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Home > Journals > Panminerva Medica > Past Issues > Panminerva Medica 2001 September;43(3) > Panminerva Medica 2001 September;43(3):171-5



A Journal on Internal Medicine

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,6

Frequency: Quarterly

ISSN 0031-0808

Online ISSN 1827-1898


Panminerva Medica 2001 September;43(3):171-5


The effect of preemptive intravenous morphine on postoperative analgesia and surgical stress response

Kiliçkan L., Toker K.

From the Department of Anaesthesiology and Resuscitation Kocaeli University, Kocaeli, Türkiye

Background. Although ­initial stud­ies of pre­emp­tive anal­ge­sia ­showed ­that pre­op­er­a­tive block­ade ­with ­local anaesthet­ics or pre­op­er­a­tive admin­is­tra­tion of system­ic opi­oids was ­more effec­tive in reduc­ing post­op­er­a­tive ­pain ­than con­trol con­di­tions involv­ing no treat­ment, the ­result of sub­se­quent inves­ti­ga­tions com­par­ing the ­effects of pre­op­er­a­tive treat­ment ­with the ­same treat­ment initiat­ed ­after sur­gery ­have pro­duced incon­sis­tent ­results. The rea­sons for the ­lack of con­sis­ten­cy are not ­clear. Studies ­about the rela­tion­ship of pre­emp­tive anal­ge­sia and ­both anal­ge­sic con­sump­tion and sur­gi­cal ­stress ­response are lim­it­ed. The pur­pose of ­this ­study was to eval­u­ate the ­effect of pre­emp­tive intra­ve­nous mor­phine on ­both post­op­er­a­tive anal­ge­sic con­sump­tion and sur­gi­cal ­stress ­response.
Methods. Sixty ­patients, ASA I or II, ­aged 20-60, under­go­ing ­total abdom­i­nal hys­ter­ec­to­my ­plus bilat­er­al sal­pin­go-ooph­e­rec­to­my and dou­ble-blind­ed ­were ran­dom­ly ­assigned to ­three ­groups of 20 ­patients. Group I (n=20) ­received 0.15 mg/kg of mor­phine fol­low­ing induc­tion and pla­ce­bo ­saline dur­ing per­i­to­neal clo­sure. Group II (n=20) ­received pla­ce­bo ­saline fol­low­ing induc­tion and 0.15 mg/kg of mor­phine dur­ing per­i­to­neal clo­sure. Group III (n=20) ­received pla­ce­bo ­saline ­both dur­ing induc­tion and per­i­to­neal clo­sure. Blood cor­ti­sol, glu­cose lev­els and leu­ko­cyte ­count ­were meas­ured in the pre and post­op­er­a­tive peri­od.
Results. Postoperative ­total mor­phine con­sump­tion was sig­nif­i­cant­ly low­er in ­group I com­pared ­with ­group III (p<0.001). In all ­groups, plas­ma cor­ti­sol lev­els ­increased sig­nif­i­cant­ly with­in 4 ­hours of sur­gery as com­pared to pre-op val­ues (p<0.001). Plasma glu­cose ­also ­increased to a sig­nif­i­cant­ly high­er lev­el in all ­groups in the post­op­er­a­tive 30 min and 8 ­hours ­than in the pre-op val­ues (p<0.001). Postoperative leu­ko­cy­to­sis was ­observed in all ­groups and the leu­ko­cyte ­count was sig­nif­i­cant­ly great­er dur­ing post­op­er­a­tive 24 h ­than pre-op val­ues (p<0.001).
Conclusions. Preemptive mor­phine 0.15 mg/kg intra­ve­nous has ­decreased ­total mor­phine con­sump­tion but has ­failed to ­supress the sur­gi­cal ­stress ­response.

language: English


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