Abstract
A randomized, placebo-controlled, double-blind clinical trial was conducted to compare the use of regularly dosed po morphine and on-demand im morphine in 47 patients undergoing total hip arthroplasty. Patients were randomized to receive either 20 mg (initial dose) of regularly dosed morphine (every four hours po) plus breakthrough pain medication on-demand consisting of both 10 mg morphine po and placebo im, or an equivalent regularly dosed oral placebo (every four hours) with breakthrough pain medication consisting of oral placebo and 5–10 mg morphine im. Subsequent to each request for break-through pain medication, the next regularly dosed oral solution was increased by 5 mg (or equivalent volume of placebo) to a maximum of 40 mg po Q4H. Time-averaged pain scores were lower on both postoperative day 1 and 2 in the group receiving regularly dosed morphine po (P < 0.05). Fewer patients requested breakthrough pain medication on both days in the oral morphine group. The incidences of nausea and vomiting, and of decreased respiratory rates were similar in both groups. Regularly dosed oral morphine is inexpensive and should be compared to other methods of opioid delivery.
Résumé
Une étude randomisée, contrôlée avec placébo et à double insu est réalisée dans le but de comparer l’utilisation de morphine po avec la morphine sur demande im chez 47 patients après une arthroplastie totale de la hanche. La randomisation est effectuées de façon à ce que les patient reçoivent: soit morphine 20 mg po (dose initiale) répétée régulièrement (aux quatre heures) avec l’addition, pour les percées douloureuses sur demande de morphine 10 mg po ou d’un placébo im; soit un placébo oral administré avec la même régularité (aux quatre heures) avec l’addition pour les percées douloureuses de placébo po et morphine 5–10 mg im. Subsequemment à chaque demande supplémentaires pour des percées douloureuses, la dose régulière suivante est augmentée de 5 mg (ou d’un volume équivalent de placébo) jusqu’à un maximum de 40 mg po aux quatres heures. Les scores d’évaluation moyens sont plus bas pour les deux premiers jours postopératoires pour le groupe qui regoit de la morphine régulièrement (P < 0,05). Moins de patients reçoivent de la morphine pour des percées douloureuses pendant ces deux jours dans le groupe morphine po. L’incidence des nausées et vomissements et de bradypnée est la même dans les deux groupes. La morphine administrée po régulièrement coûte peu et devrait être comparée aux autres méthodes d’administration.
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Supported by a grant from the Vancouver Foundation, Vancouver, British Columbia, and the Pharmaceutical Manufacturers Association of Canada/ Medical Research Council.
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McCormack, J.P., Warriner, C.B., Levine, M. et al. A comparison of regularly dosed oral morphine and on-demand intramuscular morphine in the treatment of postsurgical pain. Can J Anaesth 40, 819–824 (1993). https://doi.org/10.1007/BF03009251
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DOI: https://doi.org/10.1007/BF03009251