Co-administration of pethidine and clonidine: a spinal anaesthetic technique for total hip replacement

Grace, D.; Milligan, K. R.; Morrow, Brian; Fee, J. P. H.

doi:10.1093/bja/73.5.628

Cited by 19 publications

(22 citation statements)

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“…Thirteen trials (16 comparisons) tested morphine 0.05 to 2 mg added to bupivacaine compared with bupivacaine alone and reported on the duration of postoperative analgesia [3,4,21,30,34,37,38,43,46,61,63,69,75] (Fig. 2).…”

Section: Duration Of Postoperative Analgesiamentioning

confidence: 99%

“…Seven trials (9 comparisons) tested morphine 0.05 to 1 mg added to bupivacaine and reported on cumulative 24-h morphine consumption [4,30,38,41,56,61,74] (Supplemental Data 2). In controls, the median of the mean 24-h cumulative morphine consumption was 23 mg (range 4 to 47 mg).…”

Section: Cumulative 24-h Morphine Consumptionmentioning

confidence: 99%

“…Six trials (9 comparisons) tested morphine 0.05 to 0.5 mg added to bupivacaine and reported the number of patients requiring an opioid for rescue analgesia postoperatively [34,38,39,42,46,61] (Supplemental Data 4). The proportion of controls requiring opioids ranged from 0% to 100% (median, 73%).…”

Section: Number Of Patients Requiring Opioids Postoperativelymentioning

confidence: 99%

“…Fourteen trials (19 comparisons) tested morphine 0.05 to 0.5 mg added to bupivacaine and reported on presence or absence of postoperative respiratory depression [4,6,34,35,37,38,[41][42][43]46,56,61,75,79]. Respiratory depression was defined as respiratory rates <8, <9, <10, or <12 min À1 , or as PaCO 2 >6 kPa or different ranges of SpO 2 , or as the need for naloxone treatment.…”

Section: Respiratory Depressionmentioning

confidence: 99%

“…Seventeen trials (21 comparisons) tested morphine 0.05 to 1 mg added to bupivacaine and reported on the incidence of postoperative pruritus [4,21,30,34,[37][38][39][41][42][43]46,56,61,69,74,75,79] (Table 2; Supplemental Data 6). The average incidence of pruritus with bupivacaine alone was 4.4%.…”

Section: Pruritusmentioning

confidence: 99%

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Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-analysis of randomized trials

Pöpping

Elia

Marret

et al. 2012

Pain

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a b s t r a c tOpioids are widely used as additives to local anesthetics for intrathecal anesthesia. Benefit and risk remain unclear. We systematically searched databases and bibliographies to February 2011 for full reports of randomized comparisons of any opioid added to any intrathecal local anesthetic with the local anesthetic alone in adults undergoing surgery (except cesarean section) and receiving single-shot intrathecal anesthesia without general anesthesia. We included 65 trials (3338 patients, 1932 of whom received opioids) published between 1983 and 2010. Morphine (0.05-2 mg) and fentanyl (10-50 lg) added to bupivacaine were the most frequently tested. Duration of postoperative analgesia was prolonged with morphine (weighted mean difference 503 min; 95% confidence interval [CI] 315 to 641) and fentanyl (weighted mean difference 114 min; 95% CI 60 to 168). Morphine decreased the number of patients needing opioid analgesia after surgery and decreased pain intensity to the 12th postoperative hour. Morphine increased the risk of nausea (number needed to harm [NNH] 9.9), vomiting (NNH 10), urinary retention (NNH 6.5), and pruritus (NNH 4.4). Fentanyl increased the risk of pruritus (NNH 3.3). With morphine 0.05 to 0.5 mg, the NNH for respiratory depression varied between 38 and 59 depending on the definition of respiratory depression chosen. With fentanyl 10 to 40 lg, the risk of respiratory depression was not significantly increased. For none of these effects, beneficial or harmful, was there evidence of dose-responsiveness. Consequently, minimal effective doses of intrathecal morphine and fentanyl should be sought. For intrathecal buprenorphine, diamorphine, hydromorphone, meperidine, methadone, pentazocine, sufentanil, and tramadol, there were not enough data to allow for meaningful conclusions.Ó

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Section: Duration Of Postoperative Analgesiamentioning

confidence: 99%

Section: Cumulative 24-h Morphine Consumptionmentioning

confidence: 99%

Section: Number Of Patients Requiring Opioids Postoperativelymentioning

confidence: 99%

Section: Respiratory Depressionmentioning

confidence: 99%

Section: Pruritusmentioning

confidence: 99%

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Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-analysis of randomized trials

Pöpping

Elia

Marret

et al. 2012

Pain

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Single dose oral dihydrocodeine for acute postoperative pain

Moore

Edwards

Derry

et al. 2000

Cochrane Database of Systematic Reviews

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Background This is an updated version of the original Cochrane review published in Issue 2, 2000. Dihydrocodeine is a synthetic opioid analgesic developed in the early 1900s. Its structure and pharmacokinetics are similar to that of codeine and it is used for the treatment of postoperative pain or as an antitussive. It is becoming increasingly important to assess the relative efficacy and harm caused by different treatments. Relative efficacy can be determined when an analgesic is compared with control under similar clinical circumstances. Objectives To quantitatively assess the analgesic efficacy and adverse effects of single-dose dihydrocodeine compared with placebo in randomised trials in moderate to severe postoperative pain. Search methods Published reports were identified from electronic databases (MEDLINE, EMBASE, CENTRAL, the Oxford Pain Relief Database in December 2007, the original search was conducted in October 1999). Additional studies were identified from the reference lists of retrieved reports. Selection criteria Inclusion criteria: full journal publication, clinical trial, random allocation of participants to treatment groups, double blind design, adult participants, baseline pain of moderate to severe intensity, postoperative administration of study drugs, treatment arms which included dihydrocodeine and placebo and either oral or injected (intramuscular or intravenous) administration of study drugs. Data collection and analysis Data collection and analysis: summed pain intensity and pain relief data over four to six hours were extracted and converted into dichotomous information to yield the number of participants obtaining at least 50% pain relief. This was used to calculate relative benefit and number-needed-to-treat-to-benefit (NNT) for one participant to obtain at least 50% pain relief. Single-dose adverse effect data were collected and used to calculate relative risk and number-needed-to-treat-to-harm (NNH). Main results Fifty-two reports were identified in the original review as possible randomised trials which assessed dihydrocodeine in postoperative pain. Four reports met the inclusion criteria; all assessed oral dihydrocodeine. Three reports (194 participants) compared dihydrocodeine with placebo and one (120 participants) compared dihydrocodeine (30 mg or 60 mg) with ibuprofen 400 mg. For a single dose of dihydrocodeine 30 mg in moderate to severe postoperative pain the NNT for at least 50% pain relief was 8.1 (95% confidence interval 4.1 to 540) when compared with placebo over a period of four to six hours. Pooled data showed significantly more participants to have reported adverse effects with dihydrocodeine 30 mg than with placebo. When compared to ibuprofen 400 mg both dihydrocodeine 30 mg and 60 mg were significantly inferior. No additional studies were found for this update. Authors’ conclusions A single 30 mg dose of dihydrocodeine is not sufficient to provide adequate pain relief in postoperative pain. Statistical superiority of ibuprofen 400 mg over dihydrocodein...

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Définitions de la “dépression respiratoire” de l’analgésie postopératoire réalisée avec de la morphine intrathécale : une revue documentaire

Goldstein

VanDenKerkhof

2003

Can J Anesth/J Can Anesth

108

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P Pu ur rp po os se e: : To review the postoperative intrathecal morphine (ITM) analgesia literature for their definitions of "respiratory depression" (RD).S So ou ur rc ce e: : Medline (1966 -June Week 5 2001) and reference lists were searched for original studies involving bolus-dose ITM for postoperative analgesia, which used "respiratory depression" or similar terms. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The search identified 209 studies. These were included if ITM use was appropriate (bolus dose, postoperative analgesia) and the term "respiratory depression" was used, which left 96 studies remaining. Forty-four (46%) did not define "RD" despite using this term. A further 24 (25%) defined RD with respiratory rate (RR) alone. Only 28 (29%) defined RD with more than RR alone. There was no statistically significant association between the presence of a definition for RD with study design, study size or publication period. Also, no significant association existed between rigorousness of RD definitions and the above factors.C Co on nc cl lu us si io on n: : The term "respiratory depression" has no clear definition from a review of the literature on ITM use for postoperative analgesia. While defining RD with bradypnea is superior to having no definition, this is still inadequate. In future research, the consistent use of terms with specific meanings will facilitate understanding the true incidence of ITM's respiratory effects. If "respiratory depression" is used, then an explicit definition of its meaning should be provided. Future research must also address what is clinically significant respiratory impairment from intrathecal opioids, and how to optimally monitor for this. Further delineating their risks vs benefits will allow for more optimal dosing. Objectif : Passer en revue les documents sur l'analgésie postopéra-toire, réalisée avec la morphine intrathécale (MIT), quant à leurs défi-nitions de la "dépression respiratoire" (DR). Source : La base Medline (1966 -Semaine 5, juin 2001) et les listes de lectures de référence ont été fouillées à la recherche d'études originales sur des bolus de MIT administrés comme analgésie postopéra-toire, et dans lesquelles on retrouve le terme "dépression respiratoire" ou des termes similaires. Constatations principales : La recherche nous a fourni 209 études. Les études (96) comportant un usage approprié de la MIT (dose en bolus, analgésie postopératoire) et l'utilisation du terme

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Co-administration of pethidine and clonidine: a spinal anaesthetic technique for total hip replacement

Cited by 19 publications

References 0 publications

Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-analysis of randomized trials

Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-analysis of randomized trials

Single dose oral dihydrocodeine for acute postoperative pain

Définitions de la “dépression respiratoire” de l’analgésie postopératoire réalisée avec de la morphine intrathécale : une revue documentaire

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