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Effect of interpleural morphine on postoperative pain and pulmonary function after thoracotomy
1Institute of Anaesthesiology, Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Germany.
Abstract:
We have investigated the effect of interpleural morphine on postoperative pain and pulmonary function after thoracotomy. At the end of surgery, an interpleural catheter was inserted in 17 patients and, in a double-blind and randomized manner, either a bolus of morphine 2.5 mg interpleurally (i.p.) and normal saline i.v. (group I) or, as a control for systemic absorption, morphine 2.5 mg i.v. and i.p. saline (group II) was injected. After the initial bolus, a continuous infusion of morphine 0.5 mg h-1 i.p. and saline i.v. (group I) or morphine 0.5 mg i.v. and saline i.p. (group II) was maintained for 24 h. Postoperative pain was assessed by a visual analogue scale, a numerical rating scale and the McGill Pain Questionnaire. Pulmonary function was assessed by spirometry. Supplementary analgesics, side effects, degree of sedation, vital signs and chest tube drainage were recorded. All variables were assessed on the day before surgery and 1, 2, 3, 4, 5, 6 and 24 h and 7 days after surgery. Supplementary morphine was given upon request. There was no significant difference in any pain measure or postoperative pulmonary function variable between the groups. We conclude that, after thoracotomy, interpleural morphine does not provide superior analgesia or improve pulmonary function compared with systemic morphine.
Insights
Interpleural morphine did not offer better pain relief or improve lung function after thoracotomy compared to systemic morphine. This study found no significant differences between the two administration methods for postoperative pain management.
Area of Science:
- Anesthesiology
- Thoracic Surgery
- Pain Management
Background:
- Postoperative pain management after thoracotomy is crucial for patient recovery.
- Interpleural analgesia is an alternative method for pain control.
- The efficacy of interpleural morphine compared to systemic administration needs further investigation.
Purpose of the Study:
- To compare the effectiveness of interpleural morphine versus systemic morphine in managing postoperative pain.
- To evaluate the impact of interpleural morphine on pulmonary function after thoracotomy.
- To assess safety and side effects associated with both administration routes.
Main Methods:
- A double-blind, randomized study involving 17 patients undergoing thoracotomy.
- Patients received either interpleural morphine (group I) or systemic morphine (group II) via catheter or intravenous injection.
- Pain was assessed using visual analogue scale, numerical rating scale, and McGill Pain Questionnaire; pulmonary function was measured by spirometry.
Main Results:
- No significant differences were observed in pain scores between the interpleural and systemic morphine groups.
- Pulmonary function tests showed no significant improvement with interpleural morphine compared to systemic administration.
- Rates of supplementary analgesic use and side effects were comparable between groups.
Conclusions:
- Interpleural morphine does not provide superior postoperative analgesia compared to systemic morphine after thoracotomy.
- Interpleural morphine does not significantly improve pulmonary function post-thoracotomy when compared to systemic administration.
- Systemic morphine is a viable alternative for pain management in patients undergoing thoracotomy.