Comparison of Morphine, Ketorolac, and Their Combination for Postoperative Pain

2005 ◽  
Vol 103 (6) ◽  
pp. 1225-1232 ◽  
Author(s):  
Maria Soledad Cepeda ◽  
Daniel B. Carr ◽  
Nelcy Miranda ◽  
Adriana Diaz ◽  
Claudia Silva ◽  
...  
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Confidence Interval ◽  
Pain Intensity ◽  
Controlled Trial ◽  
Morphine Group ◽  
Opioid Sparing ◽  
Numbers Needed To Treat ◽  
Sparing Effect ◽  
Analgesic Administration

Background Meta-analyses report similar numbers needed to treat for nonsteroidal antiinflammatory drugs (NSAIDs) and opioids. Differences in baseline pain intensity among the studies from which these numbers needed to treat were derived may have confounded the results. NSAIDs have an opioid-sparing effect, but the importance of this effect is unclear. Therefore, the authors sought to compare the proportions of subjects who obtain pain relief with ketorolac versus morphine after surgery and to determine whether the opioid-sparing effect of an NSAID reduces the magnitude of opioid side effects. Methods The study was a double-blind, randomized controlled trial. The authors randomly assigned 1,003 adult patients to receive 30 mg ketorolac or 0.1 mg/kg morphine intravenously. They calculated the proportion of subjects who achieved at least 50% reduction in pain intensity 30 min after analgesic administration. Further, so long as pain intensity 30 min after analgesic administration was 5 or more out of 10, patients received 2.5 mg morphine every 10 min until pain intensity was 4 or less out of 10. The authors assessed the presence of opioid-related side effects. Results Five hundred patients received morphine and 503 received ketorolac. Fifty percent of patients in the morphine group achieved pain relief, compared with 31% in the ketorolac group (difference, 19%; 95% confidence interval, 13-25%). The ketorolac-morphine group required less morphine (difference, 6.5 mg; 95% confidence interval, -5.8 to -7.2) and had a lower incidence of side effects (difference, 11%; 95% confidence interval, 5-16%) than the morphine group. Conclusions Opioids are more efficacious analgesics than NSAIDs, although historic data for these two drugs yield similar numbers needed to treat. Adding NSAIDs to the opioid treatment reduces morphine requirements and opioid-related side effects in the early postoperative period.

A Multicenter Dose-escalation Study of the Analgesic and Adverse Effects of an Oral Cannabis Extract (Cannador) for Postoperative Pain Management

2006 ◽  
Vol 104 (5) ◽  
pp. 1040-1046 ◽  
Author(s):  
Anita Holdcroft ◽  
Mervyn Maze ◽  
Caroline Doré ◽  
Susan Tebbs ◽  
Simon Thompson
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Adverse Effects ◽  
Confidence Interval ◽  
Pain Intensity ◽  
Dose Escalation ◽  
Number Needed To Treat ◽  
Patient Controlled Analgesia ◽  
Rescue Analgesia

Background Cannabinoids have dose-related antinociceptive effects in animals. This clinical study aimed to investigate whether a single oral dose of cannabis plant extract (Cannador; Institute for Clinical Research, IKF, Berlin, Germany) could provide pain relief with minimal side effects for postoperative pain. Methods Patients (aged 18-75 yr) were recruited and consented before surgery if patient-controlled analgesia was planned for provision of postoperative pain relief. Each patient received a single dose of 5, 10, or 15 mg Cannador if he or she had at least moderate pain after stopping patient-controlled analgesia. Starting with 5 mg, dose escalation was based on the number of patients requesting rescue analgesia and adverse effects. Pain relief, pain intensity, and side effects were recorded over 6 h and analyzed using tests for trend with dose. Results Rescue analgesia was requested by all 11 patients (100%) receiving 5 mg, 15 of 30 patient (50%) receiving 10 mg, and 6 of 24 patients (25%) receiving 15 mg Cannador (log rank test for trend in time to rescue analgesia with dose P < 0.001). There were also significant trends across the escalating dose groups for decreasing pain intensity at rest (P = 0.01), increasing sedation (P = 0.03), and more adverse events (P = 0.002). The number needed to treat to prevent one rescue analgesia request for the 10-mg and 15-mg doses, relative to 5 mg, were 2.0 (95% confidence interval, 1.5-3.1) and 1.3 (95% confidence interval, 1.1-1.7), respectively. The study was terminated because of a serious vasovagal adverse event in a patient receiving 15 mg. Conclusion These significant dose-related improvements in rescue analgesia requirements in the 10 mg and 15 mg groups provide a number needed to treat that is equivalent to many routinely used analgesics without frequent adverse effects.

Oral morphine gargles: A cost effective approach for pain relief in patients with chemoradiation induced acute oral mucositis in head and neck cancers

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20504-e20504
Author(s):  
C. Haritha ◽  
V. Shankar
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Supportive Care ◽  
Head And Neck ◽  
Oral Mucositis ◽  
Oral Morphine ◽  
Head And Neck Cancers ◽  
Control Group ◽  
Morphine Group ◽  
Systemic Side Effects

e20504 Background: Painful oral mucositis is the most significant dose-limiting toxicity in head & neck cancer patients treated with conc. CT-RT protocol. The purpose of this study is to evaluate the efficacy of oral morphine gargles in reducing the severity of chemoradiation induced mucositis pain & thus, its impact on nutrition, quality of life & cost of supportive care, during the treatment period. Methods: 106 consecutive patients, recruited between May 2006 through Dec. 2007, with adv. head and neck cancers (54 oropharynx, 42 hypopharynx & 10 nasopharynx) were included in the study. All patients underwent treatment under conc. CT-RT (Inj.CDDP 40mg/m2 weekly, RT: 66–70gy/33–35# @200cgy/# delivered by 3D- CRT). Patients who had painful mucositis (RTOG Grade 3 or more) not controlled with magic mouthwash, Tab. Acetaminophen 500mg qds or Tab.Tramdol 50–100 mg tds were randomized into 2 groups: morphine group (MOP) -53 patients & Control group (CON) - 53 patients. Patients in both groups received adjusted doses of oral steroids based on the severity of oral mucositis. While CON group patients were given adjusted doses of tramadol, MOP group patients were assigned to 15ml of 2% morphine gargles administered every 4th hourly. Patients were instructed not to swallow the rinses and to hold the solution in the mouth for 3mins duration. All patients underwent weekly recording of (1) response to pain rated on VAS (2) weight (3) morphine systemic side-effects (4) QOL Questionnaire. Mann-Whitney test and ’T’ Test are used for statistical analysis of the data. Results: Patients in the MOP group had significant lower pain intensity scores, better QOL scores & less weight loss compared to patients in the CON group. The duration of the severe pain was atleast 1 week shorter in the MOP group. Systemic side-effects secondary (nausea, vomiting, constipation) to opiod use were significantly lower in the MOP group. The Cost of supportive care for pain management was less in the MOP group, with greater compliance for the treatment. Conclusions: Morphine gargles, in our experience, is an effective approach for pain relief in patients with CT-RT induced acute mucositis in head and neck cancers thus leading to better nutrition & compliance in the treatment. No significant financial relationships to disclose.

Opioid-Sparing Effect of Intravenous Paracetamol After Percutaneous Nephrolithotomy: A Double-Blind Randomized Controlled Trial

2014 ◽  
Vol 28 (1) ◽  
pp. 23-27 ◽  
Author(s):  
Robab Maghsoudi ◽  
Meghdad Tabatabai ◽  
Mohammad Hadi Radfar ◽  
Gholamreza Movasagi ◽  
Masoud Etemadian ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Percutaneous Nephrolithotomy ◽  
Controlled Trial ◽  
Double Blind ◽  
Randomized Controlled ◽  
Opioid Sparing ◽  
Intravenous Paracetamol ◽  
Sparing Effect

Relationship between time to onset of relief and total pain relief of breakthrough pain in patients with cancer using fentanyl pectin nasal spray.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19544-e19544
Author(s):  
John D. Conroy ◽  
Luis M. Torres ◽  
Julia Revnic ◽  
Ravi Tayi ◽  
Michael Sidney Perelman ◽  
...  
Keyword(s):  
Pain Relief ◽  
Pain Intensity ◽  
Nasal Spray ◽  
Breakthrough Pain ◽  
Controlled Trial ◽  
Rapid Onset ◽  
Dose Titration ◽  
Total Pain ◽  
Time To Onset ◽  
The Relationship

e19544 Background: Breakthrough pain in cancer (BTPc) is typified by a rapid onset of severe pain with a limited duration. Treatment for BTPc requires rapid onset of pain relief. The main purpose of this analysis was to assess the relationship between time to onset of pain relief and overall pain relief in patients treating BTPc with fentanyl pectin nasal spray (FPNS, Lazanda, PecFent). Methods: Data were pooled from FPNS-treated episodes of 2 randomized, double-blind, crossover studies assessing efficacy of FPNS in adults who experienced BTPc despite background pain that was adequately controlled with at least 60 mg/day morphine (or equivalent). Patients initially entered a dose-titration phase to establish dose of FPNS (100 to 800 mcg) to be used during the treatment phase of each study. Pain intensity (PI) was assessed at baseline and scheduled time points on an 11-point scale (0=no pain, 10=worst possible pain). This analysis assessed the relationship of time to onset of pain relief (≥1 point reduction in PI from baseline) to total pain relief (Summed Pain Intensity Difference [SPID] at 30 and 60 min postdose [SPID30 and SPID60]) by ANOVA. Responses are also provided for the placebo-treated episodes during the placebo-controlled trial. Results: There were 831 episodes of BTPc that were treated with FPNS. Mean SPID was highest when pain relief was earliest (p<0.001). When PI difference (PID) ≥1 was attained by 5, 10, and 15 min postdose, mean (SD) SPID30 scores were 13.1 (6.7), 7.6 (4.0), and 3.5 (1.8). In the placebo-controlled trial, a similar overall response (p<0.001) was observed during the 200 placebo-treated episodes: among those attaining PID ≥1 by 5, 10, and 15 min postdose, SPID30 was 12.2 (7.0), 5.3 (3.3), and 2.5 (1.0), respectively. Similarly, significant differences were observed for SPID60 with both treatments. Conclusions: Earlier time to onset of pain intensity reduction in BTPc treatment resulted in higher SPID at 30 and 60 minutes postdose of FPNS and placebo. Results suggest that early onset of relief may be associated with a greater overall degree of relief for episodes of BTPc, which emphasizes the need for rapid-acting agents in the management of breakthrough pain.

Analgesic administration, pain intensity, and patient satisfaction in cardiac surgical patients

1995 ◽  
Vol 4 (6) ◽  
pp. 435-442 ◽  
Author(s):  
DA Meehan ◽  
ME McRae ◽  
DA Rourke ◽  
C Eisenring ◽  
FA Imperial
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Satisfaction ◽  
Pain Management ◽  
Pain Relief ◽  
Pain Intensity ◽  
Analogue Scale ◽  
Nursing Practice ◽  
Surgical Patients ◽  
Analgesic Administration

BACKGROUND: Pain can adversely affect a patient's physiological and psychological recovery, yet little is known about the pain experience of cardiac surgical patients. OBJECTIVES: To examine nursing practice regarding analgesic administration and measure pain intensity and patient satisfaction with pain management practices. METHODS: To establish baseline nursing practice regarding analgesic administration, charts were reviewed retrospectively in 50 adult cardiac surgical patients, and the same information was collected concurrently for a prospective sample of 51 patients. The subjects completed visual analogue scales as a measure of pain intensity twice daily while in the cardiothoracic intensive care unit and Pain Relief Satisfaction Questionnaires on the day after transfer from the unit. RESULTS: Patients in the prospective group received significantly more analgesia. Pain intensity was moderate (4 or greater on the Visual Analogue Scale). Women had higher overall visual analogue scale scores than did men, 4.57 versus 3.70. Patients in whom an internal mammary artery had been used as a bypass graft had significantly higher scores compared with patients with vein grafts. The Pain Relief Satisfaction Questionnaire responses indicated that 96% of the patients experienced effective pain management in the cardiothoracic intensive care unit. CONCLUSIONS: Despite receiving analgesic doses twice those reported elsewhere for similar populations, the patients in this study reported moderate pain intensity. This finding was confounded by the fact that 96% expressed satisfaction with their pain management in the cardiothoracic intensive care unit. Frequent assessment and documentation of both pain and pain relief from interventions are necessary if the healthcare team is to implement an individualized analgesic regimen.

A Randomized Controlled Trial of Patient Controlled Analgesia Versus Continuous Infusion of Morphine during Vaso-Occlusive Crisis in Sickle Cell Disease.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3805-3805
Author(s):  
Eduard J. Beers van ◽  
Charlotte F.J. Tuijn van ◽  
Pythia T. Nieuwkerk ◽  
Philip W. Friederich ◽  
Marcel M. Levi ◽  
...  
Keyword(s):  
Side Effects ◽  
Pain Intensity ◽  
Sickle Cell ◽  
Controlled Trial ◽  
Morphine Consumption ◽  
Cell Disease ◽  
Patient Controlled Analgesia ◽  
Morphine Dose ◽  
Randomized Controlled ◽  
The Mean

Abstract Intravenous morphine is the treatment of choice for severe pain during vaso-occlusive crisis in sickle cell disease (SCD). However, side-effects of morphine may hamper effective treatment and high plasma levels of morphine are associated with severe complications such as acute chest syndrome. Furthermore, adequate dosing remains a problem since no objective measurement of pain severity exists and analgesia should be titrated upon the patient’s reported pain. Patient-controlled analgesia (PCA) may therefore be an interesting alternative since patients can titrate the level of analgesia themselves. Although PCA is currently used for the treatment of vaso-occlusive crises in SCD, no randomized controlled trials have been performed in admitted patients with a vaso-occlusive crisis so far. In the present study, we conducted a randomized controlled trial to compare the administration of morphine with PCA versus CI in sickle cell patients with vaso-occlusive crises. Patients were randomized between PCA and CI of morphine within 24 hours after hospital admission. Endpoints of the study were: the mean and cumulative morphine dose, pain intensity, incidence of side-effects (nausea, constipation, pruritus and drowsiness) and quality of life (QoL). Pain intensity was measured daily using a ten-point-scale verbal pain score. Reduction of pain intensity was measured by subtracting a pain score on a ten point visual analogue scale (VAS) before randomization from the same measurement two days after randomization. Side-effects were measured four times per day on a 11-point numerical rating scale. QoL was measured using the 36-item Short Form Healthy Survey (SF36). Twenty five consecutive episodes of vaso-occlusive crisis in 19 patients with SCD were included in the study. No difference in the mean daily pain scores were found between the two groups (4.9 versus 5.3). However, patients in the PCA-group demonstrated to have a strongly reduced mean and cumulative morphine consumption as compared to the patients in the CI-group (0.5 mg/h versus 2.4 mg/h (P<0.001) and 33 mg versus 260 mg (P=0.018) respectively). The lower mean and cumulative morphine consumption in the PCA-group led to significant less nausea and constipation during treatment as compared to the CI-group (area under the curve respectively 11 versus 18 (P= 0.045) and 30 versus 45 (P= 0.021)). Furthermore, a non-significant reduction in the duration of hospital admission of 3 days was observed in the PCA-group. Patient controlled analgesia results in adequate pain relief at a much lower morphine consumption and should considered to be first choice in morphine administration to sickle cell patients admitted with vaso-occlusive crisis. Figure. Mean morphine dose per patient Figure. Mean morphine dose per patient

scholarly journals Pregabalin has an opioid-sparing effect in elderly patients after cardiac surgery: a randomized placebo-controlled trial

2011 ◽  
Vol 106 (6) ◽  
pp. 873-881 ◽  
Author(s):  
A. Pesonen ◽  
R. Suojaranta-Ylinen ◽  
E. Hammarén ◽  
V.K. Kontinen ◽  
P. Raivio ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Elderly Patients ◽  
Controlled Trial ◽  
Opioid Sparing ◽  
Sparing Effect

scholarly journals Chronic Use of Opioids for Nonmalignant pain: A Prospective Study

1997 ◽  
Vol 2 (2) ◽  
pp. 101-107 ◽  
Author(s):  
Perry N Fuchs ◽  
Ann Gamsa
Keyword(s):  
Substance Abuse ◽  
Side Effects ◽  
Pain Relief ◽  
Pain Intensity ◽  
Leisure Activities ◽  
Opioid Therapy ◽  
Social Activities ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

OBJECTIVE: To assess the effects of long term opioid therapy on pain, mood, and social and leisure activities in patients with chronic nonmalignant pain.METHODS: Fourteen patients (eight males and six females) were treated with opioid medications for chronic nonmalignant pain not improved by previous treatments. Baseline measures of pain intensity were obtained before introducing opioids. Patients were monitored throughout the study, with outcome measured four to 32 months after opioids were started. The final measures examined drug dose, side effects, pain level, pain relief, emotional status, and involvement in social and leisure activities.RESULTS: A total of 64.3% of patients reported good to excellent pain relief with opioid medication, and 64.3% reported reduced pain intensity, the decrease ranging from 25% to 100% (from baseline measures) on a scale rated from 0 to 10. As well, 64.3% scored their emotional state as 5 or better on the 0 to 10 scale (0 indicating greatest distress), and 64.3% reported at least moderate (at least 5 on the 0 to 10 scale) involvement in leisure and social activities. There was a significant negative correlation between pain intensity and amount of leisure and social activity; 88.9% of patients who reported moderate to full involvement in leisure and social activities also noted decreased pain on the 0 to 10 scale. Other than one patient who developed tolerance, there were no notable problems with dose escalation or with any other form of substance abuse.CONCLUSIONS: Some patients with chronic nonmalignant pain benefit from long term opioid therapy without developing unmanageable side effects, tolerance or substance abuse problems. These results, together with previous findings, show that opioids can be a safe and useful long term treatment for chronic nonmalignant pain.

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