Epidural Morphine for Postoperative Pain Relief

Reiz, S.; Åhlin, Johan; Ahrenfeldt, B; Andersson, Micael; Andersson, Staffan

doi:10.1111/j.1399-6576.1981.tb01619.x

Cited by 54 publications

(12 citation statements)

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“…The results at 24 h most certainly became obscured as many patients in Groups IM, IC and EM required intramuscular oxycodone prior to testing and the x-ray examination. Only two of the epidural morphine patients managed without additional analgesics for 24 h, which is in accordance with results from our earlier study, using a similar dose (4 mg) (8) and studies by others (16,17).…”

Section: Discussionsupporting

confidence: 92%

Comparison of Intramuscular Analgesia, Intercostal Block, Epidural Morphine and On‐Demand‐i.v.‐Fentanyl in the Control of Pain after Upper Abdominal Surgery

Rosenberg

Heino

Scheinin

1984

Acta Anaesthesiol Scand

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Eighty patients undergoing upper abdominal surgery were randomly allocated to four groups according to the postoperative pain treatment. All patients had a standardized balanced anaesthesia and for postoperative analgesia either intramuscular oxycodone and/or metamizol (IM), intercostal block with 0.5% bupivacaine (IC), epidurally 4 mg morphine (EM) or i.v. infusion of fentanyl 0.54-0.99 micrograms min-1 + on-demand boluses of 7.2-13.5 micrograms (ODAC) were given. The pain intensity 2 h postoperatively was similar in all groups, mean score ranging from 3.2-4.3 on a scale from 0-10. At 24 h also, when additional intramuscular analgesics had been administered if needed, the mean pain scores did not vary much; 2.4 in the ODAC group to 3.4 in the IC group. The time until the first request for additional analgesia was longer in the EM group than in the IM group (7.5 h vs. 3.5 h). There were no differences between the groups in chest X-ray, peak expiratory flow or respiratory rate postoperatively, but in the capillary blood-gas analyses there was a greater number of slightly elevated PCO2 values (6.0-7.3 kPa) in the ODAC group than in the others. The amount of fentanyl infused in 24 h to the ODAC patients varied considerably, 814-2233 micrograms, as did the number of on-demand boluses, 3-155. At 24 h, an efficacy rating "good" was distributed as follows: IM 9/20, IC 11/20, EM 11/20 and ODAC 13/20. In the whole patient material 92.5% rated their condition as "good" or "fair".

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Section: Discussionsupporting

confidence: 92%

Comparison of Intramuscular Analgesia, Intercostal Block, Epidural Morphine and On‐Demand‐i.v.‐Fentanyl in the Control of Pain after Upper Abdominal Surgery

Rosenberg

Heino

Scheinin

1984

Acta Anaesthesiol Scand

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“…4 6 Following this report, the use of epidural opioids for postoperative pain relief quickly gained acceptance and several publications in the early 1980s confirmed its efficacy. [47][48][49] Ultimately, it was the discovery of opioid receptors in the spinal cord that led to the effective treatment of postoperative pain by neuraxial administration without profound sedative effects.…”

Section: Neuraxial Administrationmentioning

confidence: 99%

In the arms of morpheus: the development of morphine for postoperative pain relief

Hamilton

Baskett

2000

Can J Anesth/J Can Anesth

484

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Purpose: To analyse the historical development of morphine for postoperative analgesia and how this development was shaped by the evolution of anesthetic techniques.Methods: After a systematic review of the literature, information was gathered from primary sources. Principal Findings: In ancient medicine, some plant derivatives were used to alleviate pain including: alcohol, cannabis, mandrake, and opium. Over the past two centuries, opium and its derivatives have become the most widely used analgesics for severe pain. Before the development of general anesthesia, surgery was only performed out of extreme necessity. It is probable that an analgesic such as opium would have been given following surgery although its use may not have been recorded. The first description of postoperative opium was by James Moore in 1784. Morphine was isolated from opium by Friedrich Serturner in 1805. However, it was not until the development of the hypodermic needle and syringe nearly 50 yr later that the use of morphine became widespread. Over the last century, various delivery systems for morphine have been developed including subarachanoid and epidural injection, and more recently patient-controlled intravenous, epidural and intranasal analgesia. In addition, many new opioids have been synthesized. Conclusion:Since its isolation from opium almost 200 yr ago, morphine remains the most widely used analgesic and the standard against which all new opioids for postoperative pain relief are compared.Objectif : Décrire le développement historique de la morphine comme analgésique postopératoire et montrer comment il a été façonné par l'évolution des techniques anesthésiques.Méthode : On a d'abord passé systématiquement en revue la documentation pertinente, puis rassemblé les informations des principales sources.Constatations principales : La médecine ancienne utilisait certains dérivés de plantes pour soulager la douleur: l'alcool, le cannabis, la mandragore et l'opium. Au cours des deux derniers siècles, l'opium et ses dérivés sont devenus les analgésiques les plus utilisés contre la douleur vive. Avant l'avènement de l'anesthésie générale, l'intervention chirurgicale n'était réalisée qu'en cas d'extrême nécessité. Il est probable qu'un analgésique comme l'opium ait été administré à la suite d'une opération sans qu'on en consigne l'emploi. La première description de l'utilisation postopératoire d'opium revient à James Moore en 1784. La morphine a été isolée de l'opium par Friedrich Serturner en 1805. Cependant, son usage ne s'est répandu qu'avec l'arrivée, 50 ans plus tard, de l'aiguille hypodermique et de la seringue. Pendant le siècle dernier, on a mis au point différents systèmes d'administration de la morphine, y compris l'injection sous-arachnoïdienne et péridurale et, plus récemment, l'analgésie intraveineuse, péridurale et intranasale contrôlée par le patient. De plus, nombre de nouveaux opioïdes ont été synthétisés.Conclusion : Depuis que la morphine a été isolée de l'opium, il y a près de 200 ans, elle demeure l'analgésique le...

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“…Thiscompares favourably with a 20% incidence of nausea and vomiting after 2 mg of morphine. 20 The most alarming problem with epidural opiates has been late, unpredictable and very severe respiratory depression, thought to be due to the cephalad spread of the analgesic to the vital centres in the medulla.21 This spread is considered less likely to occur with the more lipophilic agents.2 Meptazinol is a relatively lipophilic agent and so theoretically should be less prone to spread towards the medulla than morphine but if this were to occur it ought to be less hazardous in view of its decreased propensity to produce respiratory depres~ion.~ These properties together with the drug's rapid onset and its effectiveness seen in the present study makeit asuitabledrugfor study period. They were also monitored half hourly by the nursing staff until the following morning.…”

Section: Side Effectsmentioning

confidence: 99%