3-day period following surgery, duration to PCA trigger (h), morphine consumption (mg), pain intensity at rest and when coughing/moving, and analgesic-re
O bjective: To compare effects and side effects or complications of epidural versus intramuscularly administered morphine for relieve of postoperative pain. Patients and methods: In the first group (epidural) analgesia is achieved by application of morphine through epidural catheter. To the amount of morphine is added physiological solution until 10 ml of total volume of the mixture is achieved. This mixture is given to 150 patients, by epidural route before the exit from the operation room. Epidural catheter is removed after 48 hours. Second group (intramuscular) analgesia is realized by application of 10 mg of morphine by intramuscular route. Morphine is injected at the end of surgery. Pain is assessed with combination of verbal categorical scale and visual analog scale. Verbal categorical scale used is 8 points scale and contains words of Tursky: 0 no pain, 1 very low pain , 2 week pain, 3 mild pain , 4 moderate pain , 5 strong pain, 6 severe pain, 7 untolerated pain. Awareness i...
Anesthesia: Essays and Researches, 2015
Background: Many adjuvants are used to increase the efficacy of epidural local anesthetics for postoperative analgesia. Aims: The aim was to compare the efficacy of epidural morphine (0.1 mg/kg) and clonidine (2 µg/kg) with bupivacaine (0.125%) for postoperative analgesia in abdominal surgeries. Settings and Design: Double-blind retrospective randomized study. Methodology: All the patients (n = 60) varying from age group belonging to American Society of Anesthesiologists I-II were randomly allocated to receive epidural analgesia Group A-Morphine (0.1 mg/kg). + Bupivacaine (0.125%) (n = 30), Group B-Clonidine (2 µ/kg) + Bupivacaine (0.125%) (n = 30). We monitored vitals and requirement of inhalational gases intra-operatively, pain by visual analogue score (VAS) and vitals postoperatively. We used rescue analgesics (injection diclofenac 1 mg/kg intravenous) when VAS score > 5. Postoperatively, various parameters were monitored for first 2 h at intervals of 30 min and at 4, 8, 12, 16, and 24 hourly intervals after giving 1 st dose. Statistical Analysis Used: Continuous data are analyzed by Student's t-test (paired 't'-test for intragroup variations and unpaired 't'-test for intergroup variations). Chi-square test was used for categorical data. A P ≤ 0.05 was considered to be statistically significant. Results: Mean duration of analgesia was 8.35 ± 0.42 h in Group A (morphine) and 7.45 ± 0.44 h in Group B (clonidine). This difference was statistically significant (P < 0.001), indicating a prolongation of analgesia in group morphine. There was no need of rescue analgesia in any subjects. Group A patients were hemodynamically stable and required less inhalation agents intra-operatively compared to group B patients. Conclusions: Epidural morphine plus bupivacaine has a longer duration of analgesia and greater hemodynamic stability as compared to epidural clonidine plus bupivacaine for postoperative analgesia in abdominal surgeries.
A PROSPECTIVE STUDY OF EPIDURAL ANALGESIA WITH BUPIVACAINE AND MORPHINE IN POSTOPERATIVE PATIENTS
National Journal of Medical Research, 2013
Background: Epidural analgesia has been shown to be superior to intravenous analgesia for postoperative analgesia after thoracic, abdominal and lower extremity surgery. However it is unclear which opioid is optimal for epidural analgesia. Morphine has potential advantages, yet there was little to establish its efficacy and safety. Thus we prospectively monitored our patients receiving epidural analgesia with Bupivacaine combined with Morphine postoperatively. Patients and Methods: A prospective study was conducted in 100 adult patients of either sex of age between 20 and 65 years belonging to ASA grade I and II. The study was conducted for relief of pain, amount of sedation and incidence of side effects like nausea, vomiting, pruritus and retention of urine in post operative patients receiving epidural analgesia when 0.125% Bupivacaine is combined with morphine. Lumbar epidural analgesia was initiated after central neuroaxial anaesthesia, with 0.125% Bupivacaine combined with 0.25mg/ml of morphine. Results: The addition of Morphine to 0.125% Bupivacaine given epidurally resulted in good analgesia in the post operative period. It also yielded sedation, especially after the second dose with minimal minor side effects. Conclusion: The addition of Morphine to Bupivacaine increases the duration of post-operative analgesia and it is more marked with the second top-up dose of Morphine and Bupivacaine.
The influence of preemptive spinal anesthesia on postoperative pain
Journal of Clinical Anesthesia, 2000
Israel-a government hospital. Measurements and Main Results: 30 ASA physical status I and II unpremedicated women undergoing elective total abdominal hysterectomy were randomly allocated into two groups of 15 patients each using a sealed envelope technique. Patients in Group 1 were given a subarachnoid injection of 12 mg hyperbaric bupivacaine and after 10 minutes general anesthesia was induced. Patients in Group 2 received only general anesthesia. Anesthesia was induced with midazolam and maintained with oxygen, N 2 O, isoflurane, and pancuronium. No opioids were given intraoperatively. Postoperatively patientcontrolled analgesia (PCA) with morphine was initiated in both groups (1 mg. mL Ϫ1 , bolus dose 1 mg, lockout interval 10 minutes, and background infusion 1 mg.mL Ϫ1) at patient first request for analgesic. Pain was assessed over 24 hours by cumulative morphine dose and visual analog score (VAS). Postoperative PCA morphine consumption at 2, 6, and 24 hours following patient first request for analgesic for Groups 1 and 2 were: 3.1 Ϯ 1 mg versus 7.2 Ϯ 3 mg (p ϭ 0.04), 13.4 Ϯ 2 mg versus 17.2 Ϯ 4 mg (p ϭ 0.03) and 35.9 Ϯ 8 mg versus 47.7 Ϯ 8 mg in Group 2 (p ϭ 0.04). VAS scores at 4, 6, 12, and 24 hours postoperatively were not significantly different between the two groups. Conclusions: Preoperative neural blockade may reduce postoperative analgesic requirements.
Safety and efficacy of postoperative epidural analgesia
British Journal of Anaesthesia, 2001
Effective analgesia for postoperative pain relief after major surgery has been a practical proposition with epidural administration of local anaesthetic (LA) and opioid drugs since the early 1980s. Although epidural administration is perceived by 80% of UK anaesthetists as the ideal analgesic technique for upper abdominal surgery, 34 there are many patients undergoing major surgery who do not receive this form of analgesia. In a recent survey of UK practice, only 15% of patients undergoing abdominal surgery had epidural analgesia in the 12 hospitals sampled. 31 The main factor which has limited the use of epidural analgesia has been the dif®culty in making a reasonable risk/bene®t analysis about the technique, which has resulted in clinicians constantly asking whether epidurals are effective for postoperative pain relief and whether the technique is safe.