Responders and non-responders to post-operative pain treatment: the loading dose predicts analgesic needs

Stamer, Ulrike; Grond, Stefan; Maier, Christoph

doi:10.1046/j.1365-2346.1999.00427.x

Cited by 15 publications

(7 citation statements)

References 22 publications

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“…We know that the size of loading dose of morphine and the use of the pain scores during the first 30 minutes of post operative care are useful in assessing the pattern of response in managing the pain. 23 This supports an early and aggressive bolus dose adjustment strategy for PCA use. We assume that mobilization was associated with most of the ineffectual doses and pain during mobilization is complex.…”

Section: Discussionmentioning

confidence: 58%

Difficulties in Controlling Mobilization Pain Using a Standardized Patient-Controlled Analgesia Protocol in Burns

Nilsson

Kalman

Sonesson

et al. 2011

Journal of Burn Care & Research

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Objectives: The aim of the study was to evaluate pain relief for patients with burns during rest and mobilization with morphine according to a standard protocol for patient-controlled analgesia (PCA). Methods:Eighteen patients with a mean (SD) burned total body surface area (TBSA %) of 26 (20) were studied for 10 days. Using a Numeric Rating Scale (NRS, 0=no pain and 10=unbearable pain), patients were asked to estimate their acceptable and worst-experienced pain by specifying a number on a scale, and at what point they would like additional analgesics. Patients were allowed free access to morphine with a patient controlled-analgesia pump device (PCA). Bolus doses were set according to age; (100-age)/24 = bolus dose (mg), and 6 minutes lockout-time. Degrees of pain, morphine requirements, doses delivered and demanded, oral intake of food, and anti-emetics given were used as endpoints.Results: Acceptable pain (mean (SD)) was estimated to be 3.8 (1.3) on the NRS scale, and additional treatment was considered necessary at scores of 4.3 (1.6) or more. NRS at rest was 2.7 (2.2) and during mobilization 4.7 (2.6). Required mean morphine/day was 81 (15) mg and number of doses requested increased during the first six days after the burn. We found no correlation between dose of morphine required and any other variables. Conclusions:Background pain can be controlled adequately with a standard PCA protocol.During mobilization, the pain experienced was too intense, in spite of having the already high doses of morphine increased. The present protocol must be refined further to provide analgesia adequate to cover mobilization as well.Word count: 257 4 (20)

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Section: Discussionmentioning

confidence: 58%

Difficulties in Controlling Mobilization Pain Using a Standardized Patient-Controlled Analgesia Protocol in Burns

Nilsson

Kalman

Sonesson

et al. 2011

Journal of Burn Care & Research

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“…These patients represent 25% to 40% of the population and have been previously described as "nonresponders." [20,21] Stamer et al [20] were the first to identify a subgroup of nonresponders who had higher pain scores and required more analgesic consumption than their "normal" counterparts. Bar Meir et al [18] found a distinct non responder subgroup of patients who had elevated pain scores despite higher morphine consumption after flap DIEP reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Deep Inferior Epigastric Perforator Flap (D.I.E.P) for Breast Reconstruction: Impact of Intraoperative Intrathecal Morphine on Outcome

Aziz¹,

Halenarova²,

Schröder³

et al. 2018

oajost

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Background: Pain control after breast reconstruction with Deep Inferior Epigastric Perforator (DIEP) often requires intravenous narcotic analgesia and inpatient hospitalization. Intrathecal morphine (ITM) administration analgesia is increasing in popularity because it decreases the use of intravenous analgesic medications and offer comparable pain relief with less systemic side effects. Questions/purposes: The aim of this retrospective study was to evaluate the effect of intrathecal morphine on postoperative morbidity of breast reconstruction by Deep Inferior Epigastric Perforator flap and compare it with intravenous narcotic analgesia. Methods: 269 patients underwent immediate or delayed DIEP reconstruction after mastectomy, by the same surgeon, at Jules Bordet Institute. Patients receiving ITM analgesia (300) were matched 1:3 with patients undergoing intravenous narcotic analgesia for pain control in the same years by the same surgeon. Differences in peri-and postoperative complications across the two groups were assessed. Results: The two groups were comparable in terms of demographic characteristics and factors of morbidity. Intraoperative variables were not statistically different between the groups except for intraoperative blood loss (P = 0.0001), transfusion (P = 0.0001) and Intraoperative liquid requirement (p = 0.0001). Intra and postoperative blood pressure were lower in ITM group (p < 0.05). Patients in ITM group showed lower postoperative analgesia requirement (P < 0,0001), less respiratory complications and less acute respiratory failure (P = 0,003 and P = 0,004, respectively). No statistically significant differences in the length of hospital stay (LOS) were noted Conclusion: We found that intrathecal morphine analgesia was associated with less blood loss and fluid administration, better postoperative pain control, and less respiratory complications with an acceptable security profile than intravenous narcotic analgesia. Clinical relevance: This study suggests that using intrathecal morphine may result in less blood loss and blood transfusion, better postoperative pain control, and less respiratory complications.

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“…The unpredictability of opioid effectiveness can be another limitation to opioid therapy, in that there is considerable variation in treatment response among patients. In a study of patient-controlled morphine for postsurgical pain, 40.4% of patients were classified as "non-responders" to morphine [49]. Thus, clinicians prescribing morphine to chronic pain patients for longterm use must be prepared to work closely with the patient to find the correct opioid and titrate the optimal dose.…”

Section: Limitations Of Opioid Therapy For Chronic Non-cancer Painmentioning

confidence: 99%

The Role of Opioids in Chronic Non-Cancer Pain Management.

et al. 2015

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Chronic pain is prevalent in Asia as well as worldwide, and physicians must carefully consider which pharmacologic or non-pharmacologic analgesic strategy is appropriate based on its availability, adverse effects, abuse liability, potential drug-drug interactions, onset of action, tolerability, cost, and-above all-effectiveness. NSAIDs increase the pain threshold by inhibiting cyclooxygenase (COX) and are the first step of the World Health Organization "pain ladder," but they have been associated with gastrointestinal complications, possible renal failure, and hypertension. Acetaminophen (paracetamol) is an effective pain reliever for mild to moderate pain, but is associated with liver toxicity at high doses. Opioids are effective pharmacologic treatment and standard therapy for moderate to severe cancer pain, but their long-term use for non-cancer pain is controversial. Opioid-associated side effects may be transient, treatable, or treatment limiting. Not all chronic non-cancer pain patients are candidates for opioid therapy, particularly if there are risk factors for misuse or abuse. Combining an opioid and a nonopioid (such as acetaminophen or NSAID) in combination therapy can create synergistic analgesic effect and reduce the patient's total opioid consumption while still achieving good analgesic results. Adjuvant agents such as anticonvulsants or tricyclic antidepressants can be useful to deal with multimechanistic pain, including pain with a neuropathic component, frequently observed in chronic non-cancer pain patients.

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Responders and non-responders to post-operative pain treatment: the loading dose predicts analgesic needs

Cited by 15 publications

References 22 publications

Difficulties in Controlling Mobilization Pain Using a Standardized Patient-Controlled Analgesia Protocol in Burns

Difficulties in Controlling Mobilization Pain Using a Standardized Patient-Controlled Analgesia Protocol in Burns

Deep Inferior Epigastric Perforator Flap (D.I.E.P) for Breast Reconstruction: Impact of Intraoperative Intrathecal Morphine on Outcome

The Role of Opioids in Chronic Non-Cancer Pain Management.

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