Subcutaneous morphine for postoperative analgesia.

OBJECTIVE: a. To confirm the efficacy of subcutaneous morphine infusion for postoperative analgesia and compare this effect with three-hourly subcutaneous bolus injections of morphine. b. To evaluate the suitability of a simple micro-infusion set to deliver subcutaneous infusion, as conventional infusion pumps are expensive and not readily available. SETTING: Double blind, prospective controlled clinical trial. PATIENTS: 21 patients belonging to the American Society of Anaesthesiologists' (ASA) classes I or II, who underwent major elective abdominal surgery were studied in an intensive care unit. INTERVENTION: All patients were given loading doses of morphine intravenously (iv) followed by subcutaneous (sc) infusion in two groups and three-hourly sc bolus injections in the third group. The doses were titrated on an individual basis. The infusion was delivered by a power driven pump in one group and by a microinfusion set in the other. Those with significant pain during this regime were given morphine supplements intravenously. MEASUREMENT: Pain scoring was done hourly using a modified verbal rating scale. The percentage of patients who required intravenous supplements in each group was compared to draw statistical conclusions. RESULTS: 1. Subcutaneous infusion provided adequate analgesia in 86% of the patients studied. 2. There was no significant difference between the groups in terms of additional iv supplement requirement. 3. The microinfusion set required frequent readjustments to maintain constant flow. CONCLUSIONS: Intermittent subcutaneous bolus injections of morphine given through an indwelling butterfly needle is a simple, safe, and effective method for postoperative analgesia after major abdominal surgery. Simple infusion sets are not suitable to deliver subcutaneous infusions, and the need for infusion pumps makes the infusion technique unsuitable for routine use in wards.

Effects of transcutaneous needle stimulation on the immune response in rabbits.

Studies in the field of neuroimmunomodulation have shown that endorphins such as methionine-encephalin may have an immunomodulatory role. This study was undertaken to test whether transcutaneous needle stimulation, which is known to release such peptides from the central neurones, has an effect on immune response in rabbits. Twelve healthy rabbits, in three similar subgroups, were exposed to pathogenic Escherichia coli and their immune response was studied under different experimental conditions. Our results show that needle stimulation causes a reversal of stress induced suppression of antibody production. Further studies are necessary to evaluate any therapeutic uses these observations may have in humans.

Chronic pain syndrome should be recognized as a separate clinical entity.

Chronic pain is a relatively new concept in our understanding of pain. It is rarely recognised or diagnosed as a separate clinical entity in Sri Lanka. Thus the extent of this problem is not known. The case histories of two patients with the chronic pain syndrome are presented, with a brief review of the theoretical aspects of chronic pain. Trends in the management of chronic pain are summarized. Unfortunately, organized treatment programmes for chronic pain are unavailable in Sri Lanka.