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The Efficacy of Adding a Continuous Intravenous Morphine Infusion to Patient-Controlled Analgesia (PCA) in Abdominal Surgery

1995; SAGE Publishing; Volume: 23; Issue: 4 Linguagem: Inglês

10.1177/0310057x9502300407

1448-0271

P J Dawson, F. C. Libreri, David Jones, G. Libreri, A. R. Bjorkstein, Colin Royse,

Pediatric Pain Management Techniques

The effect of adding a continuous infusion of morphine 1 mg/hr to patient-controlled intravenous analgesia was studied in a randomized double-blind trial. Ninety-six patients scheduled for abdominal surgery were enrolled; 38 received PCA and continuous infusion (PCA + C), 45 received PCA alone and 13 were excluded because of protocol violations. PCA was delivered via an ABBOTT 4200 pump with settings of morphine 1 mg bolus and five-minute lockout in both groups. A separate pump delivered a continuous infusion of morphine 1 mg/ml (PCA + C) or 9% normal saline (PCA) at 1 ml/hr for three postoperative days. Pain was assessed by hourly verbal pain scores (VPS) and daily visual analog pain scores at rest and on movement (VAS rest , VAS move ). PCA delivered morphine and the demand to delivery ratio (D/D ratio) were used as indirect indicators of pain. These were assessed during daytime (0800–2200 hours), sleep (2200–0500 hours) and on first waking (0500–0800 hours). Patient demographics were similar. Patients receiving a continuous infusion had lower pain scores during the first 24 hours but not thereafter (VPS P=0.04, VAS move P=0.02). The PCA group delivered more PCA morphine during 0500–0800 hours and 0800–2200 hours on the first day only. There was no significant difference in the D/D ratio for any time period during the three days. Total morphine delivery was greater in the PCA + C group on the second and third postoperative days (P= 0.009 and P=0.0001 respectively). The incidence of respiratory depression and the total number of complications were significantly higher in those receiving continuous infusion (P=0.04 and P=0.011 respectively.) Adding a continuous morphine infusion of 1 mg/hr to the described PCA settings for three days following abdominal surgery improved analgesia during the first 24 hours but was associated with a greater incidence of complications.