Controlled Comparison of the Efficacy of Fourteen Preparations in the Relief of Postoperative Pain

Morrison, J.D.; Loan, W.B.; Dundee, J. W.

doi:10.1097/00132586-197208000-00054

Cited by 9 publications

(15 citation statements)

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“…3 The results presented here confirm those of the experimental pain study.' They demonstrate that doses of doxapram which markedly antagonise morphine-induced respiratory depression have no significant effect on the analgesic action of the opiate.…”

Section: Discussionsupporting

confidence: 86%

Morphine combined with doxapram or naloxone*

Gupta¹,

Dundee²

1974

Anaesthesia

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The ability to produce adequate analgesia by opiates without the concomitant risk of respiratory depression would be highly desirable. However, it is well recognised that the antagonists nalorphine and levallorphan reduce the analgesic action of opiates as well as minimising respiratory depression and it is generally agreed that agonist-antagonist mixtures are not of value in this field.Recently, Dundee, Gupta & Jones' have shown that clinical doses of the respiratory stimulant doxapram had no effect on the analgesic action of pethidine or morphine, but these studies were carried out using an experimental pain stimulus. This paper reports a study carried out in patients after upper abdominal surgery to whom doxapram was given at three dose levels combined with large doses of morphine; the degree of analgesia was compared with that after morphine alone, The new opiate antagonist naloxone was also studied at one dose level.This study was initiated to determine whether clinically used doses of doxapram or naloxone interfere with morphine-induced analgesia and to assess the extent to which these two drugs attenuate morphine-induced respiratory depression in this clinical situation.As post-operative pulmonary complications are a recognised hazard of upper abdominal surgery, the effects of concomitant administration of doxapram or naloxone with morphine on the incidence of such complications was also investigated. MethodsThe study was carried out in the recovery ward of the Royal Victoria Hospital, Belfast, in adult patients following upper abdominal surgery. No patients were admitted to the trial who were outside the 16-70 age, or 50-75 kg weight, groups, who had had any analgesic during surgery or who suffered from any severe systemic

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Section: Discussionsupporting

confidence: 86%

Morphine combined with doxapram or naloxone*

Gupta¹,

Dundee²

1974

Anaesthesia

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“…shown that the potency of oxycodone is superior to that of morphine in the management of visceral pain [15] and postoperative pain, with fewer side effects [16]. Also, Kalso et al [17] suggested that the equianalgesic dose ratio of oxycodone to morphine was 2 : 3, as calculated based on total opioid consumption during a 2-hour period.…”

Section: Discussionmentioning

confidence: 99%

A comparison of oxycodone and fentanyl in the management of early postoperative pain and for patient-controlled analgesia after total abdominal hysterectomy

2016

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background:Although oxycodone has been known to be superior to other opioids in postoperative care, few studies have compared its analgesic potency with that of fentanyl. We therefore examined these two drugs in terms of their dose requirements, effects on pain intensity, time needed for relief of pain, and side effects after surgery. Methods: We enrolled 56 healthy women scheduled for total abdominal hysterectomy and randomly allocated them to either oxycodone or fentanyl. The opioids were administered to the two groups 10 minutes before the end of the operation. In the post-anesthesia care unit (PACU) after surgery, a visual analog scale (VAS) was used to assess the patients' pain every 10 minutes Whenever pain control was required, a bolus of the same dose of the respective drugs was repeated at 10-minute intervals. Patient-controlled analgesia (PCA) was used to manage postoperative pain. After the patient arrived on the ward, pain scores were recorded at once and then 1, 2, 3, and 24 hours thereafter. Results: During the hour spent in the PACU, fewer patients in the oxycodone group required the opioid, and the time needed to achieve pain relief was shorter with oxycodone than with fentanyl. Moreover, postoperative VAS levels were significantly lower in the oxycodone group both in the PACU and on the ward (over a 24-hours period). There were no significant differences in side effects between the patients given oxycodone and those given fentanyl. Conclusions: Oxycodone was more effective than fentanyl when administered on the basis of the recommended dose ratio (1 : 100). Although further evaluation is needed to investigate the optimal dose ratio, we would recommend a higher conversion factor (1 : 62). Fentanyl is one of the most frequently used opioids for the management of acute postoperative pain and for PCA, but various studies using intravenous fentanyl for postoperative analgesia have revealed that pain scores remain high for 4 or 6 hours after surgery [3,4]. Therefore, we decided to use oxycodone for postoperative pain management and PCA. In other studies, oxycodone was presumed to be more effective than fentanyl based on the currently recommended conversion factor of 1 : 100 [5]; however, we found that the direct conversion of intravenous fentanyl to intravenous oxycodone did not fall within a safe range.We aimed to compare the analgesic efficacy of fentanyl and oxycodone in patients who had visceral postoperative pain initially in the PACU and then in the ward for 24 hours. The known equivalent potency of these two opioids was assessed based on pain scores, cumulative drug consumption, sedation scales, and side effects. In the operating room, patients were monitored by means of pulse oximetry, electroc...

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“…The ratio obtained in this study using clinical pain is considered to be more relevant than that obtained in experimental models of pain (Beecher % 957) and the 2: 1 to 4: 1 potency ratio (i.e., the ratio of doses required to produce an equivalent amount of analgesia) has been used for subsequent studies. When compared within a 13-drug battery of analgesics for the relief of postoperative pain, there was no difference between 5 mg heroin and 18-15 rng morphine (Morrison et al 1971). When cornpaged against morphine for the relief of gain caused by suspected rnyocxdia8 infarction, heroin produced complete pain relief in more patients H 0 min after injection than did morphine, indicating a faster onset of acaion (Scott and Om 1969).…”

Section: Analgesic Properties Of Herniamentioning

confidence: 99%

The therapeutic use of heroin: a review of the pharmacological literature

Sawynok¹

1986

Can. J. Physiol. Pharmacol.

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Heroin is currently being advocated by some as a superior therapeutic agent for use in terminal illness. However, a review of the literature on heroin presently available does not support this contention. Administered orally, heroin is approximately 1.5 times more potent than morphine in controlling chronic pain in terminal cancer patients. Its effects on mood and the incidence and nature of side effects do not differ from those of morphine except in males where poorer pain control probably accounts for the worse effect on mood. Given parenterally for acute pain, heroin is 2-4 times more potent than morphine and faster in onset of action. When the potency difference is accounted for, the pharmacological effects of heroin do not differ appreciably from those of morphine. Heroin is metabolized to 6-acetylmorphine and morphine. After oral administration of heroin, morphine but not heroin or 6-acetylmorphine is detected in blood. In this case, heroin is a prodrug for the delivery of systemic morphine. Following acute i.v. administration, heroin appears transiently in blood with a half-life of about 3 min. The half-life of heroin exposed to blood or serum in vitro is 9-22 min, indicating that organ metabolism is involved in blood clearance as well. Direct renal clearance of heroin is less than 1% of the administered dose. In animal studies, heroin and 6-acetylmorphine are both more potent and faster acting than morphine as analgesics, effects attributed to their greater lipid solubility and subsequent penetration of the blood-brain barrier. Given centrally, morphine is more potent than heroin and 6-acetylmorphine in producing analgesia.(ABSTRACT TRUNCATED AT 250 WORDS)

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Controlled Comparison of the Efficacy of Fourteen Preparations in the Relief of Postoperative Pain

Cited by 9 publications

References 10 publications

Morphine combined with doxapram or naloxone*

Morphine combined with doxapram or naloxone*

A comparison of oxycodone and fentanyl in the management of early postoperative pain and for patient-controlled analgesia after total abdominal hysterectomy

The therapeutic use of heroin: a review of the pharmacological literature

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