Balanced Analgesia with Morphine , Ketorolac and Droperidol in the Treatment of Postoperative Pain in the Gynecologic Patient / 대한마취과학회지

Postoperative pain control is one of the main concern for the anesthesiologist. Intermittent narcotic injections caused inadequate pain relief in many patients. Periodic injections could improve analgesia with increased incidence of undesirable side effects including respiratory depression, nausea, vomiting, and urinary retenion. Balanced analgesia may lessen these complications without reducing analgesic effect. I assessed the effect of balanced analgesia using morphine, ketorolac and droperidol. Each 20 gynecological patients were allocated to one of four groups Morphine(initial bolus 2mg followed by 48mg continousi.v. for 2 days) or ketorolac(initial bolus 30mg, follwed by 120mg continousi.v. for 2 days) was continously injected in group 1 and group 2, respectively. In group 3, half doses of morphine and ketorolac in group 1, 2 was used in combinstion. 5mg of droperidol was added to group 3 drugs in group 4. There were no significant changes in blood pressure and heart rate in all groups. Onset time of analgesic effect was faster in morphine containing groups 1, and 4, and the effect was better in all three morphine containing group 1, 3 and 4 than ketorolac group 2. Untoward effects were least in ketorolac group 2. Droperidol could prevent nausea and vomiting, however led to increased incidence of somnolence. It could be concluded that balanced analgesia with morphine, ketorolac and droperidol with fine titration would be better than intravenous morphine or ketorolac alone.

Potentiation of Analgesic Action of Epidural Morphine by Verapamil / 대한마취과학회지

Experimental data showed that morphine interfered with calcium influx in the central nervous system and some calcium channel blockers potentiated analgesic effect of morphine. As few clinical data are available, we studied the effect of the calcium channel blocking agent, verapamil, on the analgesic effect of epidural morphine for postoperative pain control after upper abdominal surgery. The mean analgesic duration of 2mg of morphine was 17.9+/-4.3 hours and the addition of 5 and 10 mg of verapamil increased the analgesic effect of morphine significantly(28.2+/-6.1 hours and 26.7+/-6.3 hours, respectively). The quality of analgesia was improved by verapamil without significant changes in respiratory and cardiovascular functions. The data suggested that verapamil might be a useful adjunct to epidural morphine as a balanced analgesia for postoperative pain control, especially in certain patients such as the patient with coronary artery disease.