Abstract
Purpose
To compare, over a 48-hr follow-up period, the analgesia and side-effects of patient controilediv analgesia (PCA) with morphine alonevs combined intrathecal and PCA morphine (IT+PCA) in patients undergoing major abdominal surgery.
Methods
Sixty adult patients undergoing abdominal surgery for cancer were randomly allocated to receive preoperative IT (0,3 or 0,4 mg) plus postoperative PCA morphine or postoperative PCA morphine alone. Postoperative analgesia was tested at rest and while coughing on a visual analogue pain scale and morphine consumption was recorded. Patients’ satisfaction, arterial oxygen saturation, respiratory rate, episodes of nausea, vomiting and pruritus were also noted.
Results
Analgesia at rest and while coughing was significantly better in the IT+PCA morphine group (rest:P = 0,01; coughing:P = 0,005) on the first postoperative day only, IT+PCA morphine constantly provided adequate analgesia during this period. Morphine consumption was lower in the IT+PCA morphine group during this period also (IT+PCA: 9 (17)vs PCA: 40 (26); mg of morphine, mean (SD),P = 0,0001), No difference was found in pain relief and morphine consumption between the groups on the second postoperative day. Nausea and vomiting were more frequent with IT+PCA morphine on the first postoperative day. No respiratory depression occurred in either group. Satisfaction was high in both groups.
Conclusions
IT+PCA morphine improves patient comfort constantly during the first postoperative day after major abdominal surgery. However, after the first postoperative day, IT+PCA morphine provides no additional benefit.
Résumé
Objectif
Comparer, pendant un suivi de 48 h, l’anaigésie et les effets secondaires de l’anaigésie iv auto- contrôlée (AAC) avec de la morphine seule vs de la morphine en AAC combinée à de la morphine intrathécale (IT+AAC) chez des patients qui subissent une intervention chirurgicale abdominale majeure.
Méthode
Soixante patients adultes devant subir une intervention abdominale pour un cancer ont été répartis au hasard et ont reçu de la morphine IT préopératoire (0,3 ou 0,4 mg) plus de la morphine postopératoire en AAC ou seulement de la morphine postopératoire en AAC. Lanalgésie postopératoire a été testée au repos et pendant la toux au moyen d’une échelle visuelle analogique. Aussi, on a noté la consommation de morphine, la satisfaction des patients, la saturation de sang en oxygène, le rythme respiratoire, les nausées, les vomissements et le prurit.
Résultats
Lanalgésie au repos et pendant la toux a été significativement meilleure dans le groupe IT+AAC (repos: P = 0,01; toux: P = 0,005) au premier jour postopératoire seulement. La morphine IT+AAC a fourni régulièrement une analgésie adéquate pendant cette période. La consommation de morphine a été plus faible dans le groupe IT+AAC pendant ce même temps (IT+AAC: 9 (17) vs AAC: 40 (26); tmg de morphine, moyenne (écart type) P = 0,0001). Aucune différence d’analgésie et de consommation de morphine intergroupes n’a été trouvée le deuxième jour postopératoire. Les nausées et les vomissements ont été plus fréquents avec la morphine IT+AAC au premier jour postopératoire. Aucune dépression respiratoire n’a été enregistrée. La satisfaction a été élevée chez les patients des deux groupes.
Conclusion
La morphine IT+AAC améliore le confort du patient de façon constante pendant le premier jour postopératoire suivant une opération abdominale majeure. Cependant, par la suite, la morphine IT+AAC ne donne plus d’avantage supplémentaire.
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This work should be attributed to the Department of Anaesthesiology, Gustave Roussy Institute, 39 Rue Camille Desmoulins, 94805 Villejuif Cedex, France.
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Devys, JM., Mora, A., Plaud, B. et al. Intrathecal + PCA morphine improves analgesia during the first 24 hr after major abdominal surgery compared to PCA alone. Can J Anesth 50, 355–361 (2003). https://doi.org/10.1007/BF03021032
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DOI: https://doi.org/10.1007/BF03021032