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Pain Research and Treatment
Volume 2012 (2012), Article ID 612145, 11 pages
A Clinical Approach to Neuraxial Morphine for the Treatment of Postoperative Pain
1Department of Anesthesiology, Critical Care and Pain Medicine, Donostia University Hospital, 20014 San Sebastián, Spain
2Pain Relief Unit, Acute and Chronic Pain Management, Donostia University Hospital, 20014 San Sebastián, Spain
Received 4 January 2012; Accepted 16 May 2012
Academic Editor: Howard Smith
Copyright © 2012 Borja Mugabure Bujedo. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
- J. L. Apfelbaum, C. Chen, S. S. Mehta, and T. J. Gan, “Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged,” Anesthesia and Analgesia, vol. 97, no. 2, pp. 534–540, 2003.
- B. M. Bujedo, I. T. Bizueta, S. G. Santos, and R. Adrián Garde, “Multimodal approaches to postoperative pain management and convalescence,” Revista Española de Anestesiología y Reanimación, vol. 54, no. 1, pp. 29–40, 2007.
- H. Kehlet, R. C. Wilkinson, H. B. J. Fischer, and F. Camu, “PROSPECT: evidence-based, procedure-specific postoperative pain management,” Best Practice and Research: Clinical Anaesthesiology, vol. 21, no. 1, pp. 149–159, 2007.
- M. Giovannelli, N. Bedforth, and A. Aitkenhead, “Survey of intrathecal opioid usage in the UK,” European Journal of Anaesthesiology, vol. 25, no. 2, pp. 118–122, 2008.
- J. P. Rathmell, T. R. Lair, and B. Nauman, “The role of intrathecal drugs in the treatment of acute pain,” Anesthesia and Analgesia, vol. 101, no. 5, supplement, pp. S30–S43, 2005.
- L. B. Ready, K. A. Loper, M. Nessly, and L. Wild, “Postoperative epidural morphine is safe on surgical wards,” Anesthesiology, vol. 75, no. 3, pp. 452–456, 1991.
- S. Brill, G. M. Gurman, and A. Fisher, “A history of neuraxial administration of local analgesics and opioids,” European Journal of Anaesthesiology, vol. 20, no. 9, pp. 682–689, 2003.
- T. L. Yaksh and T. A. Rudy, “Analgesia mediated by a direct spinal action of narcotics,” Science, vol. 192, no. 4246, pp. 1357–1358, 1976.
- J. K. Wang, L. A. Nauss, and J. E. Thomas, “Pain relief by intrathecally applied morphine in man,” Anesthesiology, vol. 50, no. 2, pp. 149–151, 1979.
- M. Behar, F. Magora, D. Olshwang, and J. T. Davidson, “Epidural morphine in treatment of pain,” Lancet, vol. 1, no. 8115, pp. 527–529, 1979.
- C. M. Bernards, “Understanding the physiology and pharmacology of epidural and intrathecal opioids,” Best Practice and Research: Clinical Anaesthesiology, vol. 16, no. 4, pp. 489–505, 2002.
- C. M. Bernards, “Recent insights into the pharmacokinetics of spinal opioids and the relevance to opioid selection,” Current Opinion in Anaesthesiology, vol. 17, no. 5, pp. 441–447, 2004.
- B. Mugabure Bujedo, S. González-Santos, and A. Uría Azpiazu, “A review of epidural and intrathecal opioids used in the management of postoperative,” Journal of Opioid Management, vol. 8, no. 3, pp. 177–192, 2012.
- Y. Ginosar, E. T. Riley, and M. S. Angst, “The site of action of epidural fentanyl in humans: the difference between infusion and bolus administration,” Anesthesia and Analgesia, vol. 97, no. 5, pp. 1428–1438, 2003.
- O. A. De Leon-Casasola and M. J. Lema, “Postoperative epidural opioid analgesia: what are the choices?” Anesthesia and Analgesia, vol. 83, no. 4, pp. 867–875, 1996.
- E. A. Hamber and C. M. Viscomi, “Intrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia,” Regional Anesthesia and Pain Medicine, vol. 24, no. 3, pp. 255–263, 1999.
- American Society of Anesthesiologists Task Force on Acute Pain Management, “Practice Guidelines for acute pain management in the perioperative setting,” Anesthesiology, vol. 116, no. 2, pp. 248–273, 2012.
- A. K. Brown, P. J. Christo, and C. L. Wu, “Strategies for postoperative pain management,” Best Practice and Research: Clinical Anaesthesiology, vol. 18, no. 4, pp. 703–717, 2004.
- M. P. Bonnet, A. Mignon, J. X. Mazoit, Y. Ozier, and E. Marret, “Analgesic efficacy and adverse effects of epidural morphine compared to parenteral opioids after elective caesarean section: a systematic review,” European Journal of Pain, vol. 14, no. 9, pp. 894.e1–894.e9, 2010.
- M. Vercauteren, K. Vereecken, M. La Malfa, H. Coppejans, and H. Adriaensen, “Cost-effectiveness of analgesia after Caesarean section. A comparison of intrathecal morphine and epidural PCA,” Acta Anaesthesiologica Scandinavica, vol. 46, no. 1, pp. 85–89, 2002.
- P. Morley-Forster, “Epidural hematoma following epidural analgesia in a patient receiving unfractionated heparin for thromboprophylaxis,” Regional Anesthesia and Pain Medicine, vol. 25, no. 1, pp. 72–75, 2000.
- T. Kim, S. Murdande, A. Gruber, and S. Kim, “Sustained-release morphine for epidural analgesia in rats,” Anesthesiology, vol. 85, no. 2, pp. 331–338, 1996.
- M. Alam and C. T. Hartrick, “Extended-release epidural morphine (DepoDur): an old drug with a new profile,” Pain Practice, vol. 5, no. 4, pp. 349–353, 2005.
- D. Gambling, T. Hughes, G. Martin, W. Horton, and G. Manvelian, “A comparison of Depodur, a novel, single-dose extended-release epidural morphine, with standard epidural morphine for pain relief after lower abdominal surgery,” Anesthesia and Analgesia, vol. 100, no. 4, pp. 1065–1074, 2005.
- E. R. Viscusi, “Emerging techniques in the management of acute pain: epidural analgesia,” Anesthesia and Analgesia, vol. 101, no. 5, supplement, pp. S23–S29, 2005.
- C. T. Hartrick and K. A. Hartrick, “Extended-release epidural morphine (DepoDur): review and safety analysis,” Expert Review of Neurotherapeutics, vol. 8, no. 11, pp. 1641–1648, 2008.
- S. Sumida, M. R. Lesley, M. N. Hanna, J. D. Murphy, K. Kumar, and C. L. Wu, “Meta-analysis of the effect of extended-release epidural morphine versus intravenous patient-controlled analgesia on respiratory depression,” Journal of Opioid Management, vol. 5, no. 5, pp. 301–305, 2009.
- R. J. N. Mhuircheartaigh, R. A. Moore, and H. J. McQuay, “Analysis of individual patient data from clinical trials: epidural morphine for postoperative pain,” British Journal of Anaesthesia, vol. 103, no. 6, pp. 874–881, 2009.
- J. C. Gerancher and P. C. Nagle, “Management of accidental spinal administration of extended-release epidural morphine,” Anesthesiology, vol. 108, no. 6, pp. 1147–1149, 2008.
- C. M. Bernards, D. D. Shen, E. S. Sterling et al., “Epidural, cerebrospinal fluid, and plasma pharmacokinetics of epidural opioids (Part 1): differences among opioids,” Anesthesiology, vol. 99, no. 2, pp. 455–465, 2003.
- W. C. Ummenhofer, R. H. Arends, D. D. Shen, and C. M. Bernards, “Comparative spinal distribution and clearance kinetics of intrathecally administered morphine, fentanyl, alfentanil, and sufentanil,” Anesthesiology, vol. 92, no. 3, pp. 739–753, 2000.
- J. C. Carvalho, J. Tarshis, S. Katsiris, and S. Halpern, “Respiratory arrest following intrathecal sufentanil,” Canadian Journal of Anaesthesia, vol. 46, no. 2, pp. 198–199, 1999.
- R. Fournier, Z. Gamulin, and E. Van Gessel, “Respiratory depression after 5 μg of intrathecal sufentanil,” Anesthesia and Analgesia, vol. 87, no. 6, pp. 1377–1378, 1998.
- N. Meylan, N. Elia, C. Lysakowski, and M. R. Tramèr, “Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery: meta-analysis of randomized trials,” British Journal of Anaesthesia, vol. 102, no. 2, pp. 156–167, 2009.
- N. Elia, C. Lysakowski, and M. R. Tramèr, “Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials,” Anesthesiology, vol. 103, no. 6, pp. 1296–1304, 2005.
- C. Remy, E. Marret, and F. Bonnet, “Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials,” British Journal of Anaesthesia, vol. 94, no. 4, pp. 505–513, 2005.
- M. Gehling and M. Tryba, “Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: a meta-analysis,” Anaesthesia, vol. 64, no. 6, pp. 643–651, 2009.
- M. H. G. Gehling, T. Luesebrink, P. J. Kulka, and M. Tryba, “The effective duration of analgesia after intrathecal morphine in patients without additional opioid analgesia: a randomized double-blind multicentre study on orthopaedic patients,” European Journal of Anaesthesiology, vol. 26, no. 8, pp. 683–688, 2009.
- D. M. Pöpping, M. Elia, and E. Marret, “Opioids added to LA for single-shot intrathecal anaesthesia in patients undergoing minor surgery: a meta-analysis of randomized trials,” Pain, vol. 153, no. 4, pp. 784–793, 2012.
- K. Samii, M. Chauvin, and P. Viars, “Postoperative spinal analgesia with morphine,” British Journal of Anaesthesia, vol. 53, no. 8, pp. 817–820, 1981.
- P. L. Bailey, S. Rhondeau, P. G. Schafer et al., “Dose-response pharmacology of intrathecal morphine in human volunteers,” Anesthesiology, vol. 79, no. 1, pp. 49–59, 1993.
- T. Sakai, T. Use, H. Shimamoto, T. Fukano, and K. Sumikawa, “Mini-dose (0.05 mg) intrathecal morphine provides effective analgesia after transurethral resection of the prostate,” Canadian Journal of Anesthesia, vol. 50, no. 10, pp. 1027–1030, 2003.
- N. K. Girgin, A. Gurbet, G. Turker, H. Aksu, and N. Gulhan, “Intrathecal morphine in anesthesia for cesarean delivery: dose-response relationship for combinations of low-dose intrathecal morphine and spinal bupivacaine,” Journal of Clinical Anesthesia, vol. 20, no. 3, pp. 180–185, 2008.
- J. B. Dahl, I. S. Jeppesen, H. Jørgensen, J. Wetterslev, and S. Møiniche, “Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal anesthesia: a qualitative and quantitative systematic review of randomized controlled trials,” Anesthesiology, vol. 91, no. 6, pp. 1919–1927, 1999.
- P. M. Murphy, D. Stack, B. Kinirons, and J. G. Laffey, “Optimizing the dose of intrathecal morphine in older patients undergoing hip arthroplasty,” Anesthesia and Analgesia, vol. 97, no. 6, pp. 1709–1715, 2003.
- J. P. Rathmell, C. A. Pino, R. Taylor, T. Patrin, and B. A. Viani, “Intrathecal morphine for postoperative analgesia: a randomized, controlled, dose-ranging study after hip and knee arthroplasty,” Anesthesia and Analgesia, vol. 97, no. 5, pp. 1452–1457, 2003.
- A. Hein and P. Rósblad, “Low dose intrathecal morphine effects on post-hysterectomy pain: a randomized placebo-controlled study,” Acta Anaesthesiologica Scandinavica, vol. 56, no. 1, pp. 102–109, 2012.
- S. Ziegeler, E. Fritsch, C. Bauer et al., “Therapeutic effect of intrathecal morphine after posterior lumbar interbody fusion surgery: a prospective, double-blind, randomized study,” Spine, vol. 33, no. 22, pp. 2379–2386, 2008.
- N. Liu, G. Kuhlman, N. Dalibon, M. Moutafis, J. C. Levron, and M. Fischler, “A randomized, double-blinded comparison of intrathecal morphine, sufentanil and their combination versus IV morphine patient-controlled analgesia for postthoracotomy pain,” Anesthesia and Analgesia, vol. 92, no. 1, pp. 31–36, 2001.
- M. H. Fléron, R. B. Weiskopf, M. Bertrand et al., “A comparison of intrathecal opioid and intravenous analgesia for the incidence of cardiovascular, respiratory, and renal complications after abdominal aortic surgery,” Anesthesia and Analgesia, vol. 97, no. 1, pp. 2–12, 2003.
- E. Zisman, A. Shenderey, R. Ammar, A. Eden, and R. Pizov, “The effects of intrathecal morphine on patients undergoing minimally invasive direct coronary artery bypass surgery,” Journal of Cardiothoracic and Vascular Anesthesia, vol. 19, no. 1, pp. 40–43, 2005.
- G. Turker, S. Goren, S. Sahin, G. Korfali, and E. Sayan, “Combination of intrathecal morphine and remifentanil infusion for fast-track anesthesia in off-pump coronary artery bypass surgery,” Journal of Cardiothoracic and Vascular Anesthesia, vol. 19, no. 6, pp. 708–713, 2005.
- S. Ko, D. H. Goldstein, and E. G. VanDenKerkhof, “Definitions of "respiratory depression" with intrathecal morphine postoperative analgesia: a review of the literature,” Canadian Journal of Anesthesia, vol. 50, no. 7, pp. 679–688, 2003.
- T. G. Standl, E. P. Horn, M. Luckmann, M. A. Burmeister, S. Wilhelm, and J. Schulte, “Subarachnoid sufentanil for early postoperative pain management in orthopedic patients: a placebo-controlled, double-blind study using spinal microcatheters,” Anesthesiology, vol. 94, no. 2, pp. 230–238, 2001.
- R. Stenseth, O. Sellevold, and H. Breivik, “Epidural morphine for postoperative pain: experience with 1085 patients,” Acta Anaesthesiologica Scandinavica, vol. 29, no. 1, pp. 148–156, 1985.
- J. G. Fuller, G. H. McMorland, M. J. Douglas, and L. Palmer, “Epidural morphine for analgesia after Caesarean section: a report of 4880 patients,” Canadian Journal of Anaesthesia, vol. 37, no. 6, pp. 636–640, 1990.
- N. Rawal, R. Allvin, J. Neumark et al., “Epidural and intrathecal opioids for postoperative pain management in Europe - A 17-nation questionnaire study of selected hospitals,” Acta Anaesthesiologica Scandinavica, vol. 40, no. 9, pp. 1119–1126, 1996.
- A. Shapiro, E. Zohar, R. Zaslansky, D. Hoppenstein, S. Shabat, and B. Fredman, “The frequency and timing of respiratory depression in 1524 postoperative patients treated with systemic or neuraxial morphine,” Journal of Clinical Anesthesia, vol. 17, no. 7, pp. 537–542, 2005.
- R. C. Etches, A. N. Sandler, and M. D. Daley, “Respiratory depression and spinal opioids,” Canadian Journal of Anaesthesia, vol. 36, no. 2, pp. 165–185, 1989.
- M. Morgan, “The rational use of intrathecal and extradural opioids,” British Journal of Anaesthesia, vol. 63, no. 2, pp. 165–188, 1989.
- P. Sultan, M. C. Gutierrez, and B. Carvalho, “Neuraxial morphine and respiratory depression: finding the right balance,” Drugs, vol. 71, no. 14, pp. 1807–1819, 2011.
- T. T. Horlocker, A. W. Burton, R. T. Connis et al., “Practice guidelines for the prevention, detection, and management of respiratory depression associated with neuraxial opioid administration,” Anesthesiology, vol. 110, no. 2, pp. 218–230, 2009.