Postoperative Intravenous Morphine Consumption, Pain Scores, and Side Effects with Perioperative Oral Controlled-Release Oxycodone After Lumbar Discectomy

Background Previous studies have shown that genetic variability at position 118 of the human mu-opioid receptor gene altered patients' response to intravenous morphine. The purpose of this study was to investigate whether this polymorphism contributes to the variability in response to morphine for postcesarean analgesia. Methods After investigators obtained informed consent, 588 healthy women received 0.1 mg intrathecal morphine for postcesarean analgesia. Their blood samples were genotyped for the A118G polymorphism-A118 homozygous (AA), heterozygous (AG), or homozygous for the G allele (GG). Pain scores, the severity of nausea and vomiting, the incidence of pruritus, and the total self-administered intravenous morphine were recorded for the first 24 postoperative hours. Results Two hundred seventy women (46%) were AA, 234 (40%) were AG, and 82 (14%) were GG. The 24-h self-administered intravenous morphine consumption was lowest in the AA group (P = 0.001; mean, 5.9; 95% confidence interval, 5.1-6.8) versus the AG (8.0; 6.9-9.1) and GG groups (9.4; 7.3-11.5). Pain scores were lowest in the AA group and highest in the GG group, with a statistically significant difference detected between AA, AG, and GG (P = 0.049). Total morphine consumption was also influenced by patients' age and paying status. AA group was associated with the highest incidence of nausea (26 of 272 [9.6%]; P = 0.02) versus the other two groups (13 of 234 [5.6%] and 1 of 82 [1.2%] for AG and GG, respectively). Conclusion Genetic variation at position 118 of the mu-opioid receptor is associated with interindividual differences in pain scores, self-administered intravenous morphine, and the incidence of nausea postoperatively.

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Early postoperative patient-controlled analgesia ratio predicts 24-hour morphine consumption and pain in children undergoing scoliosis surgery

Journal of Opioid Management ◽

10.5055/jom.2014.0190 ◽

2014 ◽

Vol 10 (1) ◽

pp. 39 ◽

Cited By ~ 5

Author(s):

Clyde T. Matava, MBCHB ◽

Mark W. Crawford, MBBS ◽

Carolyne Pehora, RN ◽

Basem Naser, MD ◽

Conor McDonnell, MBCHB

Keyword(s):

Side Effects ◽

Postoperative Pain ◽

Hospital Stay ◽

Univariate Analysis ◽

Morphine Consumption ◽

Scoliosis Surgery ◽

Patient Controlled Analgesia ◽

Duration Of Hospital Stay ◽

Pain Scores ◽

Severe Postoperative Pain

Background: The identification of patients at risk for developing severe postoperative pain and/or opioid-related side effects is difficult due to a lack of sensitive indicators. The patient-controlled analgesia (PCA) ratio of demands to deliveries is a potential tool for early identification of patients who experience severe postoperative pain. The authors hypothesized that the PCA ratio is able to predict morphine requirement in the first 24 hours after scoliosis surgery.Methods: The authors performed a retrospective study of adolescents who had surgery for idiopathic scoliosis. They collected data describing PCA demands and deliveries, morphine consumption, numerical rating scale (NRS) pain scores, opioidrelated side effects, and duration of hospital stay. Spearman rank analysis assessed association among 4-hour PCA ratios, NRS pain score, and 24-hour morphine consumption. Patients were divided into groups on the basis of PCA ratios <1.5 and ≥1.5. Univariate analysis and multiple regression were used to identify independent factors predictive for increased 24-hour morphine. Mann-Whitney rank-sum and Fisher exact tests were used to compare data. p < 0.05 was considered statistically significant.Results: One hundred forty-seven patients were included in the analysis, mean (SD) age and weight were 15 (1.8) years and 55 (27) kg, respectively. There was a significant positive correlation between the 4-hour PCA ratio and initial 24-hour cumulative morphine consumption (r = 0.33, p = 0.0002). Patients with a 4-hour PCA ratio ≥1.5 demonstrated a significantly greater initial 24-hour morphine consumption (p = 0.0002), greater pain scores at 24 hours after surgery (p = 0.02), a greater incidence of at least one opioid-related side effect within the initial 24 hours after surgery, and a longer duration of hospital stay (p = 0.04) compared with those patients with a 4-hour PCA ratio <1.5. PCA ratio ≥1.5, age, and patient sex were predictive for 24-hour morphine consumption.Conclusions: The authors have demonstrated that a PCA ratio of demands/deliveries ≥1.5 is predictive of increased opioid requirements and is associated with greater pain scores in the initial 24 hours after surgery, an increased incidence of opioid-related side effects, and duration of hospital stay.

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Effects of 3 analgesic regimens on the perception of pain after removal of femoral artery sheaths

American Journal of Critical Care ◽

10.4037/ajcc2000.9.2.125 ◽

2000 ◽

Vol 9 (2) ◽

pp. 125-129 ◽

Cited By ~ 15

Author(s):

TR Fulton ◽

GI Peet ◽

MA McGrath ◽

JD Hilton ◽

RE Smith ◽

...

Keyword(s):

Side Effects ◽

Femoral Artery ◽

Coronary Angioplasty ◽

Percutaneous Transluminal Coronary Angioplasty ◽

Rescue Analgesia ◽

Intravenous Fentanyl ◽

Pain Scores ◽

Intravenous Morphine ◽

Transluminal Coronary Angioplasty ◽

Percutaneous Transluminal

BACKGROUND: Effective pain management after removal of femoral artery sheaths after percutaneous transluminal coronary angioplasty is highly individualized and requires frequent, accurate assessment and administration of analgesics as needed. OBJECTIVE: To determine which of 3 analgesic regimens is most effective in decreasing patients' perception of pain with the fewest side effects after removal of a femoral artery sheath. SAMPLE: 130 adult who had undergone percutaneous transluminal coronary angioplasty and were in an 8-bed cardiac short-stay unit in a 1400-bed acute care hospital. METHOD: Patients were randomized to receive either intravenous morphine, intravenous fentanyl, subcutaneous lidocaine around the sheath site, or an intravenous placebo before sheath removal. Rescue analgesia (intravenous fentanyl) was made available to all groups. Patients used a visual analog scale to assess pain within 10 minutes before, 1 minute after, and 20 minutes after sheath removal. Pain levels, frequency of side effects, and use of rescue analgesia were compared among groups. RESULTS: Age, sex, number of stents, and frequency of hematomas did not differ significantly among groups. Pain ratings, use of rescue analgesia, and side effects (nausea, vomiting, or vasovagal symptoms) were not significantly different among treatment groups. Ratings of pain were slightly higher immediately after sheath removal in all groups. CONCLUSION: For most patients, removal of femoral artery sheaths and manual compression for hemostasis are relatively pain-free. Pain scores among patients given analgesia with subcutaneous lidocaine, intravenous morphine, or intravenous fentanyl were not significantly different from pain scores among control patients.

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Analgesic Effects of Gabapentin after Spinal Surgery

Anesthesiology ◽

10.1097/00000542-200404000-00025 ◽

2004 ◽

Vol 100 (4) ◽

pp. 935-938 ◽

Cited By ~ 152

Author(s):

Alparslan Turan ◽

Beyhan Karamanlıoğlu ◽

Dilek Memiş ◽

Mustafa Kemal Hamamcıoglu ◽

Barış Tükenmez ◽

...

Keyword(s):

Placebo Group ◽

Side Effects ◽

Spinal Surgery ◽

Early Postoperative Period ◽

Morphine Consumption ◽

Control Group ◽

Double Blind Study ◽

Double Blind ◽

Pain Scores ◽

Incremental Dose

Background A combination of opioid and nonopioid analgesic drugs may improve the quality of postoperative analgesia as well as reduce opioid requirements and their associated side effects. Studies have shown synergism between gabapentin and morphine in animal and human experiments and in the treatment of incisional pain. Therefore, the authors investigated, in a randomized, placebo-controlled, double-blind study, the effects of gabapentin on acute postoperative pain and morphine consumption in patients undergoing spinal surgery. Methods After standard premedication, 25 patients in the control group received oral placebo, and 25 patients in the gabapentin group received 1,200 mg of gabapentin, 1 h before surgery in a randomized fashion. Anesthesia was induced with propofol and cisatracurium and was maintained with sevoflurane and remifentanil. The total intraoperative remifentanil consumption by each patient was noted. All patients postoperatively received patient-controlled analgesia with morphine (1 mg/ml) with an incremental dose of 2 mg, a lockout interval of 10 min, and a 4-h limit of 40 mg. The incremental dose was increased to 3 mg, and the 4-h limit to 50 mg, if analgesia was inadequate after 1 h. Patients were questioned for the first 1 h in the PACU and were later evaluated in the ward at 1, 2, 4, 6, 12, and 24 h. Pain scores, heart rate, oxygen saturation measured by pulse oximetry, mean blood pressure, respiratory rate, sedation, morphine use, and total dose of morphine were recorded. Results Overall, pain scores at 1, 2, and 4 h were significantly lower in the gabapentin group when compared with the placebo group. Total morphine consumption in the gabapentin group was 16.3 +/- 8.9 mg (mean +/- SD) versus 42.8 +/- 10.9 mg in the placebo patients. The incidence of vomiting and urinary retention was significantly (P < 0.05) higher in the placebo group, but there was no difference in incidence of other adverse effects between the groups. Conclusions Preoperative oral gabapentin decreased pain scores in the early postoperative period and postoperative morphine consumption in spinal surgery patients while decreasing some morphine-associated side effects.

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

Journal of Opioid Management ◽

10.5055/jom.2009.0027 ◽

2018 ◽

Vol 5 (5) ◽

pp. 247 ◽

Cited By ~ 3

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.

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Intercostal nerve block in pediatric minimally invasive thoracic surgery

Acta medica Lituanica ◽

10.6001/actamedica.v19i3.2438 ◽

2012 ◽

Vol 19 (3) ◽

pp. 150-153 ◽

Cited By ~ 2

Author(s):

Laura Lukošienė ◽

Lina Kalibatienė ◽

Vidmantas Barauskas

Keyword(s):

Side Effects ◽

Nerve Block ◽

Intercostal Nerve ◽

Early Postoperative Period ◽

Morphine Consumption ◽

Single Shot ◽

Intercostal Nerve Block ◽

Pain Scores ◽

Severe Postoperative Pain ◽

Minimally Invasive Thoracic Surgery

Background. Very severe postoperative pain is observed after minimal ly invasive repair of pectus excavatum (MIRPE), extremely in the early postoperative period. Pain is usually managed by either thoracic epidu ral block (TEB) or intravenous patient-controlled analgesia (PCA) with opioids. But the issue of optimal pain management is still controversial. The purpose of our study was to investigate efficiency and side effects of intercostal nerve block (ICNB) in children after MIRPE in comparison with only PCA. Materials and methods. Records of 20 patients, given PCA with mor phine (PCA group), were examined retrospectively. 27 patients, given in traoperative ICNB (single shot) and PCA with morphine (ICNB group), were examined prospectively. Postoperatively, we recorded morphine consumption, pain scores and side effects every 3 hours. Results. There was no need of the initial dose of morphine in the ICNB group. Pain scores during the first 3 hours, morphine consumption dur ing the first 3 hours and during 12 hours after surgery were significantly higher in the PCA group (p

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Interpleural Morphine vs Bupivacaine for Postthoracotomy Pain Relief

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230801600506 ◽

2008 ◽

Vol 16 (5) ◽

pp. 370-374 ◽

Cited By ~ 5

Author(s):

Shideh Dabir ◽

Tahereh Parsa ◽

Badiozaman Radpay ◽

Mojgan Padyab

Keyword(s):

Side Effects ◽

Posterolateral Thoracotomy ◽

Morphine Group ◽

Double Blind ◽

Analgesic Effects ◽

Pain Scores ◽

Postthoracotomy Pain ◽

Intravenous Morphine ◽

American Society ◽

American Society Of Anesthesiologists

This prospective randomized double-blind trial was designed to compare the analgesic effects of interpleural bupivacaine and interpleural morphine for postthoracotomy pain management. Thirty-six American Society of Anesthesiologists class I and II patients undergoing an elective posterolateral thoracotomy were randomly divided into 2 groups of 18 each. Before chest closure, an interpleural catheter was inserted under direct vision. At the end of the operation and every 4 hours thereafter, they received either 0.25% bupivacaine with epinephrine or 0.2 mg·kg−1 morphine sulfate interpleurally for 24 hours. The chest tubes were clamped during injection and for 15 min afterwards. Supplementary doses of intravenous morphine were given on request. The pain severity was evaluated at rest and on coughing before and 30 min after each interpleural injection, using an 11-point visual analog scale. Supplemental analgesic consumption and side effects were recorded. Both interpleural morphine and bupivacaine significantly reduced pain scores 30 min after each injection. However, pain scores and supplementary analgesic requirements were significantly lower in the interpleural morphine group. No serious side effects were detected in either group. Interpleural morphine provides better pain control than interpleural bupivacaine after a posterolateral thoracotomy.

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EFFICACY OF TRANSVERSUS ABDOMINIS PLANE BLOCK FOR POST CESAREAN DELIVERY ANALGESIA

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.5.5 ◽

2018 ◽

Vol 8 (5) ◽

pp. 37-41

Author(s):

Minh Nguyen Van ◽

Nga Bui Thi Thuy ◽

Thinh Tran Xuan

Keyword(s):

Caesarean Section ◽

Visual Analogue Scale ◽

Analogue Scale ◽

Transversus Abdominis Plane Block ◽

Transversus Abdominis ◽

Morphine Consumption ◽

Block Group ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Pain Scores

Background: The transversus abdominis plane block (TAP block), a regional block, provides effective analgesia after lower abdominal surgeries. The objective of this study was to assess whether transversus abdominis plane block is effective as part of multimodal pain management following Cesarean section. Materials and Method: Totally, 60 ASA I and II parturients for Cesarean section via Pfannenstiel incision under spinal anesthesia were randomly allocated to either the TAP block group or the control. The TAP block group received a landmark-orientated, bilateral TAP block with 0.25% levobupivacain 17,5ml each side in the triangle of Petit. Postoperative pain treatment followed the same protocole for both groups with 1gram paracetamol intravenously and received patrient-controlled analgesia with intravenous morphine. The time to first request of analgesic, morphine consumption, visual analogue scale (VAS) pain scores and side effects were scored at 2, 4, 6, 8, 12 h postoperatively. Results: The time to first request of analgesic was longer, morphine consumption was lower in TAP group than in the control (p < 0.05). Visual analogue scale (VAS) pain scores at rest and on mouvement were similar in two groups at 2h, but lower in TAP group from 4h (p < 0.05). No severe adverse effects were detected in two groups. Conclusion: TAP block prolonged the time to fisrt request of analgesic and reduced morphine consumption, the VAS pain scores significantly both at rest and on mouvement. Therefore, TAP block is feasible and effective as part of a multimodal analgesia regimen after Caesarean section. Key words: Caesarean section, multimodal pain management, transversus abdominis plane block

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Encapsulation of Imatinib in Targeted KIT-5 Nanoparticles for Reducing its Cardiotoxicity and Hepatotoxicity

Anti-Cancer Agents in Medicinal Chemistry ◽

10.2174/1871520620666200619174323 ◽

2020 ◽

Vol 20 (16) ◽

pp. 1966-1980

Author(s):

Jaleh Varshosaz ◽

Saeedeh Fardshouraki ◽

Mina Mirian ◽

Leila Safaeian ◽

Setareh Jandaghian ◽

...

Keyword(s):

Controlled Release ◽

Side Effects ◽

Kinase Inhibitor ◽

Lymphoblastic Leukemia ◽

Drug Carrier ◽

Free Drug ◽

Jurkat Cells ◽

Targeted Nanoparticles ◽

Inhibitor Drug ◽

Histopathological Results

Background: Using imatinib, a tyrosine kinase inhibitor drug used in lymphoblastic leukemia, has always had limitations due to its cardiotoxicity and hepatotoxicity side effects. The objective of this study is to develop a target-oriented drug carrier to minimize these adverse effects by the controlled release of the drug. Methods: KIT-5 nanoparticles were functionalized with 3-aminopropyltriethoxysilane and conjugated to rituximab as the targeting agent for the CD20 positive receptors of the B-cells. Then they were loaded with imatinib and their physical properties were characterized. The cell cytotoxicity of the nanoparticles was studied by MTT assay in Ramos (CD20 positive) and Jurkat cell lines (CD20 negative) and their cellular uptake was shown by fluorescence microscope. Wistar rats received an intraperitoneal injection of 50 mg/kg of the free drug or targeted nanoparticles for 21 days. Then the level of aspartate Aminotransferase (AST), alanine Aminotransferase (ALT), Alkaline Phosphatase (ALP) and Lactate Dehydrogenase (LDH) were measured in serum of animals. The cardiotoxicity and hepatotoxicity of the drug were also studied by hematoxylin and eosin staining of the tissues. Results: The targeted nanoparticles of imatinib showed to be more cytotoxic to Ramos cells rather than Jurkat cells. The results of the biochemical analysis displayed a significant reduction in AST, ALT, ALP, and LDH levels in animals treated with targeted nanoparticles, compared to the free drug group. By comparison with the free imatinib, histopathological results represented less cardiotoxicity and hepatotoxicity in the animals, which received the drug through the current designed delivery system. Conclusion: The obtained results confirmed that the rituximab targeted KIT-5 nanoparticles are promising in the controlled release of imatinib and could decrease its cardiotoxicity and hepatotoxicity side effects.

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Linical efficacy of percutaneous endoscopic lumbar discectomy for the treatment of lumbar spinal stenosis in elderly patients: a retrospective study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01968-0 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Hua Li ◽

Yufu Ou ◽

Furong Xie ◽

Weiguo Liang ◽

Gang Tian ◽

...

Keyword(s):

Elderly Patients ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Lumbar Discectomy ◽

Lumbar Spine Surgery ◽

Decompression Surgery ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Pain Scores ◽

Endoscopic Lumbar Discectomy ◽

Lumbar Spinal

Abstract Background Although percutaneous endoscopic lumbar discectomy (PELD) is increasingly being used to treat lumbar degenerative disease, the treatment of elderly patients with lumbar spinal stenosis (LSS) involves considerable uncertainty. The purpose of this study was to evaluate the safety and effectiveness of PELD for the treatment of LSS in elderly patients aged 65 years or older. Methods In this retrospective review, 136 patients aged 65 years or older who underwent PELD to treat LSS were evaluated. The patients were divided into two groups, group A (ages 65–74) and group B (age ≥ 75), and perioperative data were analyzed. The Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and MacNab classification were used to evaluate postoperative clinical efficacy. Results All patients successfully underwent the operation with satisfactory treatment outcomes. Compared to preoperative scores, the self-reported scores or pain while performing daily activities were significantly improved in both treatment groups (P < 0.05). No statistically significant between-group differences were observed in operation time, intraoperative blood loss, postoperative bed rest, and postoperative hospital stay (P > 0.05). The overall postoperative complication rate was similar between the two groups. Moreover, no statistically significant differences in VAS-back pain scores, VAS-leg pain scores, JOA scores, and MacNab classification were found between the groups at the 3-month and 1.5-year follow-up examinations (P > 0.05). Conclusion PELD is safe and effective for the treatment of LSS in elderly patients. Age is not a contraindication for decompressive lumbar spine surgery. PELD has advantages such as reduced trauma, fewer anesthesia-related complications, and a fast postoperative recovery. Elderly patients should be considered good candidates for lumbar decompression surgery using minimally invasive techniques.

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