The Effect of Preemptive Analgesia with Morphine, Ketorolac, Droperidol / 대한마취과학회지

BACKGROUND: Several reports have suggested that preoperative nociceptive block with opioids and nonsteroidal antiinflammatory drugs (NSAIDs) may reduce postoperative pain. This study evaluated the effects of preemptive analgesia, the analgesic efficacy and safety of intravenous opioids and NSAIDs during the first 48 hours after lower abdominal surgery. METHODS: The 40 patients were randomized to either preemptive group or postincisional group. All subjects received IV bolus of 2 mg of morphine followed by continuous IV mixture (morphine 30 mg + ketorolac 90 mg + droperidol 2 mg in 90 ml of normal saline) via Baxter 2-Day Infusor(R). Evaluations included supplementary analgesics, analgesic pain assessment (visual analogue scale, VAS), time of first analgesic request, patient comfort (comfort scale), and side effects. RESULTS: There were no differences in number of patient requiring supplemental analgesic (3/20 vs 5/20), the time of first analgesic request (42.2 hours vs 37.5 hours), pain scores measured at each time, and patient comfort between two groups. There were minor complications such as nausea and somnolence in both groups, but no patients needed any treatment. CONCLUSIONS: Preemptive or postincisional morphine-ketorolac-droperidol infusion was equally effective for postoperative analgesia after lower abdominal surgery with minor complications. Further evaluation may be needed to determine whether preemptive analgesia has any advantages over postincisional analgesia.

Analgesic Effect of Epidural Morphine and Incisional Site Infiltration with Bupivacaine in the Lower Abdominal Surgery / 대한마취과학회지

IIn a randomized double-blind study, postoperative pain was assessed in 60 patients undergoing gynecologic surgery with three types of anesthesia; inhalation anesthesia only (enflurane-N2O-O2-vecuronium)(G); inhalation anesthesia with local infiltration (infiltration of the abdominal wall with 40 ml 0.25% bupivacaine along the line of the proposed incision)(GI); and inhalation anesthesia with epidural analgesia (morphine 2 mg mixed with 10 ml 0.125% bupivacaine)(GE). The severity of constant incisional pain, movement-associated incisional pain, and pain upon pressure applied to the surgical wound using 5 pounds of weight was assessed with a visual analogue scale at 2, 6, 12, 24, and 48 hours after surgery. The duration of analgesia (time from the end of the surgery to the first request for analgesic) was 7.9+/-3.1 hours in group G, 22.8+/-4.8 hours in group GI, and 33.1+/-3.9 hours in group GE, with statistically significant differences between group G and other two groups. Forced vital capacity (FVC), peak expiratory flow, and forced expiratory volume in 1 second (FEV1) were measured with the patients in a semisitting position. In all groups, there were no differences in above parameters, These results indicate that postoperative pain after lower aMominal surgery would be managed satisfactorily with infiltration of local anesthetic as well as epidural analgesia.