A Comparison of Intrathecal Morphine-6-Glucuronide and Intrathecal Morphine Sulfate as Analgesics for Total Hip Replacement

Grace, D.; Fee, J. P. H.

doi:10.1213/00000539-199611000-00027

Cited by 38 publications

(10 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fifty‐five randomised clinical trials were included in the systematic review [10–64], and 56 reports were excluded (see http://www.postoppain.org[5]), mainly due to the lack of a defined THR data set within a mixed study population, or because pain was not scored on a linear scale. There were 51 trials of pharmacological approaches to pain management: allocation concealment was considered adequate in seven trials [17, 30, 36, 38, 42, 53, 57] and unclear in 44 trials [10–16, 18–29, 31–35, 37, 39–41, 43–52, 54–56, 58–60]. There were two trials of operative approaches (one anaesthetic for epidural catheter insertion and one orthopaedic for prosthesis implantation); allocation concealment was adequate in one trial [62] and unclear in the other [61].…”

Section: Resultsmentioning

confidence: 99%

“…Morphine was superior to nalbuphine [26] and diamorphine [23] at the doses used for decreasing supplementary analgesic consumption but pain scores were similar between groups for most time points. Morphine sulphate was similar to morphine‐6‐glucuronide (100 or 125 µg) [32], and fentanyl was similar to sufentanil [27] for pain scores and supplementary analgesic consumption. Two studies compared different morphine doses: 50, 100 and 200 µg [48] in one study and 25, 50, 100 and 200 µg in the other.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

A procedure‐specific systematic review and consensus recommendations for analgesia after total hip replacement

Fischer¹,

Simanski²

2005

Anaesthesia

164

View full text Add to dashboard Cite

Summary Total hip replacement is a major surgical procedure usually associated with significant pain in the early postoperative period. Several anaesthetic and analgesic techniques are in common clinical use for this procedure but, to date, clinical studies of pain after total hip replacement have not been systematically assessed. Using the Cochrane protocol, we have conducted a systematic review of analgesic, anaesthetic and surgical interventions affecting postoperative pain after total hip replacement. In addition to the review, transferable evidence from other relevant procedures and clinical practice observations collated by the Delphi method were used to develop evidence‐based recommendations for the treatment of postoperative pain. For primary total hip replacement, PROSPECT recommends either general anaesthesia combined with a peripheral nerve block that is continued after surgery or an intrathecal (spinal) injection of local anaesthetic and opioid. The primary analgesic technique should be combined with a step‐down approach using paracetamol plus conventional non‐steroidal anti‐inflammatory drugs, with strong or weak opioids as required.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

A procedure‐specific systematic review and consensus recommendations for analgesia after total hip replacement

Fischer¹,

Simanski²

2005

Anaesthesia

164

View full text Add to dashboard Cite

show abstract

“…In healthy volunteers M6G after shortterm infusion did not produce EEG effects or clinical symptoms [8]. On the other hand, excellent postoperative analgesia has been observed after intrathecal administration of M6G [9] with typical opiate side-effects. Similarly, M6G was reported to be a useful analgesic in 17/19 cases after i.v.…”

Section: Introductionmentioning

confidence: 88%

Pharmacokinetic modelling of morphine, morphine-3-glucuronide and morphine-6-glucuronide in plasma and cerebrospinal fluid of neurosurgical patients after short-term infusion of morphine

Meineke¹,

Freudenthaler²,

Hofmann³

et al. 2002

Br J Clin Pharmacol

View full text Add to dashboard Cite

show abstract

“…In healthy volunteers M6G after short‐term infusion did not produce EEG effects or clinical symptoms [8]. On the other hand, excellent postoperative analgesia has been observed after intrathecal administration of M6G [9] with typical opiate side‐effects. Similarly, M6G was reported to be a useful analgesic in 17/19 cases after i.v.…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetic modelling of morphine, morphine‐3‐glucuronide and morphine‐6‐glucuronide in plasma and cerebrospinal fluid of neurosurgical patients after short‐term infusion of morphine

Meineke¹,

Freudenthaler²,

Hofmann³

et al. 2002

Brit J Clinical Pharma

View full text Add to dashboard Cite

Aims Concentrations in the cerebrospinal fluid (CSF) are a useful approximation to the effect site for drugs like morphine. However, CSF samples, are available only in rare circumstances. If they can be obtained they may provide important insights into the pharmacokinetics/pharmacodynamics of opioids. Methods Nine neurological and neurosurgical patients (age 19-69 years) received 0.5 mg kg -1 morphine sulphate pentahydrate as an intravenous infusion over 30 min. Plasma and CSF were collected for up to 48 h. Concentration time-course and interindividual variability of morphine (M), morphine-3-glucuronide (M3G) and morphine-6 glucuronide (M6G) were analysed using population pharmacokinetic modelling. Results While morphine was rapidly cleared from plasma (total clearance = 1838 ml min -1 (95% CI 1668, 2001 ml min -1 )) the glucuronide metabolites were eliminated more slowly (clearance M3G = 44.5 ml min -1 (35.1, 53.9 ml min -1 ), clearance M6G = 42.1 ml min -1 (36.4, 47.7 ml min -1 )) and their clearance could be described as a function of creatinine clearance. The central volumes of distribution were estimated to be 12.7 l (11.1, 14.3 l) for morphine. Transfer from the central compartment into the CSF was also rapid for M and considerably slower for both glucuronide metabolites. Maximum concentrations were achieved after 102 min (M), 417 min (M3G) and 443 min (M6G). A P-glycoprotein exon 26 polymorphism previously found to be linked with transport activity could be involved in CSF accessibility, since the homozygous mutant genotype was associated (P < 0.001) with high maximum CSF concentrations of M but not M3G or M6G. Conclusions From the population pharmacokinetic model presented, CSF concentration profiles can be derived for M, M3G and M6G on the basis of dosing information and creatinine clearance without collecting CSF samples. Such profiles may then serve as the link between dose regimen and effect measurements in future clinical effect studies.

show abstract

A Comparison of Intrathecal Morphine-6-Glucuronide and Intrathecal Morphine Sulfate as Analgesics for Total Hip Replacement

Cited by 38 publications

References 16 publications

A procedure‐specific systematic review and consensus recommendations for analgesia after total hip replacement

A procedure‐specific systematic review and consensus recommendations for analgesia after total hip replacement

Pharmacokinetic modelling of morphine, morphine-3-glucuronide and morphine-6-glucuronide in plasma and cerebrospinal fluid of neurosurgical patients after short-term infusion of morphine

Pharmacokinetic modelling of morphine, morphine‐3‐glucuronide and morphine‐6‐glucuronide in plasma and cerebrospinal fluid of neurosurgical patients after short‐term infusion of morphine

Contact Info

Product

Resources

About