ABSTRACT
Non-steroidal anti-inflammatory drugs (NSAIDs) provide effective analgesia after orthopaedic surgery and reduce opioid requirements. The need for parenteral NSAIDs with peripheral surgery is controversial. In this study 10 patients were treated with oral tenoxicam 20 mg preoperatively, and at 4 hours and 28 hours after knee ligament reconstruction surgery. Plasma concentrations of tenoxicam, an NSAID with a long elimination half-life, were measured for 10 days. All patients received patient-controlled intravenous morphine postoperatively, which delayed absorption of the second and third tenoxicam doses. However, plasma concentrations of tenoxicam were achieved and maintained for the five-day surgical admission above the level considered to produce effective analgesia. Oral analgesic administration is a simple and feasible option in the perioperative period.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/pharmacokinetics , Knee Joint/surgery , Pain, Postoperative/prevention & control , Piroxicam/analogs & derivatives , Administration, Oral , Adult , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Female , Humans , Male , Piroxicam/administration & dosage , Piroxicam/pharmacokineticsABSTRACT
The effect of adding a continuous infusion of morphine 1 mg/hr to patient-controlled intravenous analgesia was studied in a randomized double-blind trial. Ninety-six patients scheduled for abdominal surgery were enrolled; 38 received PCA and continuous infusion (PCA + C), 45 received PCA alone and 13 were excluded because of protocol violations. PCA was delivered via an ABBOTT 4200 pump with settings of morphine 1 mg bolus and five-minute lockout in both groups. A separate pump delivered a continuous infusion of morphine 1 mg/ml (PCA + C) or 9% normal saline (PCA) at 1 ml/hr for three postoperative days. Pain was assessed by hourly verbal pain scores (VPS) and daily visual analog pain scores at rest and on movement (VAS(rest), VAS(move)). PCA delivered morphine and the demand to delivery ratio (D/D ratio) were used as indirect indicators of pain. These were assessed during daytime (0800-2200 hours), sleep (2200-0500 hours) and on first waking (0500-0800 hours). Patient demographics were similar. Patients receiving a continuous infusion had lower pain scores during the first 24 hours but not thereafter (VPS P = 0.04, VAS(move) P = 0.02). The PCA group delivered more PCA morphine during 0500-0800 hours and 0800-2200 hours on the first day only. There was no significant difference in the D/D ratio for any time period during the three days. Total morphine delivery was greater in the PCA + C group on the second and third postoperative days (P = 0.009 and P = 0.0001 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Abdomen/surgery , Analgesia, Patient-Controlled , Analgesics, Opioid/administration & dosage , Morphine/administration & dosage , Adult , Aged , Analgesia, Patient-Controlled/methods , Analgesics, Opioid/adverse effects , Double-Blind Method , Female , Humans , Infusion Pumps , Infusions, Intravenous , Male , Middle Aged , Morphine/adverse effects , Movement , Pain Measurement , Pain, Postoperative/prevention & control , Placebos , Respiration/drug effects , Rest , Sleep , Time Factors , WakefulnessABSTRACT
We have assessed the effect of i.m. ketorolac or morphine on early postoperative gastric emptying of liquids in patients undergoing orthopaedic surgery with spinal anaesthesia. Liquid gastric emptying was measured by absorption of paracetamol with patients acting as their own controls. There was no delay after ketorolac 30 mg, but morphine 10 mg resulted in marked delay. There was no difference in postoperative visual analogue pain scores between treatments.
