Une perfusion de morphine améliore l’analgésie autocontrôlée après cardiochirurgie

Güler, Tayfun; Ünlügenç, H.; Gundogan, Zehra; Özalevli, M.; Balcioglu, Okan; Topcuoglu, Mehmet Sah

doi:10.1007/bf03018432

Cited by 41 publications

(27 citation statements)

References 22 publications

(44 reference statements)

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“…However, morphine consumption and possible side effects as reported by other studies [6,12,13,16] can help clinicians to choose the best alternative.…”

Section: Discussionmentioning

confidence: 97%

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Comparison study of two different patient-controlled anesthesia regiments after cardiac surgery

Mota¹,

Marcolan²,

Pereira³

et al. 2010

Rev Bras Cir Cardiovasc

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Estudo comparativo de duas diferentes modalidades de analgesia controlada pelo paciente após cirurgia cardíacaComparasion study of two different patientcontrolled anesthesia regiments after heart surgery Abstract Introduction: Acute and severe pain is frequent in patients who undergo heart surgery and patient controlled analgesia (PCA) can be used to manage postoperative pain.Objective: To compare analgesia using PCA without continous infusion with PCA plus a continuous infusion of morphine on postoperative period of heart surgery and to assess pain scores, morphine consumption, number of demand, patient satisfaction and side effects.Methods: Randomized clinical trial was performed to assess patients who had undergone heart surgery who received either PCA with and without intravenous infusion of morphine. In the postoperative period, PCA was started at extubation in both regiments according to randomization. Pain intensity, morphine consumption, number of demand, satisfaction and side effects were assessed at zero, six, twelve, eighteen, twenty four and thirty hours after patients' extubation.Results: The study enrolled 100 patients. 50 patients received PCA without continuous infusion of morphine (Group A), and 50 patients received morphine PCA plus a continuous infusion of morphine (Group B). Group B patients had less demand of morphine, consumed more morphine and were more satisfied regarding analgesia. No statistical differences were found between groups related to pain intensity, and side effects.Conclusions: Pain control was effective and similar in both groups. The same efficacy of analgesia and the less morphine consumption suggest that PCA without continuous infusion of morphine seems to be better option for postoperative pain manage in heart surgery. Descriptors 39MOTA, FA ET AL-Comparasion study of two different patientcontrolled anesthesia regiments after heart surgery Rev Bras Cir Cardiovasc 2010; 25(1): 38-44 less side effects and drug consumption after cardiac surgery. Thus, this randomized controlled study was carried out with the aim to compare these two regiments after cardiac surgery. METHODSThe study protocol was approved by the institutional ethical and research committee and patients were enrolled in the study after formal consent. The major eligibility criteria are listed in Table 1.

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“…However, morphine consumption and possible side effects as reported by other studies [6,12,13,16] can help clinicians to choose the best alternative.…”

Section: Discussionmentioning

confidence: 97%

“…However, another study involving morphine basal infusion enrolled 35 patients and was unable to show any significant difference in pain management when compared to PCA alone [12,13].…”

Section: Discussionmentioning

confidence: 99%

Comparison study of two different patient-controlled anesthesia regiments after cardiac surgery

Mota¹,

Marcolan²,

Pereira³

et al. 2010

Rev Bras Cir Cardiovasc

View full text Add to dashboard Cite

show abstract

“…Furthermore, the study design of mixed paired and unpaired observations decreases uneven distribution of unknown confounders. Although our study is of comparable size as other trials with PCA [9][10][11][12][13][14][15][16][17][18][19][20], a larger trial will be needed to demonstrate whether the use of PCA in vaso-occlusive crisis will result in a reduction in length of hospital stay and complications such as acute chest syndrome. Second, the PCA design of our study made a complete blinding of the study impossible and could therefore be subject to bias.…”

Section: Side Effects and Adverse Eventsmentioning

confidence: 94%

“…A possible explanation for this effect, which also could explain the low morphine consumption in the PCA-treated patients in the present study, may be that a more rapid analgesic effect is induced by bolus administration of morphine rather than CI. However, comparative trials with PCA in patients with other causes of pain have demonstrated conflicting results on the cumulative morphine consumption [9][10][11][12][13][14][15][16][17][18][19][20].…”

Section: Side Effects and Adverse Eventsmentioning

confidence: 99%

Patient‐controlled analgesia versus continuous infusion of morphine during vaso‐occlusive crisis in sickle cell disease, a randomized controlled trial

et al. 2007

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Intravenous morphine is the treatment of choice for severe pain during vaso‐ occlusive crisis in sickle cell disease (SCD). However, side effects of morphine may hamper effective treatment, and high plasma levels of morphine are associated with severe complications such as acute chest syndrome. Furthermore, adequate dosing remains a problem since no objective measurement of pain severity exists and analgesia should be titrated upon the patient's reported pain. Patient‐controlled analgesia (PCA) may therefore be an interesting alternative since patients can titrate the level of analgesia themselves. In this randomized controlled study, the efficacy of intravenous morphine administration with PCA was compared with continuous infusion (CI) of morphine in patients with SCD during vaso‐occlusive crisis. Twenty five consecutive episodes of vaso‐occlusive crisis in 19 patients with SCD were included in the study. Patients in the PCA‐group had a markedly and significant lower mean and cumulative morphine consumption when compared with the patients in the CI‐group (0.5 mg/hr versus 2.4 mg/hr (P < 0.001) and 33 mg versus 260 mg (P = 0.018, respectively). The mean daily pain scores were comparable (4.9 versus 5.3). The lower mean and cumulative morphine consumption in the PCA‐group led to significant less nausea and constipation during treatment when compared with the CI‐group (area under the curve, respectively, 11 versus 18 (P = 0.045) and 30 versus 45 (P = 0.021). Furthermore, a nonsignificant reduction in the duration of hospital admission of 3 days was observed in the PCA‐group. PCA results in adequate pain relief at a much lower morphine consumption and should considered to be the first choice in morphine administration to sickle cell patients admitted with vaso‐occlusive crisis. Am. J. Hematol., 2007. © 2007 Wiley‐Liss, Inc.

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“…Some studies comparing the two types of patient-controlled analgesia (PCA) suggest that users of continuous PCA infusion of morphine have similar postoperative pain intensity but consume more morphine and have a greater incidence of adverse effects [4][5][6][7][8]. However, one study reported better postoperative analgesia [9]. Due to the inconsistency of results and the continued wide use of PCA, we performed a prospective, randomized study to evaluate the effectiveness of pain management and occurrence of side effects in two groups of women who underwent abdominal hysterectomies: one group receiving self-administered PCA only (PCA) and the other receiving continuous PCA with the ability to add extra doses if needed (continuous PCA).…”

Section: Introductionmentioning

confidence: 99%

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

Chen

Liu

Tan

et al. 2011

Journal of Clinical Anesthesia

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Une perfusion de morphine améliore l’analgésie autocontrôlée après cardiochirurgie

Abstract: Morphine PCA effectively controlled postoperative pain after cardiac surgery. The addition of a background infusion of morphine enhanced analgesia and increased morphine consumption.

Cited by 41 publications

References 22 publications

Comparison study of two different patient-controlled anesthesia regiments after cardiac surgery

Comparison study of two different patient-controlled anesthesia regiments after cardiac surgery

Patient‐controlled analgesia versus continuous infusion of morphine during vaso‐occlusive crisis in sickle cell disease, a randomized controlled trial

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

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