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Premedication with slow release morphine (MST) and adjuvants
K H Simpson1, M J Dearden, F R Ellis
1University Department of Anaesthesia, St James's University Hospital, Leeds.
British Journal of Anaesthesia
|June 1, 1988
Summary
Slow-release morphine (MST) alone provided unreliable sedation. Combining MST with diazepam improved sedation and reduced anxiety, while hyoscine delayed morphine absorption and worsened mood.
Area of Science:
- Anesthesiology
- Pharmacology
- Surgical Care
Background:
- Preoperative medication aims to improve patient comfort and surgical outcomes.
- Optimizing premedication regimens is crucial for managing surgical stress and patient experience.
Purpose of the Study:
- To evaluate the efficacy of slow-release morphine (MST) alone and in combination with hyoscine or diazepam as a premedication for major gynaecological surgery.
- To assess the impact of these premedications on sedation, anxiolysis, morphine absorption, and postoperative outcomes.
Main Methods:
- A randomized study involving 61 women undergoing major gynaecological surgery.
- Administration of slow-release morphine (MST) 60 mg, with placebo, hyoscine 0.6 mg, or diazepam 10 mg, orally 2 hours before surgery.
- Monitoring of plasma morphine concentrations, sedation levels, anxiolysis, and occurrence of emesis.
Main Results:
- MST alone achieved sedation in over 50% of patients, increasing to 85% when combined with diazepam.
- Only the MST and diazepam combination effectively produced anxiolysis.
- Hyoscine delayed morphine absorption and was associated with unhappier postoperative mood.
- Emesis rates ranged from 40-57% and were not reduced by hyoscine.
Conclusions:
- Premedication with MST alone is insufficient for reliable sedation or anxiolysis.
- Combining MST with diazepam enhances sedation and anxiolysis.
- Hyoscine is not recommended for premedication with MST due to delayed morphine absorption and negative effects on mood and antiemesis.