Effects of postoperative background PCA morphine infusion on pain management and related side effects in patients undergoing abdominal hysterectomy

Efficacy of Non-Opioid Analgesics on Opioid Consumption for Postoperative Pain Relief After Abdominal Hysterectomy

“…22 A background infusion was not provided in this study because of a possible increased risk of respiratory depression. 6 Abdominal hysterectomy was selected because it may produce considerable postoperative pain, and there is obviously no randomized, double-blind, placebo-controlled study that compares IV administered parecoxib, paracetamol, or metamizol, on piritramide consumption in the early postoperative period of abdominal hysterectomy.…”

“…1 Numerous randomized control studies have been published evaluating efficacy, side effects, and patient satisfaction with PCA. [2][3][4][5] Although the majority of PCA studies were conducted with morphine alone and in combination with many other drugs to augment analgesic effect or to reduce the adverse events, [3][4][5][6][7][8][9][10][11][12][13] piritramide has been used in parts of Europe and South America as the analgesic of choice for the management of postoperative pain for > 40 years. 14 Its relative analgesic potency compared with morphine is *0.7.…”

Hysterectomy: Advances in Perioperative Care

“…All opioids act similarly in this respect, and although side effects usually occur at higher doses than analgesic effects, they still remain a major clinical problem which render many patients helpless, unable to get out of bed, with the subsequent risk of more severe complications such as hypoxia, pneumonia, deep venous thrombosis, pulmonary embolism, ileus and decubitus. The apparent discord between the obvious need for opioids and the abhorred side effects have led clinicians to try various methods of alleviating opioid-related side effects: 1) the combination of intravenous morphine with a μ-receptor antagonist such as naloxone by patient-controlled analgesia (PCA) has been largely disappointing (Sartain, 2003;Zhao, 2005); 2) a similar combination using a μ-receptor antagonist, alvimopan, with limited oral bioavailibility (thus only acting in the GI tract) has fared better and has been shown to improve tolerance to solid foods, time to first bowel movement and passage of stool, although the magnitude of improvements were moderate (Herzog, 2006;Tan, 2007); 3) the use of simple osmotic laxatives have been shown to reduce time to first defecation from 69 to 45 hours with subsequent early hospital discharge (Hansen, 2007); 4) early postoperative oral intake seems to be superior to delayed intake by reducing time to first solid diet, presence of bowel sounds, and shorter hospital stay, at the expense of slightly increased nausea (Charoenkwan, 2007); 5) the combination of intravenous morphine with butorphanol reduces opioid requirements and some opioid-related side effects, but causes sedation, sweating and dry mouth ; 6) the combination with nalbuphine, a mixed opioid agonist-antagonist, also seems to attenuate opioid-related nausea, but other opioid-related side effects remain unchanged ; 7) the omission of a background rate of infusion of morphine for intravenous patient-controlled analgesia (PCA) seems to reduce overall morphine consumption, reduce nausea, vomiting and dizziness but, again, other opioid-related side effects remain unchanged (Chen, 2011); 8) intravenous oxycodone seems to cause less opioid-related sedation than intravenous morphine, but other side effects are similar, suggesting a difference caused by stochastic variation (Lenz, 2009). …”

Transdermal fentanyl for pain due to chemoradiotherapy-induced oral mucositis in nasopharyngeal cancer patients: evaluating efficacy, safety, and improvement in quality of life

“…The use of oral opioid analgesics has been reported, but their effects are affected by ingestion, so they cannot be widely used clinically 12,13. Additionally, the European Society for Medical Oncology and the National Comprehensive Cancer Network guidelines recommend patient-controlled analgesia (PCA) for the treatment of OM pain in hematopoietic stem cell-transplant and bone marrow-transplant patients 14,15. PCA administers analgesics intravenously at a constant rate, the effect is long-lasting and stable, the analgesic dose can be adjusted, and it has been shown that the method can control pain effectively 15.…”

“…Additionally, the European Society for Medical Oncology and the National Comprehensive Cancer Network guidelines recommend patient-controlled analgesia (PCA) for the treatment of OM pain in hematopoietic stem cell-transplant and bone marrow-transplant patients 14,15. PCA administers analgesics intravenously at a constant rate, the effect is long-lasting and stable, the analgesic dose can be adjusted, and it has been shown that the method can control pain effectively 15. However, it is an invasive treatment and the cost is high, and thus its clinical use is limited.…”