Morphine-Sparing Effect of Ketoprofen after Abdominal Surgery

2000 ◽  
Vol 28 (1) ◽  
pp. 22-26 ◽  
Author(s):  
A. S. Rao ◽  
M. Cardosa ◽  
K. Inbasegaran
Keyword(s):  
Abdominal Surgery ◽  
Morphine Consumption ◽  
Controlled Clinical Trial ◽  
Patient Controlled Analgesia ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Pain Scores ◽  
Oliguric Renal Failure ◽  
Sparing Effect ◽  
Excessive Sedation

In a double-blind, placebo-controlled clinical trial (power of 80% to detect a 30% reduction in morphine consumption, P<0.05), we have determined that the administration of two doses of intravenous ketoprofen 100 mg, one at the end of surgery and the second 12 hours postoperatively, was associated with a significant reduction in morphine consumption at eight (P=0.028), 12 (P=0.013) and 24 hours (P=0.013) but not four hours (P=0.065) postoperatively, as compared to placebo, when assessed by patient-controlled analgesia. There was no difference between the groups in pain scores or in the incidence of nausea and vomiting. One patient in the placebo group suffered from excessive sedation while one patient from the ketoprofen group suffered from transient oliguric renal failure. There were no other adverse effects. The results of this study show that ketoprofen does provide a morphine-sparing effect in the management of postoperative pain after abdominal surgery.

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 Intravenous Tenoxicam for Analgesia following Laparoscopic Cholecystectomy

1998 ◽  
Vol 26 (1) ◽  
pp. 56-60 ◽  
Author(s):  
F. J. Munro ◽  
S. J. Young ◽  
I. J. Broome ◽  
H. M. Robb ◽  
G. J. Wardall
Keyword(s):  
Clinical Trial ◽  
Laparoscopic Cholecystectomy ◽  
Placebo Group ◽  
Adverse Effects ◽  
Controlled Clinical Trial ◽  
Patient Controlled Analgesia ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Double Blind Placebo ◽  
Pain Scores

In a double-blind, placebo-controlled clinical trial (power of 80% to detect a 30% reduction in morphine consumption, P<0.05) we have determined that intraoperative intravenous administration of tenoxicam 40 mg during laparoscopic cholecystectomy, when compared with placebo, was associated with a significant reduction in consumption of morphine at 6 hours and 12 hours (P<0.05) but not at 24 hours, when assessed by patient-controlled analgesia. Furthermore there was a significantly greater requirement for “rescue” analgesia with intramuscular morphine in the placebo group during the period of the study. There was no difference between the groups in pain scores, either at rest or on movement, nor in the incidence of nausea and vomiting. No patient in either group suffered a respiratory rate less than 8/min or oversedation at any time, and there were no other adverse effects.

Bilateral mandibular block improves pain relief and morphine consumption in mandibular osteotomies: a prospective, randomized, double-blind, placebo-controlled clinical trial

2021 ◽  
Vol 46 (4) ◽  
pp. 322-327
Author(s):  
Marina Bertuit ◽  
Francesca Rapido ◽  
Habib Ly ◽  
Charlotte Vannucci ◽  
Jérôme Ridolfo ◽  
...  
Keyword(s):  
Postoperative Analgesia ◽  
Severe Pain ◽  
Postoperative Nausea And Vomiting ◽  
Sensory Innervation ◽  
Morphine Consumption ◽  
Controlled Study ◽  
Controlled Clinical Trial ◽  
Block Group ◽  
Double Blind ◽  
Double Blind Placebo

BackgroundThe sensory innervation of the lower jaw mainly depends on the third root of the trigeminal nerve, the mandibular nerve (V3). The aim of this single-center, prospective, randomized, double-blind, placebo-controlled study was to evaluate the effectiveness of bilateral V3 block for postoperative analgesia management in mandibular osteotomies.Methods107 patients undergoing mandibular surgery (75 scheduled osteotomies and 32 mandible fractures) were randomized in two groups. A bilateral V3 block was performed in each group, either with ropivacaine 0.75% (block group, n=50) or with a placebo (placebo group, n=57). A postoperative multimodal analgesia was equally provided to both groups. The primary outcome was the cumulative morphine consumption at 24 hours. Secondary outcomes were the occurrence of severe pain and the incidence of postoperative nausea and vomiting (PONV) in the first 24 hours. Data were analyzed on an intention-to-treat basis.ResultsThe cumulative morphine consumption at 24 hours was significantly lower in the block group (median 8.0 mg (IQR 2.0–21.3) vs 12.0 mg (IQR 8.0–22.0), p=0.03), as well as the incidence of severe pain during the 24 hours of follow-up (4.0% vs 22.8%, p<0.01). The mandibular block had no impact on the incidence of PONV.ConclusionBilateral V3 block for mandibular osteotomies is an effective opioid-sparing procedure. It provided better postoperative analgesia in the first 24 hours, and it did not affect PONV incidence.Trial registration numberNCT02618993.

scholarly journals Comparison of Patient-Controlled Analgesia and Nurse-Controlled Infusion Analgesia after Cardiac Surgery

1994 ◽  
Vol 22 (6) ◽  
pp. 672-678 ◽  
Author(s):  
Paul S. Myles ◽  
Mark R. Buckland ◽  
Graham B. Cannon ◽  
Michael A. Bujor ◽  
Mark Langley ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Serum Cortisol ◽  
Tracheal Extubation ◽  
Morphine Consumption ◽  
Controlled Clinical Trial ◽  
Randomized Controlled Clinical Trial ◽  
Patient Controlled Analgesia ◽  
Elective Cardiac Surgery ◽  
Randomized Controlled ◽  
Pain Scores

A randomized, controlled clinical trial was conducted on 72 patients undergoing elective cardiac surgery to compare patient-controlled analgesia (PCA) to nurse-titrated infusion of morphine. Pain and nausea scores were assessed at 5, 20, 32 and 44 hours after cardiopulmonary bypass. Serum cortisol estimations were performed at 24 and 48 hours, and morphine consumption was measured at 0-24 and 24-48 hours. There was no difference between pain scores (P=0.72), nausea scores (P=0.52), serum cortisol at 24 and 48 hours (P=0.32 and P=0.34), and morphine consumption at 0-24 and 24-48 hours (P=0.16 and P=0.12). There was also no difference in the time to tracheal extubation (P=0.79) and discharge from ICU (P=0.64). There was a significant association between pain and serum cortisol at 48 hours (P=0.023). This study also found a tenfold difference in the amount of morphine used (range = 11 to 108 mg), with no significant association with patient age or sex. We could find no significant benefit from the routine use of PCA in cardiac surgical patients.

Effects of Nonsteroidal Antiinflammatory Drugs on Patient-controlled Analgesia Morphine Side Effects

2005 ◽  
Vol 102 (6) ◽  
pp. 1249-1260 ◽  
Author(s):  
Emmanuel Marret ◽  
Okba Kurdi ◽  
Paul Zufferey ◽  
Francis Bonnet ◽  
David C. Warltier
Keyword(s):  
Adverse Effects ◽  
Meta Analysis ◽  
Postoperative Nausea And Vomiting ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Nausea And Vomiting ◽  
Morphine Consumption ◽  
Patient Controlled Analgesia ◽  
Antiinflammatory Drugs ◽  
Double Blind ◽  
Sparing Effect

Nonsteroidal antiinflammatory drugs (NSAIDs) are commonly combined with intravenous morphine patient-controlled analgesia to relieve postoperative pain. NSAIDs have a documented 30-50% sparing effect on morphine consumption. However, most of the studies have not demonstrated a decrease in morphine adverse effects. A meta-analysis of randomized controlled trials was performed to evaluate the risk of morphine adverse effects in patients treated with NSAIDs. Twenty-two prospective, randomized, double-blind studies including 2,307 patients were selected. NSAIDs decreased significantly postoperative nausea and vomiting by 30%, nausea alone by 12%, vomiting alone by 32% and sedation by 29%. A regression analysis yielded findings indicating that morphine consumption was positively correlated with the incidence of nausea and vomiting. Pruritus, urinary retention, and respiratory depression were not significantly decreased by NSAIDs.

Efficacy of a Combination of Ketamine and Morphine for Intravenous Patient Controlled-Analgesia in Upper Abdominal Surgery: A Prospective, Double-blind, Randomized Controlled Trial

2021 ◽  
Vol 104 (9) ◽  
pp. 1528-1534
Keyword(s):  
Abdominal Pain ◽  
Side Effects ◽  
Abdominal Surgery ◽  
Rating Scale ◽  
Morphine Consumption ◽  
Patient Controlled Analgesia ◽  
Double Blind ◽  
Upper Abdominal Surgery ◽  
Upper Abdominal ◽  
Postoperative Morphine

Background: Most postoperative upper abdominal pain is severe, and various methods can be employed to control it. Presently, morphine is the main drug used for anesthesia, but it may contribute to the occurrence of many uncomfortable side effects. Ketamine is an analgesic drug that inhibits NMDA receptors, making it a synergistic effect of morphine. Objective: To investigate the efficacy of a combination of ketamine and morphine in controlling postoperative upper abdominal pain. Materials and Methods: Informed consents were obtained from patients enrolled into the present double-blind randomized study that divided into two groups, (i) the M group, which received 1 mg/mL of morphine, and (ii) the MK group, which received 1 mg of ketamine plus 1 mg/mL of morphine as intravenous patient-controlled analgesia (IV-PCA) post-operation. All patients were assessed based on postoperative morphine consumption, a numeric rating scale (NRS) used to rate pain, and the presence of side effects. Results: Sixty-seven patients completed the study including 34 patients in the MK group and 33 patients in the M group. Cumulative postoperative morphine consumption at 24 and 48 hours was significantly lower in the MK group at 27.91±11.11 and 46.44±15.21 mg compared to the M group at 43.24±15.32 and 71.33±19.67 mg, respectively (p<0.001). NRS were similar between the two groups and no observable differences regarding to side effects. Conclusion: A combination of ketamine and morphine via IV PCA is effective in controlling postoperative upper abdominal pain. Keywords: Ketamine; Morphine; Upper abdominal surgery; Intravenous patient-controlled analgesia

Double blind placebo controlled clinical trial of homoeopathic medicines in HIV infection

1998 ◽  
Vol 87 (2) ◽  
pp. 86-88
Author(s):  
D P Rastogi ◽  
V P Singh ◽  
Vikram Singh ◽  
S K Dey ◽  
K Rao
Keyword(s):  
Clinical Trial ◽  
Hiv Infection ◽  
Controlled Clinical Trial ◽  
Double Blind ◽  
Double Blind Placebo
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