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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; Nov2017, Vol. 58 Issue 11, p666-673, 8p
- Publication Year :
- 2017
-
Abstract
- <bold>Introduction: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusion: </bold>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. [ABSTRACT FROM AUTHOR]
- Subjects :
- MORPHINE
ROPIVACAINE
ANALGESIA
KIDNEY transplantation
FENTANYL
THERAPEUTIC use of narcotics
ANALGESICS
PAIN management
ISONIPECAINE
CHRONIC kidney failure
AMIDES
COMPARATIVE studies
INTRATHECAL injections
INTRAVENOUS therapy
ITCHING
RESEARCH methodology
MEDICAL cooperation
ORGAN donors
PATIENT-controlled analgesia
POSTOPERATIVE pain
POSTOPERATIVE period
RESEARCH
RESPIRATORY insufficiency
TIME
EVALUATION research
PAIN measurement
TREATMENT effectiveness
SURGERY
THERAPEUTICS
Subjects
Details
- Language :
- English
- ISSN :
- 00375675
- Volume :
- 58
- Issue :
- 11
- Database :
- Complementary Index
- Journal :
- Singapore Medical Journal
- Publication Type :
- Academic Journal
- Accession number :
- 126589070
- Full Text :
- https://doi.org/10.11622/smedj.2017077