Effects of Prophylactic Nalmefene on the Incidence of Morphine-related Side Effects in Patients Receiving Intravenous Patient-controlled Analgesia 

1999 ◽  
Vol 90 (4) ◽  
pp. 1007-1011 ◽  
Author(s):  
Girish P. Joshi ◽  
Larry Duffy ◽  
Jamal Chehade ◽  
Jay Wesevich ◽  
Noor Gajraj ◽  
...  
Keyword(s):  
Side Effects ◽  
Low Dose ◽  
Opioid Antagonist ◽  
Postanesthesia Care Unit ◽  
Patient Controlled Analgesia ◽  
Total Consumption ◽  
Duration Of Action ◽  
Residual Neuromuscular Blockade ◽  
Prophylactic Administration ◽  
To Receive

Background Opioid-related side effects associated with intravenous patient-controlled analgesia can be reduced by a low-dose naloxone infusion. The influence of nalmefene, a pure opioid antagonist with a longer duration of action, on opioid-related side effects has not been evaluated. This study was designed to determine the dose-response relation for nalmefene for the prevention of morphine-related side effects in patients receiving intravenous patient-controlled analgesia. Methods One hundred twenty women undergoing lower abdominal surgery were enrolled in the study. General anesthesia was induced using thiopental and rocuronium and maintained with desflurane, nitrous oxide, and fentanyl or sufentanil. All patients received neostigmine and glycopyrrolate to reverse residual neuromuscular blockade. No prophylactic antiemetics were administered. At the end of surgery, patients were randomized to receive saline, 15 microg nalmefene, or 25 microg nalmefene intravenously. The need for antiemetic and antipruritic drugs and the total consumption of morphine during the 24-h study were recorded. The incidences of postoperative nausea, vomiting, pruritus, and pain were recorded 30 min after patients were admitted to the postanesthesia care unit. In addition, patient remembrance of these side effects was noted at 24 h after operation. Results The need for antiemetic and antipruritic medications during the 24-h study period was significantly lower in the patients receiving nahmefene compared with those receiving placebo. However, the need to treat side effects was similar in the two nahmefene groups. Prophylactic administration of nalmefene reduced the patients remembrance of nausea and itching as assessed 24 h after operation. Although the total consumption of morphine during the 24-h study period was similar in the three groups, retrospectively patients who received nalmefene characterized their pain as less severe in the previous 24 h. Conclusion Compared with placebo, prophylactic administration of nalmefene significantly decreased the need for antiemetics and antipruritic medications in patients receiving intravenous patient-controlled analgesia with morphine.

The Application of Entonox for Pain Relief

1985 ◽  
Vol 1 (2) ◽  
pp. 169-170
Author(s):  
Peter J.F. Baskett
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Low Dose ◽  
Prehospital Care ◽  
Injured Patient ◽  
Tissue Perfusion ◽  
Rapid Onset ◽  
Duration Of Action ◽  
Significant Depression ◽  
Seriously Ill

Pain relief is important — not only for humane reasons — but also for protection of the circulation and tissue perfusion which suffer as a result of the enormous secretion of catecholamines which occur. In the operating room during anesthesia we take care to combat this trend by giving adequate analgesics, and it is logical that we should attempt to take similar steps in the prehospital care phase.One of the reasons why the provision of analgesia is so poor in practice is that the usual parenteral agents — the opiates — are accompanied by side effects which are particularly dangerous in the seriously ill or injured patient. The introduction of low dose ketamine, however, has altered this position somewhat, offering, as it does, good analgesia without significant depression of respiration or the circulation.A major practical difficulty in providing analgesia outside hospital lies in the fact that the majority of the patients are being cared for by personnel who are not physicians. We, therefore, need an agent which can be administered by an ambulance attendant or trained rescuer. In many countries the opiates and ketamine may only be administered by a physician and therefore they are effectively ruled out for the majority of patients.Let us look at the properties of an ideal analgesic for use outside hospital. It should be: 1) effective but safe; 2) have no undesirable side effects; 3) have a rapid onset and short duration of action; 4) be easy to administer; and 5) be capable of being used by paramedical personnel.

Epidural Fentanyl Produces Labor Analgesia by a Spinal Mechanism 

1998 ◽  
Vol 88 (6) ◽  
pp. 1519-1523 ◽  
Author(s):  
Robert D'Angelo ◽  
J. C. Gerancher ◽  
James C. Eisenach ◽  
Brenda L. Raphael
Keyword(s):  
Side Effects ◽  
Low Dose ◽  
Labor Analgesia ◽  
Epidural Fentanyl ◽  
Saline Control ◽  
Intravenous Fentanyl ◽  
Epidural Bupivacaine ◽  
Spinal Mechanism ◽  
Intravenous Saline ◽  
To Receive

Background The purpose of this study was to determine if epidural fentanyl produces analgesia in laboring patients by a primary spinal or supraspinal action. Methods Fifty-four parturients were randomized to receive epidural 0.125% bupivacaine plus one of three treatments: epidural saline-intravenous saline, epidural fentanyl (20 microg/h)-intravenous saline, or epidural saline-intravenous fentanyl (20 microg/h). The study treatments were administered by continuous infusion, whereas epidural bupivacaine use was patient controlled. Results Epidural bupivacaine use was significantly reduced by epidural (11.5+/-4.6 ml/h) but not by intravenous fentanyl (15.9+/-4.5 ml/h) compared with saline control (16+/-5.9 ml/ h). Analgesia characteristics and side effects were similar among groups. Conclusions Low-dose epidural infusions of fentanyl produce labor analgesia by a primary spinal action.

scholarly journals Effects of Reduction of the Caudal Morphine Dose in Paediatric Circumcision on Quality of Postoperative Analgesia and Morphine-Related Side-Effects

2007 ◽  
Vol 35 (5) ◽  
pp. 743-747 ◽  
Author(s):  
M. Cesur ◽  
H. A. Alici ◽  
A. F. Erdem ◽  
T. Yapanoglu ◽  
F. Silbir
Keyword(s):  
Side Effects ◽  
Epidural Morphine ◽  
Low Dose ◽  
Low Doses ◽  
Respiratory Complications ◽  
Rescue Analgesia ◽  
Morphine Dose ◽  
To Receive ◽  
Caudal Epidural

This study compared the efficacy and adverse effects of three low doses of morphine (10, 15 and 30 μg.kg1) for caudal epidural analgesia in children undergoing circumcision. A total of 135 boys undergoing outpatient circumcision were randomly assigned to receive 10, 15 or 30 μg.kg1 of caudal morphine. Anaesthesia was induced and maintained with propofol. After induction, the morphine was added to 0.5 ml.kg1 1% lignocaine solution with adrenaline 5μg.ml1 and injected caudally. Anaesthesia quality, postoperative pain and adverse events in a 24-hour period were evaluated. Paracetamol (20 mg. kg’ orally) was used as rescue analgesia as required. No patient required paracetamol in the first eight hours after the caudal injections. In the first 24 hours postoperatively no further analgesia was required in 66.7%, 77.8% and 91.1% of the patients in the 10, 15 and 30 μg.kg1 groups, respectively (P=0.01 for 10 vs. 30 groups). All patients had excellent analgesia. No respiratory complications were observed. Nausea-vomiting occurred in 13.3%, 20% and 46.7% of the patients in the 10, 15 and 30 μg.kg1 groups (P=0.002 for 10 vs. 30 and 0.044 for 15 vs. 30). Pruritus occurred in 8.9%, 11% and 15.6% in the 10, 15 and 30 μg.kg1 groups but was localised and did not require treatment. This study was not powered to assess concerns that low dose epidural morphine may rarely be associated with delayed apnoea and is therefore considered unsuitable for outpatient use in many centres. Increases in caudal morphine dose above 10 μxg. kg1 produce some ‘paracetamol sparing’ but no improvement in analgesia, some pruritus and a significant increase in nausea and vomiting.

Patient-controlled Analgesia after Major Shoulder Surgery 

1997 ◽  
Vol 87 (6) ◽  
pp. 1343-1347 ◽  
Author(s):  
Alain Borgeat ◽  
Beatrice Schappi ◽  
Nicola Biasca ◽  
Christian Gerber
Keyword(s):  
Patient Satisfaction ◽  
Side Effects ◽  
Pain Relief ◽  
Shoulder Surgery ◽  
Bolus Administration ◽  
Patient Controlled Analgesia ◽  
Analog Scale ◽  
Initial Block ◽  
Group A ◽  
To Receive

Background The authors compared patient-controlled interscalene analgesia (PCIA) with local anesthetics with intravenous patient-controlled analgesia (PCA) with opioids to manage postoperative pain after major shoulder surgery. Methods Forty patients scheduled for elective major shoulder surgery were prospectively randomized to receive either PCIA or PCA. Before surgery, all patients had an interscalene block. In the PCIA group, a catheter was introduced within the interscalene sheath. Six hours after the initial block, patients received for 48 h either a continuous infusion of 0.15% bupivacaine through the interscalene catheter at a rate of 5 ml/h plus a bolus of 3 or 4 ml with a lock-time of 20 min (group PCLA) or a continuous intravenous infusion of nicomorphine at a rate of 0.5 mg/h plus a bolus of 2 or 3 mg with a lock-time of 20 min (group PCA). Pain relief was regularly assessed using a visual analog scale, side effects were noted, and the patients were asked to rate their satisfaction at the end of the study. Results Pain relief was significantly better controlled in the PCIA group at t = 12 and 18 h (P < 0.05). Vomiting and pruritus were 0 versus 25% and 0 versus 25% for the PCIA and PCA groups, respectively (P < 0.05). Patient satisfaction was greater in the PCIA group (P < 0.05). Time of first bolus administration and paracetamol supplement were similar in both groups. Conclusions The use of the PCIA technique was uncomplicated and provided better pain relief than PCA during the first 18 h after operation. The incidence of side effects such as vomiting and pruritus was significantly decreased with the use of PCIA, and patient satisfaction was superior in the PCIA group.

A randomized trial of two doses of nicardipine in aneurysmal subarachnoid hemorrhage

1994 ◽  
Vol 80 (5) ◽  
pp. 788-796 ◽  
Author(s):  
E. Clarke Haley ◽  
Neal F. Kassell ◽  
James C. Torner ◽  
Laura L. Truskowski ◽  
Teresa P. Germanson ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Side Effects ◽  
Dose Group ◽  
Low Dose ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
High Dose ◽  
Content Type ◽  
Symptomatic Vasospasm ◽  
To Receive ◽  
Fine Print

✓ High-dose intravenous nicardipine has been shown to reduce the incidence of angiographic and symptomatic vasospasm in patients with aneurysmal subarachnoid hemorrhage (SAH), but treatment may be complicated by side effects, including hypotension or pulmonary edema/azotemia. From August, 1989, to January, 1991, 365 patients at 21 neurosurgical centers were entered into a randomized double-blind trial comparing high-dose (0.15 mg/kg/hr) nicardipine with a 50% lower dose (0.075 mg/kg/hr) administered by continuous intravenous infusion for up to 14 days following SAH. Patients in all neurological grades were eligible for the study. During the study period, 184 patients were randomly assigned to receive high-dose nicardipine and 181 to receive the low dose. There were no significant differences in patient age, admission neurological condition, or amount and distribution of blood clot on initial computerized tomography scan. Patients in the high-dose group received a significantly smaller proportion of the planned dose than those in the low-dose group (80% ± 0.2% vs. 86% ± 0.2%, p < 0.05), largely because of premature treatment termination after adverse medical events. The incidence of symptomatic vasospasm was 31% in both groups, and the overall 3-month outcomes were nearly identical. These data suggest that, from a clinical standpoint, the results of high-dose and low-dose nicardipine treatment are virtually equivalent, but administration of low-dose nicardipine is attended by fewer side effects.

Comparison of the effect of adding remifentanil to patient-controlled tramadol or morphine for postoperative analgesia after major abdominal surgery

2018 ◽  
Vol 5 (5) ◽  
pp. 247 ◽  
Author(s):  
Hakki Unlugenc, MD ◽  
Sibel Tetiker, MD ◽  
Selim Büyükkurt, MD ◽  
Tayfun Guler, MD ◽  
Geylan Isik, MD
Keyword(s):  
Side Effects ◽  
Abdominal Surgery ◽  
Outcome Measure ◽  
Major Abdominal Surgery ◽  
Morphine Consumption ◽  
Patient Controlled Analgesia ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Pain Scores ◽  
To Receive

Objective: In this study, the authors investigated the effect of the addition of remifentanil to tramadol or morphine for patient-controlled analgesia (PCA).Design: Prospective, randomized, double-blind, controlled study.Setting: University Hospital.Patients, participants: The authors randomly allocated 133 patients undergoing major abdominal surgery to receive IV PCA with tramadol alone, tramadol plus remifentanil, morphine alone or morphine plus remifentanil.Interventions: Bolus doses of tramadol (0.2 mg/kg), tramadol (0.2 mg/kg) plus remifentanil (0.2 μg/kg), morphine (0.02 mg/kg), or morphine (0.02 mg/kg) plus remifentanil (0.2 μg/kg) were available every 10 minutes without time limit or background infusion.Main outcome measure(s): Discomfort, sedation, pain scores, side effects, and total and bolus tramadol and morphine consumption were recorded for up to 24 hours after the start of PCA.Results: Pain scores at rest and movement were greater with tramadol alone than in the other groups at 1, 2, and 6 hours (p < 0.0125). The addition of remifentanil reduced cumulative tramadol consumption at 6, 12, and 24 hours, but not morphine consumption. More patients required supplementary rescue analgesia with meperidine, and with greater dosage, with tramadol alone (p < 0.001), and the incidence of nausea was greater with tramadol alone. The addition of remifentanil not only significantly improved discomfort scores in remifentanil groups, but also increased the degree of sedation in morphine-remifentanil group.Conclusions: After major abdominal surgery, adding remifentanil to PCA tramadol resulted in better pain scores, lower analgesic consumption, and fewer side effects when compared with tramadol alone. However, analgesic outcome with remifentanil was not prominent in MR group as much as in TR group.

scholarly journals Combination of Low-dose Nalbuphine and Morphine in Patient-controlled Analgesia Decreases Incidence of Opioid-related Side Effects

2009 ◽  
Vol 108 (7) ◽  
pp. 548-553 ◽  
Author(s):  
Yu-Chang Yeh ◽  
Tzu-Fu Lin ◽  
Hung-Chi Chang ◽  
Wing-Sum Chan ◽  
Yong-Ping Wang ◽  
...  
Keyword(s):  
Side Effects ◽  
Low Dose ◽  
Patient Controlled Analgesia

Low-dose Clonidine and Neostigmine Prolong the Duration of Intrathecal Bupivacaine–Fentanyl for Labor Analgesia

2000 ◽  
Vol 92 (2) ◽  
pp. 361-361 ◽  
Author(s):  
Medge D. Owen ◽  
Özer Özsaraç ◽  
Şükran Şahin ◽  
Nesimi Uçkunkaya ◽  
Nuray Kaplan ◽  
...  
Keyword(s):  
Side Effects ◽  
Low Dose ◽  
Fetal Heart ◽  
Vital Signs ◽  
Labor Analgesia ◽  
Pain Scores ◽  
Active Labor ◽  
Effective Pain Relief ◽  
Spinal Epidural ◽  
To Receive

Background Intrathecal (IT) opioid and local anesthetic combinations are popular for labor analgesia because of rapid, effective pain relief, but the duration of analgesia is limited. This study was undertaken to determine whether the addition of clonidine and neostigmine to IT bupivacaine-fentanyl would increase the duration of analgesia without increasing side effects for patients in labor. Methods Forty-five healthy parturients in active labor were randomized to receive a 2-ml IT dose of one of the following dextrose-containing solutions using the combined spinal-epidural technique: (1) bupivacaine 2.5 mg and fentanyl 25 microg (BF); (2) BF plus clonidine 30 microg (BFC); or (3) BFC plus neostigmine 10 microg (BFCN). Pain, sensory levels, motor block, side effects, maternal vital signs, and fetal heart rate were systematically assessed. Results Patients administered BFCN had significantly longer analgesia (165+/-32 min) than those who received BF (90+/-21 min; P&lt;0.001) or BFC (123+/-21 min; P&lt;0.001). Pain scores, block characteristics, maternal vital signs, Apgar scores, maternal satisfaction, and side effects were similar among groups except for nausea, which was significantly greater in the BFCN group (P&lt;0.05 as compared with BFC). Conclusions The addition of clonidine and neostigmine significantly increased the duration of analgesia from IT bupivacaine-fentanyl during labor, but neostigmine caused more nausea. Although serious side effects were not observed in this study, safety must be further addressed before the routine use of multiple IT drugs is advocated.

CONTRACEPTION IN DIABETIC PATIENTS

1974 ◽  
Vol 77 (3_Suppl) ◽  
pp. S87-S94 ◽  
Author(s):  
J. Wiese ◽  
M. Osler
Keyword(s):  
Side Effects ◽  
Contraceptive Method ◽  
Low Dose ◽  
Unplanned Pregnancy ◽  
Intrauterine Device ◽  
Diabetic Patients ◽  
Intrauterine Contraception ◽  
Unwanted Pregnancies ◽  
Unreliable Method ◽  
Retrospective Investigation

ABSTRACT A retrospective investigation was made of contraception in diabetic women delivered in our department in 1969 and 1970. Seventy-nine (69 per cent) answered the questionnaires. About one third had found the contraceptive instruction insufficient. A shift from conventional to intrauterine contraception and sterilization was seen, but nearly 25% of the patients were still using conventional methods, mainly the condom. The patients consider this an unreliable method. Thirty-three patients were using intrauterine contraception. Although 10 of them had bleeding irregularities, all were satisfied with the method. Sterilization had been performed on 17 patients, all of whom were fully satisfied and had experienced no side effects. Four of 11 insulin-requiring diabetics, who have used combined oestrogen-progesterone medication have had difficulties in the regulation of the diabetes. Of 24 unwanted pregnancies 12 occurred since the hospitalization in 1969 and 1970. In diabetic women the contraceptive method should either be sterilization, intrauterine device or low dose progestagens, and only in a few cases conventional. A thorough contraceptive instruction as well as a close control of the diabetic women are of importance in order to avoid unplanned pregnancy. The best way to achieve this is by having an out-patient clinic in connection with the obstetrical department to supervise contraception in all diabetic women in the area.

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