Postoperative Effects of Opioid Analgesics Administered via Continuous Perfusion and Patient Controlled Analgesia after Open Heart Surgery

Abstract

Critical care nurses and physicians are familiar with the principles of patient controlled analgesia and the opioid analgesics' regimens and observations necessary for pain control in the postoperative cardiac surgical patients. The objective of the study was to compare the eŠects of morphine, fentanyl, meperidine, remifentanil and tramadol which were administered by patient controlled analgesia and continuous intravenous infusion combination on the various parameters. This study was designed as prospective randomised trial. Fifty patients undergone open heart surgery with sternotomy were entered equally intoˆve randomized groups. Visual analog scale was used by researcher nurse to assess the patient' pain status. Respiratory rate, heart rate and blood gases (pO 2 , pCO 2 , SaO 2 ), radial arterial blood pressures were measured in theˆrst 24 hrs postoperatively. Bolus requirements were determined by physicians and side eŠects of the analgesics were documented. Fentanyl group showed statistically higher levels of mean pO 2 ( p＝0.002). Meperidine had the lowest number of bolus doses ( p＝0.001). There were no signiˆcant diŠerences between the groups for pain management except higher visual analog scales on tramadol. Headache, stomachache and, palpitations were observed in our patients. Remifentanil, meperidine, fentanyl and morphine showed similar eŠect with each other for pain relief except tramadol.

Analgesic Efficacy and Adverse Effects of Meperidine in Managing Postoperative or Labor Pain: A Narrative Review of Randomized Controlled Trials

“…Only 3 studies showed that meperidine had a better safety or side-effect profile compared to other analgesics. PCA meperidine caused fewer incidences of nausea and vomiting than PCA morphine or fentanyl after open-heart surgery (75), and PCA oxymorphone after Cesarean section (54).…”

“…Morphine was the most common comparator of meperidine. Intravenous or PCA meperidine was associated with a higher incidence of vomiting (55)(56)(57) and similar level of sedation (27,55,56,75) compared to IV, PCA, or epidural morphine. One study reported PCA morphine to cause more sedation when compared to PCA meperidine after Cesarean section (54).…”

“…The third study showed that the use of IM meperidine following laparoscopic ovarian cystectomy significantly lowered pain scores compared to PCA morphine, but the PCA morphine group had significantly higher patient satisfaction scores (58). In the fourth study, PCA meperidine had better analgesic efficacy than PCA tramadol following open-heart surgery (75). In the fifth study, IM meperidine was associated with greater pain relief than IM tramadol at 30 and 60 minutes after drug administration, but there were no differences after that (46).…”

“…PCA meperidine was associated with more sedation compared to PCA fentanyl after orthopedic or abdominal surgery but did not differ for nausea, vomiting, or pruritus (27). A study comparing PCA fentanyl with PCA meperidine after open heart surgery found higher levels of sedation with meperidine (75). The same study found that nausea and vomiting were more common with PCA fentanyl.…”

Estudio de los efectos térmicos de la sedación postoperatoria tras cirugía cardíaca con circulación extracorpórea: Estudio comparativo entre la sedación intravenosa con propofol versus inhalatoria con sevofluorano

“…Analgésicos Opiáceos Los analgésicos opiáceos son parte fundamental del tratamiento analgésico del postoperatorio inmediato tras cirugía cardiaca, si bien hay diferencias en cuanto al opiáceo, dosis y al sistema de administración entre las unidades de críticos para esta práctica. Se ha descrito y comparado el efecto entre remifentanilo, meperidina, fentanilo, morfina y tramadol, encontrando que un efecto similar entre todos salvo con el tramadol, que no se aconseja para esta situación [153] .…”