medigraphic.com

2012, Number 1

<< Back Next >>

Rev Mex Anest 2012; 35 (1)

Analgesic postoperative effect with single intrathecal morphine microdose versus intravenous ketorolac in gynecologic surgery

Gallegos-Allier MM, Santacruz L, Lomelí J

Language: Spanish
References: 22
Page: 15-19
PDF size: 98.59 Kb.


ABSTRACT

Background: Morphine –the prototype of opioid agonists– is the most effective drug for the treatment of acute and chronic pain. Postoperative pain is one of the three leading causes of prolonged hospitalization. Patients and methods: This is double-blind, randomized controlled trial comparing the efficacy of a combination of intrathecal morphine (1 µg/kg) plus intravenously ketorolac versus intravenous ketorolac only (90 mg/day), in patients undergoing gynecologic surgery and combined spinal-epidural anesthesia by Visual Analogue Scale, at 6, 12 and 24 h after surgery. To statistical analysis, association was assessed with χ² Pearson test; Mann Whitney and t Student test to difference between groups. Results: 97 females (mean age 41.75 ± 8.48) were included in the study. 49 were randomized to active treatment and 48 to control treatment. Mean Visual Analogue Scale in the morphine group was 1.27 (± 1.25) versus 4.08 (± 2.05) in the ketorolac group (p ‹0.001). Conclusion: Adding intrathecal morphine to the IV ketorolac treatment reduces the intensity of postoperative pain, morphine requirements and opioid-related side effects in the early postoperative period.


REFERENCES

  1. Bonica J. The management of pain. 1st edition ed. Philadelphia: Lea & Febiger; 1990:1-2.

  2. Anesthesiologists ASo. Practice Guidelines for Acute Pain Management in the Perioperative Setting. Anesthesiology. [Special Articles]. 2004;100:1573-1581.

  3. Sorkin LSWM. Acute pain mechanisms. Surg Clin North Am 1999;79:213-229.

  4. Rocchi ACF, Forte L. Canadian survey of postsurgical pain and pain medication experiences. Can J Anaesth 2002;49:1053-1056.

  5. Gracely RH. Pain language and ideal pain assessment. In: Melzack R, ed. Pain measurement and assessment. New York: Raven Press 1983:71-78.

  6. Aubrun FSN, Coriat P, Riou B. Sex-and age- related differences in morphine requirements for postoperative pain relief. Anesthesiology 2005;103:156-160.

  7. Cepeda MSCD, Miranda N, Diaz A, Silva C, Morales O. Comparison of morphine, ketorolac and their combination for postoperative pain. Results from a large, randomized, double-blind trial. Anesthesiology 2005;103:1225-1232.

  8. Palmer CMES, Volgoropolous D, Alves D. Dose-response relationship of intrathecal morphine for postcesarean analgesia. Anesthesiology 1999;90:437-444.

  9. Mugabure BEE, Marín M. Physiology and clinical pharmacology of epidural and intrathecal opioids. Rev Soc Esp Dolor [Review Article] 2005;12:33-45.

  10. Cohen SPDA. Analgesia intratecal. Anesthesiology Clin N Am 2007;25:863-882.

  11. Labrada AJ-GY. Preventive multimodal analgesia: a comparative study. Rev Soc Esp Dolor 2004;11:122-128.

  12. Power I. Recent advances in postoperative pain therapy. Br J Anaesth 2005;95:43-51.

  13. Gallego JIRdlTM, Vázquez-Guerrero JC, Gil M. Estimation of the prevalence and severity of postoperative pain and relation with patient satisfaction. Rev Soc Esp Dolor 2004;11:197-202.

  14. Vadivelu NMS, Narayan D. Recent advances in postoperative pain management. Yale Journal of Biology and Medicine [Review] 2010;83:11-25.

  15. Soler-Company EBJ, Faus-Soler T. Analgesic use for postoperative pain: differences arise when comparing departments of surgery. Pharmacoepidemiol Drug Saf 2002;11:607-614.

  16. Galindo-Miranda ELP-DM, Moreno-Alatorre MA. Metabolismo y farmacodinamia de los analgésicos morfínicos en el ser humano. Rev Méx Anest 1978;1:45-51.

  17. Rathmell JPLTR, Nauman B. The role of intrathecal drugs in the treatment of acute pain. Anesthesiology [Review Articles] 2005;101:S30-S43.

  18. Gerancher JCFH, Eisenach J. Determination of an effective dose of intrathecal morphine for pain relief after cesarean delivery. Anesth Analg 1999;88:346-351.

  19. Ummenhofer WC AR, Shen DD, Bernards CM. Comparative spinal distribution and clearance kinetics of intrathecally administered morphine, fentanyl, alfentanyl and sufentanyl. Anesthesiology 2000;92:739-753.

  20. Shafer SLEJ. Location, location, location. Anesthesiology [Editorial Views] 2000;92:641-643.

  21. Ko S GD, VanDenKerkhof EG. Definitions of “respiratory depression” with intrathecal morphine postoperative analgesia: a review of the literature. Can J Anesth 2003;50:679-688.

  22. Benyamin RTA, Datta S, Buenaventura R, Adlaka R, Sehgal N, Glaser SE, Vallejo R. Opioid complications and side effects. Pain Physician 2008;11:S105-S120.




2020     |     www.medigraphic.com