SummaryThe requirements for analgesia after upper abdominal surgery were evaluated in 100 patients who received morphine by way of a patient-controlled analgesia system. Hourly and cumulative 24-hour No correlation was found between morphine consumption and patient weight. The pattern of hourly morphine consumption appeared to follow a diurnal rhythm, with peak times of demand at 0900 and 2000 hours. The variations in requirements for analgesia among patients and with time of day should be taken into account when a regimen for postoperative analgesia is prescribed. Key wordsAnalgesia; postoperative, patient-controlled analgesia.Effective postoperative analgesia is of paramount importance, particularly after major abdominal surgery. Several studies have reported a wide range of individual requirements for, and responses to, analgesic However most patients still receive intramuscular o p i o i d~,~ prescribed at fixed time intervals, for pain relief in the early postoperative period. The bolus dose is determined usually by patient variables such as age, gender and weight, which are considered to influence the pharmacokinetic profile of analgesic drugs, although previous studies have shown no correlation between weight, height or body surface area and pain relief after a single dose of morphine or pentazocine. A significant inverse correlation between age and pain relief has been demon~trated.~ Patient-controlled analgesia (PCA) is a relatively new concept in the management of postoperative pain.' It provides a unique opportunity to examine the requirements for analgesia and to reassess the factors which are thought to influence them. We have studied the morphine requirements of 100 patients who received morphine delivered by a PCA system as the sole method of analgesia in the first 24 hours after upper abdominal surgery, and analysed these requirements with regard to age, weight, gender and time of day. MethodsOne hundred patients aged 18-75 years, who had undergone upper abdominal surgery were studied. Patients with cardiac, hepatic, or renal dysfunction were excluded, as were those patients who received regular analgesic drugs pre-operatively. All patients had given informed consent for the study.The system comprised an Imed 929 computer-controllable infusion pump connected to an Apple IIe microcomputer.8 The PCA system was connected to the patient's intravenous infusion by way of a nonreturn valve, and was programmed to deliver an incremental dose of morphine 0.02 mg/kg, with a lock-out interval of 2 minutes. Maximum dosage was 0.4 mg/kg in one hour. Start time and the time of each bolus dose were recorded and stored on disk.
A randomized, double-blind, placebo-controlled study was performed to assess the analgesic efficacy of intramuscular nefopam hydrochloride after upper abdominal surgery. Patients received either 20 mg nefopam (n = 23) or matching placebo (n = 26), 90 min before surgery, immediately after surgery, and 6, 12 and 18 h after the end of surgery. The 24-h morphine requirements were measured using a patient-controlled analgesia system delivering on-demand intravenous bolus doses of morphine. Pain was assessed using visual analogue scales. Patients receiving nefopam had a mean (+/- s.e.m.) cumulative morphine consumption of 4.1 +/- 0.8 mg in the first hour, compared with 8.5 +/- 0.8 mg in the control group (P less than 0.01). After 24 h the consumptions were 44.1 +/- 7.2 mg and 62.5 +/- 6.9 mg respectively (P less than 0.05). The pain scores in both groups were similar. This study confirms that nefopam hydrochloride has significant analgesic effects and would be a useful supplement to morphine in the management of postoperative pain.
Objective-To establish whether positive suggestions given to a patient under general anaesthesia reduce postoperative pain and analgesic requirements.Design-Prospective double blind randomised study.Setting-Operating theatre and gynaecology ward of a teaching hospital.Patients-63 Woman undergoing elective abdominal hysterectomy were randomised to be played either a tape of positive suggestions or a blank tape during the operation through a personal stereo system.Interventions-Three women were withdrawn from the study. Anaesthesia was standardised for all of the women. Postoperative analgesia was provided through a patient controlled analgesia system for the first 24 hours. Pain scores were recorded every six hours.Main outcome measures -Morphine consumption over the first 24 hours after the operation; pain scores.Results-Mean morphine requirements were 51-0 mg (95% confidence interval 42-1 to 60-0 mg in the women played positive suggestions; and 65-7 mg (55-6 to 75-7 mg) in those played a blank tape. The point estimate (95% confidence interval) for the difference of means was 14-6 mg (22.4%) (1.9 (2.9%) to 27-3 mg (41.6%)) (p=0.028). Pain scores were similar in the two groups.Conclusion-Positive intraoperative suggestions seem to have a significant effect in reducing patients' morphine requirements in the early postoperative period.
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