Title: Comparative Evaluation of Low Dose Intrathecal Morphine Vs Multimodal Analgesia in Patients Undergoing Abdominal Surgeries under General Anaesthesia
Abstract: INTRODUCTION:
Opioids have been used in the treatment of pain for thousands of years. The opioids contains 20 alkaloids. Opium means juice, from Greek word. Morphine is the prototype drug and named after Greek God of dreams, Morpheous. Morphine was used in American civil war in 1869. In 1950. Opioid anesthesia came with advent of cardiac surgery. However, because of incomplete suppression of stress response, hypotension, awareness during anesthesia and increased fluid and blood requirement and need to ventilate post operatively, limited its use.
Opioid refers to drugs derived from opium both natural and synthetic.
Narcotic refers to morphine and morphine-like analgesics.
Morphine can be used as spinal analgesic, Epidural analgesic as shown by Behar et al. Despite the high efficacy, it was not widely used because of early reported high incidence of respiratory depression and somnolence. It was due to high doses, rather than route of administration.
Gwirtz and associates recently reported high patient satisfaction and low incidence of side effects and complication of morphine over 6000 patients.
Therefore, this study has been undertaken to analyze the effect of intrathecal morphine as more cost effective analgesic when compared to Multimodal analgesia.
AIM OF STUDY:
To evaluate the effect of preservative free morphine 0.5 mg administered intrathecally, on intraoperative anaesthetic requirement and postoperative analgesia in patients undergoing laparotomies under general anesthesia compared with multimodal analgesia, during the Ist 24 hours of postoperative period.
The following parameters were studied
1. Intra operative hemodynamics
2. Post operative pain score and analgesic requirement
3. Post operative hemodynamics
4. Complications: both intraoperative and postoperative period.
MATERIALS AND METHODS:
This study was conducted at Government General Hospital, Madras Medical College General between July 2008 to September 2008 at General surgical operation theatre.
1. The study was done after getting Institutional Ethical committee approval.
2. Written informed consent were obtained from all patients included in the study.
All patients were explained preoperatively about the procedure and visual analog scale (Pain score) 10 cm scale so that it can be effectively used by the patient during the postoperative period.
50 patients of ASA physical status I, II and III undergoing both upper and lower abdominal surgeries like partial Gastrectomy, open cholecystectomy, incisional hernia, hemicolectomy and laparotomy under general anesthesia.
The patients are categorized into one of two groups.
Group M - Morphine - Study Group
Group C - Control Group
All patients were assessed preoperatively using standard protocols and underwent preoperative evaluation.
All patients received Premedication T.alprazolam using T.Ranitidine 150 mg P.O. the night before surgery and on the day of surgery 2 hours before operation P.O. with sips of water.
Preservative free Morphine sulphate comes in two strengths 15 mg / ml and 10 ml / ml ampoule manufactured by verve health care Ltd. We used 10 mg/ml of morphine sulphate (Vermor - 10). This was taken in sterile 10 ml syringe mixed with sterile Normal saline by the incharge Anaesthesiologist uninvolved in the administration of Subarachnoid block or in further conduct of the study. This solution was isobaric to cerebrospinal fluid.
SUMMARY:
The study was conducted at Government General Hospital, Chennai on fifty patients to compare the effect of IT morphine ( 0.5 mg) for providing postoperative analgesia in patients undergoing major laprotomies. The summary of the findings include:
1. Intrathecal Morphine produced better post-operative analgesia as shown by lower VAS scores.
2. Intrathecal Morphine group demonstrated lesser amounts of analgesic and rescue analgesic requirements during the post-operative period.
3. Intrathecal Morphine group of patients has better sedation as shown by better scores on the Ramsay scale.
4. Intrathecal Morphine produced better hemodynamic stability in the postoperative period and also was associated with lower heart rates.
5. Intrathecal Morphine produced more side effects in the form of nausea, vomiting, hypotension, bradycardia and hypotension. Although not statistically significant these findings seem to be clinically relevant. A larger sample of study may have revealed statistical significance.
6. All the side effects produced by IT Morphine were easily manageable and did not contribute to any increase in mortality or morbidity.
7. IT Morphine did not seem to produce any significant changes in the Hemodynamics or management of the patient during the intra-operative period. This may be related to the lag time for the rostral spread of the drug.
8. IT Morphine is a good substitute or adjunct to various modalities used to offer analgesia during the post-operative period in patients undergoing major laprotomies.
9. IT Morphine does not require any complex procedures and or equipment for administration.
10. IT Morphine is a cost effective adjunct and alternative to the various modalities available to provide pain relief during the post-operative period.
CONCLUSION:
Preservative free morphine 0.5 mg administered intrathecally in patients undergoing laparotomies under general anesthesia Provides effective analgesia during the first 24 hours of the postoperative period.
It decreases the requirement of rescue analgesics during the postoperative period.
It is associated with stable Hemodynamics and better levels of sedation.
It is associated with increased adverse effects but these are easily manageable by simple measures.
Publication Year: 2009
Publication Date: 2009-03-01
Language: en
Type: dissertation
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