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

lingua: Inglese

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.

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