nicomorphine and Pain--Postoperative

The authors compared the effects of patient-controlled interscalene analgesia (PCIA) with ropivacaine 0.2% and patient-controlled intravenous analgesia (PCIVA) with opioids on hemidiaphragmatic excursion and respiratory function after major shoulder surgery.. Thirty-five patients scheduled for elective major shoulder surgery were prospectively randomized to receive either PCIA or PCIVA. All patients received an interscalene block before surgery. In the PCIA group, a catheter was introduced between the anterior and middle scalene muscles. Six hours after the initial block, patients received for 48 h either a continuous infusion of 0.2% ropivacaine through the interscalene catheter at a rate of 5 ml/h plus a bolus dose of 3 or 4 ml with a lockout time of 20 min (PCIA group) or a continuous intravenous infusion of nicomorphine at a rate or 0.5 mg/h plus a bolus dose of 2 or 3 mg with a lockout time of 20 min (PCIVA group). Hemidiaphragmatic excursion and respiratory function were assessed with the patient in a 45 degrees semirecumbent position the day before the operation and 20 min (in the operating room), 24 h, and 48 h after the initial block by means of ultrasonography and spirometry, respectively. Pain relief was regularly assessed, side effects were noted, and patient satisfaction was rated 6 h after the end of the study.. Hemidiaphragmatic excursion was similar in the two groups 20 min after interscalene block. Hemidiaphragmatic excursion was increased in the PCIA group on the nonoperated side 24 and 48 h after the interscalene block (P < 0.05). Pulmonary function was similar in the two groups at each time. Pain was better controlled in the PCIA group at 12 and 24 h (P < 0.05). The incidence of nausea and vomiting were 5.5% versus 60% for the PCIA and PCIVA groups, respectively (P < 0.05). Patient satisfaction was greater in the PCIA group (P < 0.05).. The use of PCIA or PCIVA techniques to provide analgesia after major shoulder surgery is associated with similar effects on respiratory function. In the PCIA group, hemidiaphragmatic excursion showed a significantly greater amplitude 24 and 48 h after the initial block on the nonoperated side. The PCIA technique provided better pain control, a lower incidence of side effects, and a higher degree of patient satisfaction.

Topics: Adult; Aged; Amides; Analgesia, Patient-Controlled; Anesthesia, General; Anesthetics, Local; Diaphragm; Female; Humans; Male; Middle Aged; Morphine Derivatives; Nicotinic Acids; Pain, Postoperative; Patient Satisfaction; Respiration; Respiratory Function Tests; Ropivacaine; Shoulder; Ultrasonography

We have compared the efficacy of patient-controlled interscalene analgesia (PCIA) using ropivacaine with patient-controlled analgesia (PCA) using nicomorphine in 60 patients (n = 30 in each group), in a prospective, randomized study. In both groups, all patients received interscalene block with 0.75% ropivacaine before induction of anaesthesia. Six hours after interscalene block, patients in group PCIA received continuous infusion of 0.2% ropivacaine at a rate of 5 ml h-1 with a bolus dose of 3 or 4 ml and a lockout time of 20 min; patients in group PCA received continuous infusion of nicomorphine 0.5 mg h-1 and a bolus dose of 2 or 3 mg with a lockout time of 20 min. Control of pain was significantly better from 12 to 48 h after operation (except at 42 h) in group PCIA. Nausea and pruritus occurred significantly more frequently in group PCA. Patient satisfaction was greater in group PCIA. We conclude that the use of 0.2% ropivacaine using PCIA was an efficient way of managing pain after major shoulder surgery and compared favourably with PCA nicomorphine in terms of pain relief, side effects and patient satisfaction.

Topics: Adolescent; Adult; Aged; Amides; Analgesia, Patient-Controlled; Analgesics, Opioid; Anesthetics, Local; Female; Humans; Male; Middle Aged; Morphine Derivatives; Nerve Block; Nicotinic Acids; Pain Measurement; Pain, Postoperative; Prospective Studies; Ropivacaine; Shoulder Joint

The authors compared patient-controlled interscalene analgesia (PCIA) with local anesthetics with intravenous patient-controlled analgesia (PCA) with opioids to manage postoperative pain after major shoulder surgery.. Forty patients scheduled for elective major shoulder surgery were prospectively randomized to receive either PCIA or PCA. Before surgery, all patients had an interscalene block. In the PCIA group, a catheter was introduced within the interscalene sheath. Six hours after the initial block, patients received for 48 h either a continuous infusion of 0.15% bupivacaine through the interscalene catheter at a rate of 5 ml/h plus a bolus of 3 or 4 ml with a lock-time of 20 min (group PCLA) or a continuous intravenous infusion of nicomorphine at a rate of 0.5 mg/h plus a bolus of 2 or 3 mg with a lock-time of 20 min (group PCA). Pain relief was regularly assessed using a visual analog scale, side effects were noted, and the patients were asked to rate their satisfaction at the end of the study.. Pain relief was significantly better controlled in the PCIA group at t = 12 and 18 h (P < 0.05). Vomiting and pruritus were 0 versus 25% and 0 versus 25% for the PCIA and PCA groups, respectively (P < 0.05). Patient satisfaction was greater in the PCIA group (P < 0.05). Time of first bolus administration and paracetamol supplement were similar in both groups.. The use of the PCIA technique was uncomplicated and provided better pain relief than PCA during the first 18 h after operation. The incidence of side effects such as vomiting and pruritus was significantly decreased with the use of PCIA, and patient satisfaction was superior in the PCIA group.

Topics: Analgesia, Patient-Controlled; Anesthetics, Local; Bupivacaine; Female; Humans; Male; Middle Aged; Morphine Derivatives; Nausea; Nicotinic Acids; Pain Measurement; Pain, Postoperative; Patient Satisfaction; Shoulder; Vomiting

The aim of the present investigation was to study the effects of intraoperative and postoperative epidural pain management during and after coronary artery bypass grafting (CABG) on the recovery time, postoperative pulmonary and cardiac parameters, visual analog scale (VAS) scores, and sedation scores (SS) compared with patients anesthetized with general anesthesia (GA) whose postoperative pain was relieved with intermittent intravenous (IV) administration of nicomorphine. Fifty-four patients were studied postoperatively after uncomplicated CABG. In the thoracic epidural analgesia (TEA) group (n = 27), intraoperative analgesia was based on high TEA in combination with GA. In the GA group (n = 27), IV anesthesia with high-dose sufentanil and midazolam was used. Postoperative pain management in the GA group consisted of intermittent IV administration of nicomorphine, 0.1 mg/kg every 6 hours, whereas for the TEA group continuous high TEA with 0.125% bupivacaine plus sufentanil, 1:1,000,000 (0.05 mL/cm body length/hr) was used. Patients in the TEA group awakened earlier (148 [34] minutes vs 335 [51] minutes), resumed spontaneous respiration earlier (326 [79] minutes vs 982 [52] minutes), and were extubated earlier (463 [79] minutes vs 1140 [58] minutes). VAS score, SS, and postoperative PaO2 were significantly (P less than or equal to 0.01) better in the TEA group. The incidence of tachycardia (15 vs 2 patients) and postoperative myocardial ischemia (12 vs 4 patients) was higher in the GA group. It is concluded that intraoperative and postoperative pain treatment with epidurally administered bupivacaine plus sufentanil improved the recovery time, as well as pulmonary and cardiac outcome after CABG, when compared with IV postoperative pain treatment after intraoperative GA with sufentanil and midazolam.

Topics: Analgesia, Epidural; Anesthesia, Intravenous; Bupivacaine; Coronary Artery Bypass; Fentanyl; Humans; Injections, Intravenous; Midazolam; Morphine Derivatives; Nicotinic Acids; Pain, Postoperative; Preanesthetic Medication; Sufentanil; Treatment Outcome

The influence of indomethacin on the need for postoperative analgesics was investigated in a double-blind study of 41 patients scheduled for abdominal hysterectomy. The incidence of side effects was evaluated. The patients were randomly allocated to treatment with either indomethacin, 0.8 mg/kg i.v. preoperatively, followed by 100 mg rectally 8-hourly for 3 days (Group I), or placebo (Group P), in both cases supplemented with nicomorphine as needed. Thiopentone was used for induction of anaesthesia, followed by nitrous oxide, enflurane, suxamethonium, and pancuronium. The average nicomorphine requirement during the study was 14.0 mg/24 h lower in Group I than in Group P. The pain score values were slightly lower in Group I when resting, but similar on movement. A significant increase in perioperative blood loss was found in Group I. Beginning the indomethacin treatment with a preoperative i.v. bolus seems to offer few advantages compared to a purely postoperative regime and may increase the risk of bleeding complications.

Topics: Administration, Rectal; Adolescent; Adult; Double-Blind Method; Female; Hemorrhage; Humans; Hysterectomy; Indomethacin; Injections, Intravenous; Middle Aged; Morphine Derivatives; Nicotinic Acids; Pain Measurement; Pain, Postoperative; Placebos; Premedication; Random Allocation

One hundred and twenty-nine patients were subjected to three different types of thoracic operations. The patients were randomly allocated to balanced intravenous anaesthesia including i.v. nicomorphine during surgery and epidural nicomorphine post-operatively (epidural group, n = 58) or to balanced intravenous anaesthesia without i.v. opiates but with high thoracic epidural regional block during the operation and with post-operative intramuscular nicomorphine (intramuscular group, n = 71). Post-operative nicomorphine was only given at the request of the patients, and as frequently as needed to obtain satisfactory pain relief. Patients in the epidural group were given nicomorphine exclusively by epidural injection. Post-operatively, both groups (i.m. and epidural) obtained effective and rapid onset of analgesia, but the pain assessments by the patient and the medical team favoured the epidural group. The requirements of nicomorphine over a period of 3 days were significantly lower in the epidural group 42 mg (s.d. = 18) versus 92 mg (s.d. = 33) in the intramuscular group. Significantly fewer pulmonary complications were observed in the epidural group: 7 atelectases compared to 27 in the intramuscular group. The epidural group showed no signs of ventilatory depression in spite of a catheter inserted at the T3-T4 level.

Topics: Analgesia; Arrhythmias, Cardiac; Carbon Dioxide; Female; Humans; Injections, Epidural; Male; Middle Aged; Morphine Derivatives; Nicotinic Acids; Pain, Postoperative; Preanesthetic Medication; Thoracotomy

In this study the effects of nicomorphine, administered either intramuscularly or by high thoracic epidural route, on the ventilatory and airway occlusion pressure response to CO2 were investigated and compared. Twenty-four patients scheduled for thoracic surgery were allocated randomly to postoperative pain relief by i.m. nicomorphine or by high thoracic epidural nicomorphine. The ventilatory response to 5% carbon dioxide was measured in all patients: first 1 day before operation, secondly on the first day after surgery immediately before nicomorphine administration and finally after the administration, at the moment when no further rise in end-tidal PCO2 (PETCO2) was measured. Respiratory response was assessed in two ways, by measuring minute ventilation (VE) and mouth occlusion pressure (P0.1). There was a significant depression in ventilatory response to CO2 in the intramuscular group (P = 0.03) due to nicomorphine as assessed by the slope of VE vs PETCO2. No significant depression was found in the epidural group, irrespective of measurement of VE or P0.1. No significant shift of apnoeic threshold-PETCO2 was observed in either group.

Topics: Analgesia; Carbon Dioxide; Humans; Injections, Epidural; Injections, Intramuscular; Morphine Derivatives; Nicotinic Acids; Pain, Postoperative; Respiration; Respiratory Function Tests; Thoracic Surgery

Twenty patients scheduled for lateral thoracotomy were randomly allocated to receive either epidural morphine at regular intervals or subcutaneous nicomorphine on demand for postoperative pain relief. The daily dose of opiate administered was greater in the group receiving subcutaneous nicomorphine than in the epidural group although four patients in the latter needed additional subcutaneous injections of opiate. During the first three days of the postoperative course, a profound decrease of the forced vital capacity (FVC), the forced expiratory volume in one second (FEV1), peak expiratory flow rate (PEF) and the arterial oxygen tension (PaO2) was found in both groups, whereas the visual analogue pain score showed a marked increase, and the arterial pH and carbon dioxide tension (PaCO2) remained unchanged. No significant difference could be demonstrated between the group;s. The conclusion is that epidural morphine may produce sufficient pain relief after thoracotomy, but compared with conventional pain treatment the benefits are limited.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Morphine; Morphine Derivatives; Nicotinic Acids; Pain, Postoperative; Respiration; Thoracic Surgery

One hundred and sixty-three patients subjected to three different types of thoracic operation were allocated randomly either to balanced intravenous anaesthesia including i.v. opiates with post-operative intramuscular opiates (intramuscular group) or to balanced intravenous anaesthesia without i.v. opiates but with high thoracic epidural regional block during the operation as well as epidural nicomorphine post-operatively (epidural group). Post-operative nicomorphine in either group was given only at the request of the patient and as frequently as needed to obtain satisfactory pain relief. Patients in the epidural group were given nicomorphine exclusively by epidural injection. Patients in the epidural group required significantly less nicomorphine for effective pain relief (29 mg (sd = 10) over a period of 3 days compared to 52 mg (sd = 27) in the intramuscular group. Significantly fewer pulmonary complications in the epidural group were observed (9 atelectases in 83 patients in the epidural group compared to 24 atelectases in 80 patients in the intramuscular group). Only one patient developed pneumonia (intramuscular group). Although the epidural catheter was inserted at the T3-T4 level, no signs of ventilatory depression were found; on the contrary, respiration in the epidural group was significantly better than the intramuscular group. None of the patients, in either analgesia group, needed to be ventilated post-operatively.

Topics: Adolescent; Adult; Aged; Arrhythmias, Cardiac; Carbon Dioxide; Epidural Space; Female; Humans; Injections, Intramuscular; Lung Diseases, Obstructive; Male; Middle Aged; Morphine Derivatives; Nicotinic Acids; Pain, Postoperative; Postoperative Complications; Pulmonary Atelectasis; Respiration; Thoracic Surgery

One hundred and sixty-three patients subjected to three different types of thoracic operation were allocated randomly either to balanced intravenous anaesthesia including i.v. opiates with post-operative intramuscular opiates (intramuscular group) or to balanced intravenous anaesthesia without i.v. opiates but with high thoracic epidural regional block during the operation as well as epidural nicomorphine post-operatively (epidural group). Post-operative nicomorphine was given only at the request of the patient and as frequently as needed to obtain satisfactory pain relief. Patients in the epidural group received nicomorphine exclusively by epidural injection. In this paper (Part I), general parameters between the epidural group and the im. group are compared. The epidural group showed acceptable cardiovascular stability during the operation. With the catheter tip at the T3-T4 level, there was apparently a preferential spread downwards of the local anaesthetics. Post-operatively both groups (i.m. and epidural) provided effective and rapid onset of analgesia. There were no major differences in post-operative pain assessment, either by the patient or by the team.

Topics: Adolescent; Adult; Age Factors; Aged; Analysis of Variance; Anesthesia; Body Weight; Catheterization; Epidural Space; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Morphine Derivatives; Nicotinic Acids; Pain, Postoperative; Posture; Sex Factors; Thoracic Surgery

Analgesic effects as well as side effects, circulatory and respiratory parameters of 0.3 mg Buprenorphine (Temgesic) were compared to 10 mg Nicomorphine (Vilan) intramuscularly injected in a double-blind, randomized study for the relief of postoperative pain. Buprenorphine produced an equally potent but longer acting analgesic effect compared to Nicomorphine, although slight delayed. There were only few and slight side effects and no influence on the circulation and the respiration. In the search for a new long-acting and strong analgesic Buprenorphine proved to be superior to Nicomorphine in the control of postoperative pain.

Topics: Adult; Buprenorphine; Double-Blind Method; Female; Humans; Injections, Intramuscular; Male; Morphinans; Morphine Derivatives; Nicotinic Acids; Pain, Postoperative

The analgesic effect of nicomorphine in two different solutions was tested in 120 patients after cholecystectomy. The patients were divided into three groups: group I was given nicomorphine diluted with water, group II nicomorphine diluted with propylenglykol, group III propylenglykol alone. The degree of pain sensation was determined by interrogation. Pulse, respiratory rate, blood pressure as well as capillary pO2 and pCO2 were measured 10 and 30 minutes after medication. No difference in pain relief could be established in the two groups receiving nicomorphine. Respiratory depression with a significant decrease of respiratory rate together with an increase of pCO2 was observed in the two nicomorphine groups. In the placebo group there was no significant change in the tested parameters. A small decrease of pO2 was observed in all patients after laparotomy.

Topics: Adult; Aged; Blood Pressure; Carbon Dioxide; Cholecystectomy; Drug Evaluation; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Morphine Derivatives; Nicotinic Acids; Oxygen; Pain, Postoperative; Propylene Glycols; Pulse; Respiration; Solutions; Water

Nalbuphine and nicomorphine were administered intramusculary in single doses for the relief of moderate to severe pain after abdominal surgery in a group of 40 patients to compare the analgesic effect and clinical tolerance during a 2 hour period. There was no statistically significant difference of the analgesic effect. In both groups SBP, DBP and RR decreased and HR increased significantly after injection but the tolerance of nalbuphine seems to be beter. Nalbuphine is a good choice for postoperative pain.

Topics: Adult; Aged; Blood Pressure; Female; Heart Rate; Humans; Injections, Intramuscular; Male; Middle Aged; Morphinans; Morphine Derivatives; Nalbuphine; Nicotinic Acids; Pain, Postoperative; Respiration

Postoperative pain and rehabilitation parameters were compared in groups of patients with or without transcutaneous electric nerve stimulation (TENS) after orthopedic surgery. There was a subjective improvement, but only a non significant difference in opiate requirements with the use of TENS postoperatively; rehabilitation parameters turned out to be of limited value in evaluating its effect. Two patients had an allergic reaction after the use of TENS for postoperative pain relief.

Topics: Electric Stimulation Therapy; Evaluation Studies as Topic; Humans; Knee Joint; Morphine Derivatives; Nicotinic Acids; Pain, Postoperative; Transcutaneous Electric Nerve Stimulation