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Does a Concurrent Opioid Infusion Improve Pain Management After Surgery?

Robert K. Parker, DO; Barbel Holtmann, MD; Paul F. White, PhD, MD, FFARCS

JAMA. 1991;266(14):1947-1952.

Abstract
Objective.
—To assess the influence of a continuous (basal) morphine infusion as part of a patient-controlled analgesia (PCA) system on the postoperative analgesic requirement and on recovery parameters following abdominal hysterectomy.

Design.
—Single-center, randomized, controlled protocol.

Setting.
—University medical center.

Participants.
—A total of 230 adult women were randomly assigned to receive no morphine infusion (control group) or a continuous 0.5-, 1.0-, or 2.0-mg/h morphine infusion. Each patient was able to self-administer supplemental intravenous bolus doses of morphine (1 to 2 mg) using a PCA infuser.

Main Outcome Measures.
—Use of the PCA device, opioid-related side effects, recovery times, and the patients' assessment of pain and sedation on linear visual analog scales were recorded during the 72-hour study period. Follow-up questionnaires were completed by the patients and their health care professionals to assess the overall adequacy of PCA therapy.

Results.
—Patients who received the 2-mg/h morphine infusions received significantly more opioid medication 9 to 72 hours after their operation than those who received no infusion (control group). The presence of a continuous morphine infusion of 0.5 to 2 mg/h did not significantly decrease the number of patient demands or supplemental bolus doses administered compared with the control group. Overall, 168 (84%) of the 199 patients who completed the 72-hour study were able to achieve adequate analgesia without requiring changes in the PCA regimen or experiencing major side effects. Recovery times and outcome variables were similar in all four groups.

Conclusion.
—The routine use of a continuous opioid infusion in combination with a standard PCA regimen does not improve pain management compared with PCA alone after abdominal hysterectomy.

(JAMA. 1991;266:1947-1952)

Author Affiliations
From the Department of Anesthesiology, Washington University School of Medicine, St Louis, Mo.

Footnotes
Presented in part at the annual meeting of the American Society of Anesthesiologists, New Orleans, La, October 14-18,1989.

Reprint requests to Department of Anesthesiology, Washington University School of Medicine, Box 8054, 660 S Euclid Ave, St Louis, MO 63110 (Dr White).

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