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Query: UMLS:C0220723 (PCA)
 4,687 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This double blind study aimed to assess the effects of a continuous intravenous (i.v.) infusion of morphine added to an intermittent bolus patient controlled analgesia on morphine demand and related side-effects. Patients scheduled for abdominal and thoracic surgery (ASA 2 or 3) were randomly allocated postoperatively to three groups (n = 10 each): group 1 were given i.v. boluses of 2 mg of morphine (lockout interval = 15 min); the other two groups were given the same boluses as well as a continuous i.v. infusion of either 1 mg.kg-1 of morphine (group 2) or 2 mg.kg-1 (group 3). Pain was assessed with a visual analog scale before starting analgesia, and after 1, 2, 3, 4, 8, 16, 24 and 36 h. Total and bolus morphine doses were recorded at the same time. Breathing rate and the level of sedation were measured every hour and blood gases every time 40 mg of morphine had been consumed. Morphine administration was stopped if breathing rate decreased to less than 10 c.min-1, the patient became too sedated, or PaCO2 rose to more than 45 mmHg. Pain scores were similar in the three groups. Total amounts of morphine were higher in groups 2 (56.8 +/- 23.8 mg) and 3 (116.2 +/- 41.8 mg) compared with group 1 (38.2 +/- 17.8 mg) (p < 0.05). Morphine administration was stopped in 5 patients in group 3 and in 1 in group 2 because PaCO2 had risen to more than 45 mmHg. Therefore, a continuous i.v. infusion is not required in patients receiving PCA, all the more so as this has deleterious respiratory effects.
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PMID:[Patient-controlled analgesia: effect of adding continuous infusion of morphine]. 147 77

The use of patient-controlled analgesia is described for forty children who had undergone major orthopaedic or general surgery. Ages ranged from 6 to 18 years (mean 11.4 years) and PCA was used for an average of 46.2 hours postoperatively. Morphine requirements overall averaged 40.5 micrograms/kg/hr (SD 22.6). Requirements for the first six hours were not significantly different to a similar period 24 hours later. There was a large individual variation for patients undergoing similar procedures. Patients undergoing scoliosis surgery required significantly more morphine than any other group of patients. Problems with patient-controlled analgesia have been of a minor nature. We conclude that patient-controlled analgesia is a suitable and safe method of pain relief for paediatric patients and that the lower age limit is that at which a child can understand the concept after suitable explanation. In this study children as young as six years were able to successfully use the method.
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PMID:Patient-controlled analgesia in children. 277 44

Patient-controlled analgesia (PCA, intravenous self-application of narcotics) was studied during the early postoperative period. Subjects were 40 ASA I-III patients recovering from elective major and minor surgery (each 20 having undergone abdominal or orthopaedic operations). Morphine boluses each of 1.92 mg were available via a hand-button whenever the patients felt pain relief necessary, and delivered by a microprocessor-controlled injection pump (On-Demand Analgesia Computer, ODAC). Hourly maximum dose was set to 15 mg with a pump refractory time of 1 min between valid demands. A continuous low-dose morphine infusion (0.23 mg/h was additionally administered in order to prevent catheter obstruction. Duration of the PCA period was 20.3 +/- 4.3 h (mean, standard deviation). During this time, 18.3 +/- 10.6 demands per patient were recorded resulting in individual morphine consumption of 29.6 +/- 16.6 micrograms/kg/h. Self-administration was characterized by considerable intra- and inter-individual variability. Following abdominal surgery, significantly more morphine was needed compared with orthopaedic patients, although pain relief was found less in the former group. There were no statistically significant differences in drug requirements or pain scores between the sexes. With respect to different anaesthetic techniques, patients recovering from spinal anaesthesia needed lower morphine doses only during the first few (1-4) h in comparison with neuroleptanalgesia. Over-all efficacy and patient acceptance proved to be excellent. Effectiveness of PCA was judged superior by about 84% of patients when compared with previously experienced conventional postoperative analgesia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Postoperative on-demand analgesia with morphine]. 407 43

Postoperative analgesia must be adapted to each case. When postoperative course is moderately painful, as in day case surgery, non opioid analgesics are sufficient. In case of a more painful surgery, opioids are necessary. Morphine by intravenous PCA is the technique of choice for it provides an optimal comfort in most cases. Nevertheless, when an intensive analgesia is needed, as for active physiotherapy in a risk patient after an important surgery, an epidural combination of opioids and local anaesthetics is much more suitable.
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PMID:[Peridural morphine or intravenous patient-controlled (PCA) morphine: which is the best choice?]. 808 34

Using a randomized, double-blind, placebo-controlled design, we have investigated, in 40 patients undergoing major abdominal surgery, the effect of oral clonidine 300 micrograms, 1 h before and 12 h after surgery on postoperative morphine requirements (evaluated by PCA). During the 24 h of the study, pain scores measured every 6 h did not differ significantly. Morphine requirements tended to be reduced in the clonidine group but the difference was not significant. There were no significant differences also in mean arterial pressure, ventilatory frequency and the incidence of pruritus and nausea. Heart rate was significantly lower until 18 h after surgery and sedation was significantly more pronounced in patients receiving clonidine. We cannot recommend routine oral administration of clonidine before surgery to improve postoperative analgesia.
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PMID:Addition of oral clonidine to postoperative patient-controlled analgesia with i.v. morphine. 819 4

We studied 151 patients undergoing total hip or knee arthroplasty, or cruciate ligament reconstruction in a multicentre study in Australia and New Zealand. Patients were openly allocated randomly to one of five treatment groups or to a control group. General anaesthesia was induced after introduction of extradural block with 0.5% ropivacaine. After surgery, patients received an extradural infusion of 0.2% ropivacaine at 6, 8, 10, 12 or 14 ml h-1 or received no postoperative extradural infusion (control group). All patients had access to i.v. PCA morphine for supplementary analgesia. Morphine consumption was lower in all treatment groups compared with the control group, decreasing with increasing ropivacaine infusion rate. Median VAS scores were lower in all ropivacaine infusion groups compared with the control group for the first 10 h of the study; however by the end of the study, VAS scores were similar in all groups. The higher ropivacaine infusion rates caused a slower convergence of spread of the initial sensory block and a higher degree of motor block. The overall incidence of side effects was similar, with the exception of a higher incidence of urinary retention and hypotension in the groups receiving the higher rates of ropivacaine. The quality of treatment scores were similar for all treatment groups (Br. J. Anaesth. 1996; 76: 606-610).
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PMID:Continuous extradural infusion of ropivacaine for prevention of postoperative pain after major orthopaedic surgery. 868 55

The objective of this investigation was to determine if the variability in the use of opioids for pain following surgery is related to variability in blood concentration of opioids used for pain relief. We measured morphine use and morphine blood concentration in a group of otherwise healthy adolescent girls following spinal surgery. There was considerable variability in morphine use and morphine blood levels as indicated by a large range of values and a moderately large standard deviation. Morphine blood concentration correlated with morphine use. Neither morphine use nor morphine concentration correlated with pain scores. The data indicate that there is considerable variability among patients in the amount of opioid needed to achieve comfort and in the blood concentration associated with comfort. The cause of this variability does not appear to be related to metabolism of opioid, but may be related to psychological differences, differences in pain tolerance and threshold, or differences in the way patients use PCA.
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PMID:Variation in opioid use during PCA in adolescents. 888 Aug 29

Evidence of pre-emptive analgetic effect of opioid would offer great potential benefit to patients with postoperative pain, a better pain relief with less opioid. The aim of this double blind randomised trial was to study the effect of intramuscular morphine premedication on postoperative pain. Forty-one patients undergoing total knee arthroplasty were randomly allocated to four groups. Two groups received epidural morphine, 4 mg immediately after operation and 3 mg ten hours later, and two groups the same volume of saline. All patients had access to intravenous PCA-fentanyl. One epidural morphine and one epidural saline group (PreEpiMo and PreMo, respectively) received morphine, 0.14 mg/kg i.m. as premedication. Pain was measured with a visual analogue scale (VAS). Respiration was monitored by means of pulseoximetry, arterial blood gas analysis and rate of breathing. Morphine premedication reduced postoperative pain in the immediate postoperative period in patients with epidural placebo (PreMo), but the effect was absent in patients with PreEpiMo. Epidural morphine (EpiMo) provided stable analgesia with reduced need of PCA-fentanyl. Two patients (10%) (one in EpiMo and one in PreEpiMo) developed respiratory depression requiring naloxone treatment. The dosage of epidural morphine used in this study was a likely explanation of this depression. Nausea, vomiting, itching and urinary retention were the most frequent side effects without significant differences between the groups. In conclusion, morphine premedication had a temporary rest effect on the postoperative pain. Epidural morphine provides a better analgesia than intravenous PCA-fentanyl.
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PMID:Does morphine premedication influence the pain and consumption of postoperative analgesics after total knee arthroplasty? 890 63

We studied the pain control, narcotic side effects, and PCA utilization with intravenous PCA morphine during 24 hours post cesarean section period. Fifty-two consecutive women were included in the study. Each received subarachnoid block with hyperbaric bupivacain with addition of fentanyl. After surgery, the patient received diclofenac suppository and IV-PCA commenced in the recovery room. Severity of pain and sedation was assessed hourly, and maximum pain and sedation scores for each 6-hour period were recorded. Two-third of the patients felt mild to moderate pain during transition from spinal analgesia to IV-PCA. Pain severity steadily improved during four 6-hour periods (p-value <0.001). Highest mean sedation score was noticed during the third six-hour postoperative period. Mean morphine consumption was 50 mg. The ratio between number of time PCA activated and dose received and pain score helped in managing the postoperative pain. Morphine IV-PCA, adequately replaces post cesarean section spinal (bupivacain-fentanyl) analgesia with fewer side effects.
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PMID:PCA after subarachnoid block for cesarean section. 1544 48

There is experimental evidence that nimodipine, an L-type dihydropiridine calcium channel blocker with relatively high blood-brain barrier penetration, enhances the antinociceptive properties of morphine. We tested the hypothesis that oral nimodipine taken preoperatively and 6 hourly for 48 h postoperatively would reduce visual analog scale pain scores and morphine consumption in morphine-naive patients with acute postoperative pain. Forty patients undergoing total knee replacement surgery (age 70 +/- 7 yr, 28 male) were randomized by computer-generated numbers to receive capsules containing either nimodipine 30 mg or placebo in a double-blind study design. All patients received 3 capsules (nimodipine 90 mg or placebo) 1-2 h before induction of anesthesia followed by oral nimodipine 30 mg or placebo 6 hourly for 48 hours postoperatively. Spinal anesthesia was induced with hyperbaric bupivacaine 0.5% (2.4-3.0 mL) and fluids and ephedrine were given at the discretion of the anesthesiologist. Morphine patient-controlled analgesia (PCA, bolus 1 mg, lockout 5 min) was given for postoperative analgesia. Primary outcome measures were visual analog pain scores at rest and on moving (sitting forward) and PCA morphine consumption. Morphine consumption was significantly larger in nimodipine patients at 12 h (39 +/- 18 versus 29 +/- 15; P = 0.04), 24 h (62 +/- 23 versus 45 +/- 24; P = 0.02), and 48 h (88 +/- 34 versus 61 +/- 27; P = 0.01). There were no significant differences in pain scores at rest or moving or in time to first use of morphine analgesia. This study has demonstrated increased morphine consumption after 12 h in postoperative patients receiving nimodipine, suggesting that, in patients undergoing knee replacement surgery, it has no adjunctive analgesic effect and may actually inhibit the analgesic effect of morphine.
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PMID:Perioperative nimodipine and postoperative analgesia. 1642 51


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