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Effect of somatostatin analogue octreotide on pain relief after major abdominal surgery

2008; Wiley; Volume: 13; Issue: 8 Linguagem: Inglês

10.1016/j.ejpain.2008.10.006

1532-2149

Ashraf A. Dahaba, Gabriele Mueller, Georg Mattiassich, Gudrun Rumpold‐Seitlinger, Helmar Bornemann‐Cimenti, Peter Rehak, Guillermo Linck, Hans‐Joerg Mischinger, Helfried Metzler,

Nausea and vomiting management

ABSTRACT Background: Octreotide acetate is an 8‐amino‐acids synthetic octapeptide analogue of somatostatin with much‐enhanced duration of action and lower incidence of side effects. We assessed the utility of using intravenous octreotide as an adjuvant to opioid analgesia that might exert a post‐operative opioid‐sparing effect. Methods: Forty‐four patients were randomly allocated, to receive either a placebo or intraoperative octreotide 0.33μgkg −1 h −1 intravenous infusion that was maintained in the post‐operative period. Patients received for post‐operative analgesia an intravenous piritramide patient controlled analgesia (PCA), set to deliver a piritramide 0.02mgkg −1 dose. Results: Two‐way ANOVA revealed significantly fewer ( P =0.0003) mean±SD weighted piritramide dose requirements in the octreotide group (19.5±6.3μgkg −1 h −1 ) than in the control group (35.7±8.2μgkg −1 h −1 ). Dunnett's two‐sided multiple‐comparison post hoc test revealed a significant difference between the two groups during the first 22 post‐operative hours, following which there were no differences between the two groups. There were no significant differences over time in the mean arterial pressure ( P =0.722), heart rate ( P =0.579) and respiratory rate ( P =0.823) between the octreotide group (80±10mm Hg, 74±12, 14±2) and the control group (82±9mm Hg, 76±11, 15±3), respectively. Conclusion: We demonstrated that perioperative octreotide intravenous infusion could be an adjuvant to opioid analgesia as it exerted a piritramide opioid‐sparing effect. We encountered more systemic side effects such as nausea, abdominal discomfort, and diarrhea in the octreotide group than in the control group. Our findings could be beneficial to patients who cannot tolerate the adverse effects of opioids.