A double‐blind comparison of codeine and morphine for postoperative analgesia following intracranial surgery

Goldsack, C.; Scuplak, Stephen; Smith, M. B.

doi:10.1111/j.1365-2044.1996.tb14997.x

Cited by 78 publications

(39 citation statements)

References 11 publications

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“…3,[6][7][8] Codeine is widely used on our neurosurgical ward and although the 75% overall prevalence of moderate to severe pain is within the 60 to 84% reported by others, 1-3 the present study certainly reinforces the concern that a more potent analgesic needs to be used in this surgical population.…”

Section: Discussionsupporting

confidence: 56%

Craniotomy site influences postoperative pain following neurosurgical procedures: a retrospective study

Thibault

Girard

Moumdjian

et al. 2007

Can J Anesth/J Can Anesth

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Objective: This retrospective study was designed to assess the intensity of postoperative pain in relation to the location of craniotomy. Methods:After Research Ethics Board approval, data were collected from the charts of all patients who underwent a craniotomy at our institution between January 2004 and December 2005. The severity of post-craniotomy pain was assessed by collecting scores obtained using an 11-point verbal rating scale and calculating the cumulative analgesic requirements for the first 48 hr postoperatively. Data were compared according to the craniotomy location. Results:Data from 299 patients was available for analysis. On average, 76% of patients experienced moderate to severe postoperative pain. Frontal craniotomy was associated with lower pain scores than four of six craniotomy sites analyzed, with 49% of patients reporting mild pain, a significant difference (P < 0.05) compared with all other groups except for parietal craniotomies. Frontal craniotomy patients also had lower opioid analgesic requirements compared to patients who underwent posterior fossa craniotomy (P < 0.05). Logistic regression analysis showed that craniotomy location (P < 0.0001) and age (P = 0.004) were both independent predictors of the intensity of postoperative pain, with lower pain scores as age increased. Postoperative use of steroids, gender and presence of preoperative pain were not statistically linked to postoperative pain intensity. The prevalence of postoperative nausea and vomiting was 56% and it did not vary according to the location of craniotomy. Conclusion:This study shows that the intensity of postoperative pain in neurosurgery is affected by the site of craniotomy. Frontal craniotomy patients experienced the lowest pain scores, and required significantly less opioid than patients undergoing posterior fossa interventions.

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Section: Discussionsupporting

confidence: 56%

Craniotomy site influences postoperative pain following neurosurgical procedures: a retrospective study

Thibault

Girard

Moumdjian

et al. 2007

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

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“…This finding was unexpected. Goldsack et al [14], who compared the change in P a CO 2 20-120 min after intramuscular morphine or codeine, and Tanskanen et al [19], who studied paracetamol and ketoprofen as adjuncts to an oxycodone PCA in 45 patients, found similar mean changes but a smaller standard deviation in the measured P a CO 2 . In our study we found two patients who had changes in P a CO 2 that were noticeably greater than the changes in the other patients.…”

Section: Discussionmentioning

confidence: 97%

“…Ten percent of the population demethylate less than 0.5% of a dose of codeine, resulting in no analgesic effect, and many others metabolise < 15%. Goldsack and colleagues demonstrated that better analgesia can be achieved using morphine than codeine given by the intramuscular route [14]. Tramadol has been available in the UK since 1994 and has the advantage of a dual mechanism of analgesia, being both an agonist at opioid receptors and activating monoaminergic spinal inhibition of pain transmission.…”

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confidence: 99%

Comparison of the analgesic efficacy and respiratory effects of morphine, tramadol and codeine after craniotomy*

et al. 2007

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SummaryPain after craniotomy remains a significant problem. The effect of morphine and tramadol patient‐controlled analgesia (PCA) on arterial carbon dioxide tension is unknown in patients having such surgery. Sixty craniotomy patients were randomly allocated to receive morphine PCA, tramadol PCA or codeine phosphate 60 mg intramuscularly. Baseline values of pain score (0–10), sedation and arterial carbon dioxide tension were recorded at the time of first analgesic administration and at 30 min, 1, 4, 8, 12, 18 and 24 h. Patient satisfaction was assessed at 24 h. There were no differences in arterial carbon dioxide tension or sedation between groups at any time, but in all three groups some patients had rises greater than 1 kPa. Morphine produced significantly better analgesia than tramadol at all time points (p < 0.005) and better analgesia than codeine at 4, 12 and 18 h. Patients were more satisfied with morphine than with codeine or tramadol (p < 0.001). Vomiting and retching occurred in 50% of patients with tramadol, compared with 20% with morphine and 29% with codeine.

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“…Morphine was also more effective than codeine following craniotomy; this was found for IM prn administration of both compounds (Goldsack et al, 1996 Level II) but also in a comparison of PCA morphine with IM codeine (Sudheer et al, 2007 Level II). PCA fentanyl was more effective than prn IV fentanyl and did not increase the risk of adverse effects after craniotomy (Morad et al, 2009 Level II).…”

Section: Opioidsmentioning

confidence: 90%

Safety of opioid patch initiation in Australian residential aged care

Gadzhanova

Roughead

Pont

2015

Medical Journal of Australia

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Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross‐sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period. Main outcome measure: The proportion of residents who were opioid‐naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid‐naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up‐titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid‐naive in the 4 weeks before initiation.

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A double‐blind comparison of codeine and morphine for postoperative analgesia following intracranial surgery

Cited by 78 publications

References 11 publications

Craniotomy site influences postoperative pain following neurosurgical procedures: a retrospective study

Craniotomy site influences postoperative pain following neurosurgical procedures: a retrospective study

Comparison of the analgesic efficacy and respiratory effects of morphine, tramadol and codeine after craniotomy*

Safety of opioid patch initiation in Australian residential aged care

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