Comparison of the analgesic efficacy between Intravenous Patient Controlled Analgesia Fentanyl, Epidural morphine and Intravenous morphine given around the clock in post operative Anatrophic nephrolithotomy surgery at Mahasarakham Hospital
Keywords:
IV PCA FENTANYL, Epidural Morphine, IV morphine around the clockAbstract
Introduction : Anatrophic nephrolithotomy surgery usually cause severe pain and might cause respiratory complications. The efficient pain control permits patients to have quick recovery, save cost, and shorten hospitalization time. Besides, good pain control also benefit to emotional condition of both patient and relatives.
Purposes : To compare the efficacy of pain control of IV PCV Fentanyl, Epidural morphine and IV morphine around the clock in patients undergoing Anatrophic nephrolithotomy surgery in Mahasarakham hospital during October 2013-February 2015. Besides, cost effectiveness, complications and satisfaction are also compared.
Methods : A pilot study in 60 patients undergoing Anatrophic nephrolithotomy surgery under general anesthesia. The study population were randomly assigned into 3 groups. Each group received each type of post operative pain control as follow IV PCA Fentanyl, Epidural morphine and IV morphine around the clock. Pain score, complications, cost, length of hospital stay and satisfaction score were recorded.
Result : There were no statistically significant difference between the 3 groups. Pain score in Epidural morphine group was statistically significant less than in IV morphine around the clock group (p<0.001) and also in IV PCA group. Epidural morphine causes more itching and nausea than IV morphine around the clock group ,p=0.001 and p=0.032 respectively. Furthermore, IV morphine around the clock technique provide least cost benefit, cause highest cost and least satisfaction of all 3 techniques.
Conclusions : Epidural morphine is an effective method for post operative pain control in Anatrophic nephrolithotomy surgery, Besides level of satisfaction is superior too other methods. However Epidural morphine may cause itching in some patients. IV morphine around the clock group cause highest cost during hospital stay and least cost-effectiveness. In conclusion, from this study we assume that Epidural morphine is the most effective post operative pain control method.
References
ราชวิทยาลัยวิสัญญีแพทย์แห่งประเทศไทย. แนวทางพัฒนาการระงับปวดเฉียบพลันหลังผ่าตัด.กรุงเทพมหานคร : ราชวิทยาลัย;2554.
Geetha C.R, Tejesh C. A, Prathima P.T. Anesthetic management of Anatrophic nephrolithotomy. Journal of Evolution of Medical and Dental Sciences 2013;16(2): 2648-2651.
ราชวิทยาลัยศัลยแพทย์แห่งประเทศไทย.แนวทางการรักษาพยาบาลด้านศัลยกรรม Clinical Practice Guidelines in surgery สาขา ศัลยศาสตร์ยูโร.เรื่อง:โรคนิ่วในไต.กรุงเทพมหานคร:ราชวิทยาลัย;2554.
John A., Libertino and Chad Wotkowicz. Renovascular disease. Glenn’s urologic surgery .seventh edition; Lippincott William &Wilkins; October 26,2009.
Lombard M.C., J.M. Besson . Attempts to gauge the relative importance of pre- and postsynaptic effects of morphine on the transmission of noxious messages in the dorsal horn of the rat spinal cord .Pain, 1989:37:335-345..
Sivilotti L.G., G. Gerber, B. Rawat, C.J. Woolf. Morphine selectively depresses the slowest, NMDA-independent component of C-fibre-evoked synaptic activity in the rat spinal cord in vitro. Eur J Neurosci, 1995:7: 12–18.
Bader P, Echtle D, Fonteyne V, De Meerleer G, Papaioannou EG, Vranken JH. Guidelines on pain management . Arnhem, The Nethelands: European Association of Urology (EUA);2009 Mar.p.62-82.
George KA, Wright PM, Chisakuta AM, Rao NV. Thoracic epidural analgesia compared with patient controlled intravenous morphine after upper abdominal surgery. Acta Anaesthesiol Scand 1994; 38 : 808-812.
Werawatganon T, Charuluxanun S. Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. The Cochrane Database of Systematic Reviews 2005; Issue 1: CD004088.
Wu CL, Cohen SR, Richman JM, Rowlingson AJ, Courpas GE, Cheung K, et al. Efficacy of postoperative patient-controlled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids: A meta-analysis. Anesthesiology 2005; 103: 1079-88.
Jeffrey A. Grass, MD, MMM. Patient-Controlled Analgesia. Anesth Analg 2005;101:S44-S61.
Gan TJ, Meyer T, Apfel CC, et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 2003;97:62–71.
Boonmak S, Boonmak P, Bunsaengjaroen P, Srichaipanha S, Thincheelong V. Comparison of intrathecal morphine plus PCA and PCA alone for post-operative analgesia after kidney surgery. J Med Assoc Thai 2007;90:1143-1149.
Bozkurt P - The analgesic effi cacy and neuroendocrine response in pediatric patients treated with two analgesic techniques: using morphine-epidural and patient-controlled analgesia. Paediatr Anaesth, 2002;12:248-254.
Charuluxananan S, Somboonviboon W, Kyokong O, Nimcharoendee K. Ondansetron for treatment of intrathecal morphine-induced pruritus after cesarean delivery. Reg Anesth Pain Med 2000;25:535-539.
Warwick JP, Kearns CF, Scott WE. The effect of subhypnotic doses of propofol on the incidence of pruritus after intrathecal morphine for caesarean section. Anaesthesia 1997;52:270-5.
Charuluxananan S, Kyokong O, Somboonviboon W, Narasethakamol A, Promlok P. Nalbuphine versus ondansetron for prevention of intrathecal morphine-induced pruritus after cesarean delivery. Anesth Analg 2003;96:1789-1793.
Bonnet MP, Marret E, Josserand J, Mercier FJ. Effect of prophylactic 5-HT3 receptor antagonists on pruritus induced by neuraxial opioids: A quantitative systematic review. Br J Anaesth 2008;101:311-319.
Kamal Kumar, Sudha Indu Singh, Neuraxial opioid-induced pruritus: An update. Journal of Anaesthesiology clinical Pharmacology, 2013:29:3:303-307.
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