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Revista Cubana de Anestesiología y Reanimación

2016, Number 3

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Revista Cubana de Anestesiología y Reanimación 2016; 15 (3)

Analgesic effectiveness and safety of single-dose intrathecal morphine

Gonzalez BY, Velázquez GK, Tamargo BTO

Language: Spanish
References: 35
Page: 174-186
PDF size: 137.84 Kb.


ABSTRACT

Introduction: The superior hemiabdomen postoperative pain is severe and essential to be managed in order to avoid complications.
Objectives: To assess the analgesic effectiveness and safety of single-dose intrathecal morphine in the postoperative period of the upper hemiabdomen major surgery.
Method: Single-blind randomized clinical trial in 40 patients, after upper hemiabdomen interventions. We used single doses of intrathecal morphine (ITM) of 1 or 2 mg/kg per patient weight according to the treatment group. The statistical analysis used the Chi-square test, Fisher's exact test, univariate analysis of variance, Mauchly's test and Univariate F-test; the significance level was 0.05.
Results: Opioids administration during surgery was similar in both groups (3.1 ± 2.2 mL vs 4.1 ± 2.7 mL). In the 2 mg/kg of ITM dose group, the patients reported no pain after 12 and 14 hours; there were differences between treatments regarding pain relief (p ‹ 0.001) and also between the time when it was measured (p= 0.001). Rescue analgesia was used in 25 % of the patients. Respiratory depression was the only onset complication.
Conclusions: ITM at a single dose of 2 µg/kg is an effective method for postoperative analgesia in upper hemiabdomen surgery, the incidence of complications was low and both doses proved safe.


REFERENCES

  1. Neugebauer E, Schug S. Procedure specific postoperative pain management. [Internet]. [Citado en mayo de 2010]. Disponible en: http://journals.lww.com/ejanaesthesiology/fulltext/2006/06001/procedure_specific_p ostoperative_pain_management.20.aspx

  2. Block B, Liu S, Rowlingson A, Cowan A, Cowan Jr J, et al. Efficacy of postoperative epidural analgesia: A meta-analysis. JAMA 2003;290:2455-63.

  3. Joshi GP, Bonnet F, Shah R, Wilkinson R, Camu F, Fischer B, et al. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg. 2008;107:1026-40.

  4. Martínez-Vázquez J, Torres LM. Prevalencia del dolor posoperatorio. Repercusiones fisiopatológicas. Rev Soc Esp Dolor. 2007;7:465-76.

  5. Bader P, Echtle D, Fonteyne V, Livadas K, De Meerleer G, Paez Borda A, et al. Postoperative pain management. In: Guidelines on pain management. Arnhem. The Netherlands: European Association of Urology. (EAU); 2010;35:61-82.

  6. Practice guidelines for acute pain management in the perioperative setting: a report by the American Society of Anaesthesiologists Task Force on Pain Management, Acute Pain Section. [Internet]. [Citado en octubre de 2007]. Disponible en: http//www.asahq.org/publicationsServices.htm

  7. VHA/DoD Clinical practice guideline for the management of postoperative pain. Working group. Veterans Health Administration. Department of Defense. [Internet]. [Citado en julio de 2001] Disponible en: http//www.ncbi.nlm.nih.gov/pubmed/22227789

  8. Escobar J. Opioides intratecales para el manejo del dolor agudo postquirúrgico. Rev Chil Anesth. 2011;40:283-91.

  9. Cruz Correa MA. Opioides intratecales. En: Opioides en la Práctica médica. Ed: Asociación Colombiana para el estudio del dolor. Bogotá. 2009. p. 135-52.

  10. Nuri Deniz M, Erhan E, Ugur G. Intrathecal morphine reduces postoperative tramadol consumption in patients undergoing radical retropubic prostatectomy: a randomized trial. Eur Rev Med Pharmacol Sci. 2013r;17:834-8.

  11. dos Santos LM, Santos VC, Santos SR, Malbouisson LM, Carmona MJ. Intrathecal morphine plus general anesthesia in cardiac surgery: effects on pulmonary function, postoperative analgesia, and plasma morphine concentration. Clinics (Sao Paulo) 2009;64:279-8.

  12. Kara I, Apiliogullari S, Oc B, Celik JB, Duman A, Celik C, Dogan NU. The effects of intrathecal morphine on patient-controlled analgesia, morphine consumption, postoperative pain and satisfaction scores in patients undergoing gynaecological oncological surgery. J Int Med Res. 2012;40(2):666-72.

  13. Meylan N, Elia N, Lysakowski C, Tramer MR. Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery: metaanalysis of randomized trials. Br J Anaesth. 2009;102(2):156-67.

  14. Pöpping D, Elia N, Marret E, Wenka M, Tramèr M. Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-analysis of randomized trials. Pain 2012;153:784-93.

  15. Agüero O. Métodos anestésicos multimodales en el procedimiento quirúrgico de revascularización miocárdica sin circulación extracorpórea. Ensayo clínico aleatorizado y meta-análisis. Rev Cubana Anest Rean. 2013. [Internet]. [Citado en octubre de 2014]. Disponible en: http://scielo.sld.cu/pdf/scar/v12n3/scar08313.pdf

  16. Riley JL, Robinson ME, Wise EA, Myers CD, Fillingim RB. Sex differences in the perception of noxius experimental stimuli: a meta-analysis. Pain. 1998;74:181-7.

  17. Gagliese EA. Correlates of postoperative pain and intravenous patient- controlled analgesia use in younger and older surgical patients. Pain Med. 2008;9(3):299-314.

  18. Ip HY, Abrishami A, Peng PW, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology. 2009 Sep; 111:657-77.

  19. Llamas A. El dolor pertenece a la vida del hombre. [Internet]. [Citado en octubre de 2014] Disponible en: http//www.familiaqueesyquenoes.org

  20. Bujedo M, González Santos S, Uría Azpiazu A, Torán García L. Actualizaciones en el manejo clínico de los opioides espinales en el dolor agudo postoperatorio. Rev. Soc. Esp. Dolor. 2012;19(2):112-21.

  21. An updated report by the American Society of Anesthesiologists Task Force on neuraxial opioids. Practice Guidelines for the prevention, detection and management of respiratory depression associated with neuraxial opioid administration. Anesthesiology. 2009;110:218-30.

  22. Hernández R, González O, Hidalgo P, Marrero I, Rodríguez J, Nazco O, et al. Valor de la morfina liofilizada intratecal en la revascularización miocárdica quirúrgica. CorSalud. 2013;5:252-60.

  23. Pervez S, Gutiérrez M, Carvalho B. Revisan las dosis óptimas de la morfina administrada por vía intratecal o epidural. Drugs. 2011;71(14):1807-19.

  24. Duman A, Apiliogullari S, Balasar M, Gürbüz R, Karcioglu M. Comparison of 50 micrograms and 25 micrograms doses of intrathecal morphine on postoperative analgesic requirements in patients undergoing transurethral resection of the prostate with intrathecal anesthesia. J Clin Anesth. 2010;22(5):329-33.

  25. Ozbek H, Deniz M, Erakgun A, Erhan E. Comparison of 75 and 150 μg doses of intrathecal morphine for postoperative analgesia after transurethral resection of the prostate under spinal anesthesia. J Opioid Manag. 2013;9(6):415-20.

  26. Amaral F, Tenório S. Estudo comparativo entre doses de morfina intratecal para analgesia após cesariana. Rev Bras Anestesiol. 2013;63(6). [Internet]. [Citado en enero de 2015] Disponible en: http://dx.doi.org/10.1016/j.bjan.2013.01.001

  27. Gehling MH, Luesebrink T, Kulka PJ, Tryba M. The effective duration of analgesia after intrathecal morphine in patients without additional opioid analgesia: a randomized double-blind multicentre study on orthopaedic patients. Eur J Anaesthesiol. 2009;26:683-8.

  28. Gehling M, Tryba M. Risk and side effects of intratecal morphine combined with spinal anaesthesia: a meta-analysis. Anaesthesia. 2009;64:643-51.

  29. Bisgaard T. Analgesic treatment after laparoscopic cholecystectomy: a critical assessment of the evidence. Anesthesiology. 2006;104(4):835-6.

  30. González de Mejía N. Postoperative multimodal analgesia. Rev Soc Esp. Dolor. 2005;12:112-8.

  31. Labrada A, Jiménez- GarcÍa Y. Analgesia Multimodal Preventiva: estudio comparativo. Rev Soc Esp Dolor. 2004;11:122-8.

  32. Mota F, Marcolan J, Pereira M, Milanez A, Dallan L, Diccini S. Comparison study of two different patient-controlled anesthesia regiments after cardiac surgery. Rev Bras Cir Cardiovasc. 2010;25(1):38-44.

  33. Ready L. Acute Perioperative Pain. En: Miller RD. Anesthesia. New York. Ed: Interamericana. Mc Graw Hill. 5ta. Ed. 2000. p. 215-35.

  34. Jorgensen H, Wetterslev J, Moiniche S, Dahl J. Anestésicos locales epidurales versus regímenes analgésicos basados en opiáceos sobre la parálisis gastrointestinal, las NVPO y dolor posoperatorios después de la cirugía abdominal (Revisión Cochrane traducida). En: La Biblioteca Cochrane Plus, número1, 2005. Oxford, Update Software Ltd. Disponible en: http://www.update-software.com

  35. De Cosmo G, Aceto P, Gualtieri E, Congedo E. Analgesia in thoracic surgery: review. Minerva Anestesiol. 2009;75(6):393-400.




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