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Comparison of intrathecal morphine and surgical-site infusion of ropivacaine as adjuncts to intravenous patient-controlled analgesia in living-donor kidney transplant recipients.
- Source :
-
Singapore medical journal [Singapore Med J] 2017 Nov; Vol. 58 (11), pp. 666-673. Date of Electronic Publication: 2017 Aug 14. - Publication Year :
- 2017
-
Abstract
- Introduction: This prospective observational study compared the postoperative analgesic effectiveness of intrathecal morphine (ITM) and surgical-site infusion (SSI) of ropivacaine as adjuncts to intravenous (IV) patient-controlled analgesia (PCA) (fentanyl) in living-donor kidney transplant recipients.<br />Methods: Patients undergoing living-donor kidney transplantation who received ITM or SSI in addition to IV PCA were included. Rescue analgesia was achieved with IV meperidine as required. The primary outcome, measured using the Numeric Pain Rating Scale (NRS), was pain at rest and when coughing. Patients were assessed for 48 hours after surgery.<br />Results: A total of 53 patients (32 ITM, 21 SSI) were included in the study. The ITM group showed significantly lower NRS scores, at rest and when coughing, for up to 12 and eight hours. NRS scores were comparable between the groups at other times. The ITM group had significantly less postoperative systemic opioid requirement in the first 24 hours, but there was no significant difference between the systemic opioid consumption of the groups on postoperative Day 2. In the ITM group, 3 (9.4%) patients presented with bradypnoea and 1 (3.1%) with excessive sedation in the first 12 postoperative hours. More patients in the ITM group developed pruritus requiring treatment during the first 24 hours. There were no differences between the groups in other outcomes (e.g. nausea/vomiting, change in pulmonary or kidney functions).<br />Conclusion: Compared with SSI, ITM reduced immediate postoperative pain and IV opioid consumption on postoperative Day 1 after living-donor kidney transplantation, but at the cost of increased pruritus and respiratory depression.<br /> (Copyright: © Singapore Medical Association)
- Subjects :
- Adult
Aged
Analgesics, Opioid therapeutic use
Female
Humans
Infusions, Intravenous
Injections, Spinal
Living Donors
Male
Meperidine therapeutic use
Middle Aged
Pain Management
Pain Measurement
Pain, Postoperative
Postoperative Period
Pruritus etiology
Respiratory Insufficiency etiology
Ropivacaine
Time Factors
Treatment Outcome
Amides administration & dosage
Analgesia, Patient-Controlled
Fentanyl administration & dosage
Kidney Failure, Chronic surgery
Kidney Transplantation
Morphine administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 0037-5675
- Volume :
- 58
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Singapore medical journal
- Publication Type :
- Academic Journal
- Accession number :
- 28805236
- Full Text :
- https://doi.org/10.11622/smedj.2017077