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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To compare the management of postoperative pain using morphine administered by epidural catheter with intravenous patient-controlled analgesia (PCA), we prospectively studied 47 consecutive cases involving repair of the anterior cruciate ligament of the knee. Both the quality of analgesia and the incidence of side effects were documented. Compared with patients receiving PCA morphine, patients given epidural morphine reported significantly lower pain scores both at rest (0.7 +/- 1.1 versus 3.4 +/- 2.1, P less than 0.01) and with mobilization (3.2 +/- 2.1 versus 6.1 +/- 2.1, P less than 0.01). Although patients receiving epidural morphine had a greater incidence of urinary retention, there were no significant differences in the incidence of nausea or pruritus. There was no respiratory depression in either group. We conclude that epidural morphine provides superior analgesia with a clinically inconsequential increase in side effects. Further, epidural morphine may have special advantages when early mobilization is indicated.
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PMID:Epidural morphine after anterior cruciate ligament repair: a comparison with patient-controlled intravenous morphine. 291 74

The safety and efficacy of epidural morphine injected into the caudal space for control of postoperative pain following open cardiac surgery in children was studied. Thirty-two children between the ages of 2-12 yr for whom early postoperative tracheal extubation was anticipated were randomly assigned to control and study groups. Study subjects received a caudal injection of preservative free morphine sulfate (0.075 mg/kg) in preservative-free normal saline (5-10 ml) following completion of surgery, but prior to awakening and extubation of the trachea. Supplemental intravenous morphine administration and pain scores were recorded for 24 h. Patients in the study group received significantly less (P less than 0.03) morphine (0.32 mg.kg-1.24 h-1) and had significantly lower pain scores than did patients in the control group (0.71 mg.kg-1.24 h-1). The mean duration of complete analgesia in patients receiving caudally administered morphine was 6 h (range 2-12), but decreased analgesic requirements were noted for the entire 24 h. No respiratory depression was evident by clinical variables or repeated arterial blood gas values. Nausea without vomiting occurred in 4/16 patients in the study group. No patient described pruritus. The authors were unable to evaluate the occurrence of urinary retention because all patients had indwelling urinary catheters. They found caudal epidural morphine to be safe and effective in the treatment of postoperative pain in children following open heart surgery.
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PMID:Caudal epidural morphine for control of pain following open heart surgery in children. 292 90

Post-operative analgesia by peridural injection of morphine in the thoracic spine was evaluated in a series of 117 successive patients with pulmonary pathology operated upon by the same surgeon. The catheters were introduced, either on the day preceding the operation or at the end of it, above or below T6-T7, after localization of the peridural space by the hanging drop technique or by loss of resistance to a liquid mandrel; 5 mg of preservative-free morphine diluted in 3 ml isotonic saline were injected. The catheter was left in situ for 3 days, then systematically removed and cultivated. Analgesia was considered excellent in 66.7% of the cases, good in 26.5% and insufficient or non-existent in 6.8%. Each dose was effective for 15 hours on average. The mean total dose administered was 18.2 mg and did not exceed 40 mg during the first three post-operative days. There was no respiratory depression requiring naloxone or mechanical ventilation. Urinary retention occurred in 62% of the patients and troublesome pruritus in 0.3%. No death attributable to the method and no neurological or infectious complication was noted. There was no problem in removing the catheter, and no redness, pain or haematoma was observed at the site of injection. In view of the potential risk of insidious and delayed respiratory depression, the patients must be closely supervised specialized by staff. This technique must not be used unless the conditions required are fulfilled.
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PMID:[Postoperative analgesia with thoracic peridural morphine in pulmonary surgery. 117 cases]. 293 42

Duration of analgesia and side effects following single bolus doses of epidural fentanyl (100 micrograms) or sufentanil (10, 20, 30 or 50 micrograms) were studied in 50 patients who underwent Caesarean section under epidural anaesthesia. Fewer patients experienced pain peroperatively in the fentanyl group than in a joint group of those given sufentanil 20 or 30 micrograms (p less than 0.05). The combined fentanyl and sufentanil 50 micrograms groups had fewer patients in pain than the sufentanil 10 micrograms group at 3 hours after injection (p less than 0.05). Patients given fentanyl also had a longer pain-free interval than those who received sufentanil 10 micrograms (p less than 0.02). The sufentanil 50 micrograms group had more patients asleep than the 10 micrograms group and also had more patients with pruritus than the 10 micrograms or 30 micrograms groups (p less than 0.02). The patients given sufentanil 30 and 50 micrograms had more emetic sequelae than those who received sufentanil 10 and 20 micrograms or fentanyl 100 micrograms (p less than 0.05). There was no detectable excretion of drug into breast milk and no significant respiratory depression at the time of first postoperative analgesia in the patients who received fentanyl or 30 micrograms or less of sufentanil.
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PMID:Comparison of epidural fentanyl with sufentanil. Analgesia and side effects after a single bolus dose during elective caesarean section. 296 61

The effects of epidural morphine (50 micrograms X kg-1) after abdominal and urologic surgery were studied in 20 children ranging in age from 2 to 15 yr and weighing between 9 and 54 kg. The onset and the duration of analgesia were 30 +/- 12 min and 19.5 +/- 8 h, respectively (mean +/- SD). Side effects were pruritus (4/20), nausea and vomiting (8/20), and urinary retention (4/14). No apnea was observed. Ventilation control was studied in seven children. No significant change in resting respiratory variables occurred after both surgery and epidural morphine injection. However, the slope of the ventilatory response to CO2 was significantly (P less than 0.05) decreased after surgery but before morphine, as compared with its preoperative control value (0.84 +/- 0.44 versus 1.51 +/- 0.72 l X min-1 X mmHg-1), and remained low for 22 h after epidural morphine (0.90 +/- 0.57 l X min-1 X mmHg-1). Sixty minutes after morphine injection, the plasma morphine concentration was always less than 12 ng X ml-1 in the seven children studied. Pharmacokinetic parameters were similar to those observed after epidural injection of morphine in adults, except for a shorter terminal half-life (73.8 +/- 41.6 min) attributed to a greater total body clearance of morphine in the children (28.3 +/- 3.4 ml X min-1 X kg-1). It is concluded that epidural morphine provides effective and prolonged analgesia in children after abdominal and urologic surgery and that it is associated with prolonged respiratory depression that requires close monitoring for at least 24 h.
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PMID:Epidural morphine in children: pharmacokinetics and CO2 sensitivity. 309 37

To determine the safety, efficacy, and the ventilatory responses to carbon dioxide (CO2) of epidurally administered butorphanol or morphine, 122 healthy women who underwent cesarean section with epidural anesthesia were studied. Patients were randomly assigned to receive one of four epidural regimens for the relief of postoperative pain: 5 mg morphine (n = 32), 4 mg butorphanol (n = 30), 2 mg butorphanol (n = 29), or 1 mg butorphanol (n = 31). Epidural morphine provided satisfactory analgesia with slow onset and long duration of approximately 21 hr. When butorphanol was administered, analgesia of rapid onset was seen with increasing duration and effectiveness observed with increasing dose; approximately 8 hr when using 4 mg. Sixty-two percent of the patients who received morphine had pruritus. Somnolence was the main side effect encountered in patients who received epidural butorphanol. The ventilatory response to CO2 was depressed after morphine and after 2 and 4 mg butorphanol, but the duration of depression was more prolonged after morphine. It is concluded that epidural butorphanol is effective in providing pain relief after cesarean section with minor side effects. However, patients must be observed closely because of possible respiratory depression.
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PMID:Epidural butorphanol or morphine for the relief of post-cesarean section pain: ventilatory responses to carbon dioxide. 311 91

The effect of nalbuphine on the respiratory depression, pruritus and analgesia induced by epidural morphine was determined in a randomized, prospective, double-blind, placebo-controlled fashion. Twenty ASA physical status I women received 0.1 mg.kg-1 epidural morphine at induction of general anaesthesia for elective total abdominal hysterectomy. Group 1 (n = 14) received 0.3 mg.kg-1 nalbuphine intravenously six hours after the epidural morphine administration. Group 2 (n = 6) received saline. Prior to agent administration, six patients from the nalbuphine group and four patients from the saline group had respiratory depression indicated by a PaCO2 greater than 45 mmHg. After nalbuphine administration the PaCO2 (mean +/- SE) decreased from 49.5 +/- 1.2 mmHg to 42.5 +/- 0.7 mmHg (p less than 0.005) while there was no significant change after saline administration. Nine of the 14 patients receiving nalbuphine appeared to become more sedated, despite an improvement in ventilation. Pruritus was antagonized by 0.1 mg.kg-1 nalbuphine (p less than 0.006). There was no reversal of analgesia after administration of 0.3 mg.kg-1 nalbuphine.
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PMID:Reversal of epidural morphine-induced respiratory depression and pruritus with nalbuphine. 314 43

An open pilot study was undertaken to evaluate the analgesic properties of epidurally administered sufentanil in the early postoperative period. After orthopaedic surgery of the lower extremity, four different groups of five adult patients each received either 15 micrograms (group 1), 30 micrograms (group 2), 50 micrograms (group 3) or 75 micrograms (group 4) sufentanil via an epidural catheter previously used for the surgical procedure. Results were satisfactory in groups 3 and 4 with very good relief of pain and a mean duration of action of 372 and 307 minutes respectively. Dosage above 50 micrograms did not seem to improve the quality or duration of pain relief, although the onset of action was faster with 75 micrograms. Sedation was always present in patients with effective analgesia. In the present study respiratory depression was not evident, but three patients complained of itching and two of urinary retention.
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PMID:Epidural sufentanil for postoperative pain relief. 316 8

We performed a double-blind study of the dose-response relationship of intrathecal morphine (0, 0.3, 1, and 2.5 mg) for postoperative pain relief in 33 subjects who underwent total knee or hip replacement surgery. Assessments commenced 1 hour after the opioid injection, which was given at the end of surgery, and continued for 24 hours. Pain measurements, supplementary analgesia requirements, and adverse effects were recorded. Intrathecal morphine provided effective, long-lasting pain relief. All doses delayed the initial perception of discomfort (T-Pain) and also postponed the onset of severe pain requiring analgetic supplementation (T-Morphine) (1.25 hours control with placebo injections; greater than 20 hours with intrathecal morphine 0.3, 1, and 2.5 mg: P less than 0.05). Although 0.3 mg usually provided good analgesia it was unsatisfactory in three of 10 patients (30%), whereas 1 and 2.5 mg were absolutely reliable. Respiratory depression (increased PaCO2), common after the administration of 1 or 2.5 mg intrathecal morphine, was slow in onset and prolonged. The respiratory depression after 2.5 mg was more profound than after 1 mg, and produced apnea necessitating large-dose naloxone therapy. Pruritus was unique to intrathecal morphine administration, but nausea, vomiting, and urinary retention were common in all the groups. We conclude that no ideal dose of intrathecal morphine exists because, even with small quantities, minor adverse effects are evident. Doses between 0.3 and 1 mg, however, should provide good analgesia free from the major complication, respiratory depression.
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PMID:A dose-response study of intrathecal morphine: efficacy, duration, optimal dose, and side effects. 318 98

A double-blind study was carried out to assess the efficiency and possible side-effects of a single epidural injection of either morphine or buprenorphine at equipotent doses after elective thoracic surgery. The series included 24 patients aged 53.7 +/- 11.4 years; 13 underwent a lobectomy and 11 a pneumonectomy. 6 h after the last intravenous injection of fentanyl, the patients were randomly allocated to one of three equal groups. They received an epidural injection at T8-9 or T9-10 level of either 100 micrograms.kg-1 morphine (group M) or 6.6 micrograms.kg-1 buprenorphine (group B) or a subcutaneous injection of 0.1 ml.kg-1 normal saline placebo at the same level (group T). The following parameters were measured 20 and 60 min, and every 6 h up to 48 h after the injection: patient wakefulness, respiratory rate, blood gases, pain (according to a verbal scale), FVC and FEV1, adverse effects (euphoria, hallucinations, sweating, facial pruritus, nausea) and atelectasis. The duration of surgery, the anaesthetic protocol, the age, weight and height, as well as all the parameters before injection were similar in all three groups. There was a fall in pain intensity from the 20th min to the 24th hour in group M and from the 20th min to the 36th hour in group B, significant for both groups when compared with group T. Similarly, there was a prolonged increase in FEV1 in both groups M and B. There was no case of severe respiratory depression; PaCO2 was increased at the 1st hour (+0.3 +/- 0.6 kPa) in group B and at the 6th hour (+0.5 +/- 0.7 kPa) in group M.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Epidural analgesia after thoracic surgery: morphine versus buprenorphine]. 322 39


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