Abstract
The present study examined the impact of two methods of pain management on recovery in 38 women undergoing hysterectomy. One group received IV morphine in the recovery room and IM morphine on the ward on a PRN basis (PRN group). In the other group, a loading dose of morphine 8 mg IV was given when the patient first complained of pain and patientcontrolled IV morphine (PCA) was initiated and continued for 48 h (PCA group). Both groups received similar amounts of morphine overall, differently distributed over time. The PCA patients received 8 mg · h− 1 in the recovery room (approximately 2.5 hrs) and less thereafter. The PRN patients received approximately 2 mg · h− 1 for the entire 48- hr period. Pain control was better throughout convalescence and less variable across time with PCA management. Minute ventilation also recovered faster and by day four was 25 per cent above the preoperative baseline in the PCA group. In addition, oral temperature became normal one day earlier, ambulation recovered more rapidly and patients were discharged from hospital earlier. The data suggest that early treatment with relatively high, selftitrated morphine doses may alter the course of the metabolic response to surgery.
Résumé
Nous avons mesuré l’impact de deux méthodes d’analgésie sur la récupération posthystérectomie de 38 patientes. A celles du groupe PRN, on injectait de la morphine IV à la salle de réveil puis de la morphine IM au besoin. Aux autres (groupe PCA), on donnait 8 mg de morphine IV dès l’avènement des douleurs et on les laissaient ensuite elles-mêmes contrôler l’injection de la morphine IV pendant 48 hre. Les patientes des deux groupes utilisèrent des quantités semblables de morphine quoique vec des profits temporels différents soil 8 mg · h− 1 en salle de réveil (∼2,5 hre) et moins par la suite pour celles du groupe PCA contre approximativement 2 mg · h− 1 pendant 48 hre pour celles du groupe PRN. L’analgésie était plus stable et de meilleure qualité pendant la convalescence chez le groupe PCA. La ventilation/minute remontait aussi plus vite dans ce groupe, dépassant même les valeurs pré- opératoires de 25 pour cent au quatrième jour post- opératoire. De plus la température orale s’y normalisait un jour plus tôt, la mobilisation y était plus rapide et le congé y survenait plus précocement. Il semble done que l’auto- injection précoce de doses relativement importantes de morphine puisse modifier la réponse métabolique au stress chirurgical.
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This work was supported by Grant #MA8914 from the Medical Research Council of Canada.
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Wasylak, T.J., Abbott, F.V., English, M.J.M. et al. Reduction of post-operative morbidity following patient-controlled morphine. Can J Anaesth 37, 726–731 (1990). https://doi.org/10.1007/BF03006529
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DOI: https://doi.org/10.1007/BF03006529