Comparison of the effectiveness of fentanyl versus morphine for severe postoperative pain management. A randomized, double blind, clinical trial
Keywords:
Analgesics, postoperative, Fentanyl, Morphine, Randomized controlled trial, Opioid pain
Abstract
Introduction: Intravenous rescue analgesia in the postoperative anesthesia care unit (PACU) is the most effective method for reducing postoperative pain (POP) when perioperative multimodal analgesia fails to control it. Appropriate analgesia during these first postoperative hours may prevent morbidity associated with pain.
Objective: To compare the effectiveness of intravenous morphine versus fentanyl in the PACU for reducing severe POP.
Methods: Randomized, prospective, double blind trial that included patients with severe POP using VAS in the PACU. Rescue was performed on one group with 01 mg/kg morphine and with another with 1 mcg/kg of fentanyl every 5 min intravenously until pain was reduced from severe to mild (VAS<4). 30 patients were included in both groups.
Results: There were no significant differences in the percentage of patients with reduction of severe POP to mild 5 min after the injection of morphine or fentanyl, or in the subsequent rescue analgesia intervals (p > 0.05). Similarly, there were no significant differences in mean VAS (95% CI) in morphine or fentanyl groups beginning 5 min after the first analgesic dose (p > 0.05) between the groups. There were no significant differences in side effects such as respiratory depression, nausea, vomiting or pruritus (p = 1.0). There was a high satisfaction in both groups (p > 0.05).
Conclusions: Morphine and fentanyl were equally effective in treating severe POP after 5 min and following intervals after rescue analgesia was initiated, during 25 min at PACU, with no differences in efficacy or adverse effects between groups.
Register # NCT02145975 clinical-trials.gov, prospective.
References
1. Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth. 2002;89:409-23.
2. Cardona E, Castaño M, Builes A, Castro G. Manejo del dolor postquirúrgico en el Hospital Universitario San Vicente de Paul de Medellín. Rev Colomb Anestesiol. 2003;31:111-6.
3. Machado JE, Machado ME, Calderón V, Gonzalez A, Cardona F, Ruiz R, et al. ¿Estamos controlando el dolor postquirúrgico? Rev Colomb Anestesiol. 2013;41:132-8.
4. Cadavid AM, Mendoza JM, Gómez ND, Berrío MI. Prevalencia de dolor agudo postoperatorio y calidad de la recuperación en el Hospital Universitario San Vicente de Paúl, Medellín, Colombia, 2007. Iatreia. 2009;22:11-5.
5. Martínez JM, Torres LM. Prevalencia del dolor postoperatorio. Alteraciones fisiopatológicas y sus repercusiones. Rev Soc Esp Dolor. 2000;7:465-76.
6. Fotiadis RJ, Badvie S, Weston MD, Allen-Mersh TG. Epidural analgesia in gastrointestinal surgery. Br J Surg. 2004;91:828-41.
7. Joshi GP, Ogunnaike BO. Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol Clin N Am. 2005;23:21-36.
8. Liu SS, Block BM, Wu CL. Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery. Anesthesiology. 2004;101:153-61. [ Links ]
9. Baig MK, Wexner SD. Postoperative ileus: a review. Dis Colon Rectum. 2004;47:516-26.
10. Chia YY, Kuo MC, Liu K, Sun GC, Hsieh SW, Chow LH. Does postoperative pain induce emesis? Clin J Pain. 2002;18:317-23.
11. Palazzo MGA, Strunin L. Anaesthesia and emesis I: etiology. Can Anaesth Soc J. 1984;31:178-87.
12. Ballantyne JC, Carr DB, de Ferranti S, Suarez T, Lau J, Chalmers TC, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg. 1998;86:598-612.
13. Desai PM. Pain management and pulmonary dysfunction. Crit Care Clin. 1999;15:151-66.
14. Cohen MJ, Schecter WP. Perioperative pain control: a strategy for management. Surg Clin N Am. 2005;85:1243-57.
15. American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting. Anesthesiology. 2012;116:248-73.
16. Aubrun F, Valade N, Riou B. Intravenous morphine titration. Ann Fr Anesth Reanim. 2004;23:973-85.
17. Aubrun F. Intravenous morphine titration. Ann Fr Anesth Reanim. 2009;28:33-7.
18. Fukuda K. Anestésicos Intravenosos Opioides. In: Miller R, Eriksson L, fleisher L, editors. Anestesia de Miller. 6th ed. Chicago: Churchill Livingstone; 2004. p. 379-437.
19. Torres LM, Calderón E, Rey RM. Fentanilo transdérmico (Durogesic®): características farmacológicas y aplicación clínica. Rev Soc Esp Dolor. 1999;6:121-31.
20. Grass JA. Patient-controlled analgesia. Anesth Analg. 2005;101:44-61.
21. Aubrun F, Monsel S, Langeron O, Coriat P, Riou B. Postoperative titration of intravenous morphine. Eur J Anaesthesiol. 2001;18:159-65.
22. Aubrun F, Mazoit J-X, Riou B. Postoperative intravenous morphine titration. Br J Anaesth. 2012;108:193-201.
23. Curtis KM, Henriques HF, Fanciullo G, Reynolds CM, Suber F. A fentanyl-based pain management protocol provides early analgesia for adult trauma patients. J Trauma. 2007;63:819-26.
24. Claxton AR, McGuire G, Chung F, Cruise C. Evaluation of morphine versus fentanyl for postoperative analgesia after ambulatory surgical procedures. Anesth Analg. 1997;84:509-14.
25. Macintyre PE, Jarvis DA. Age is the best predictor of postoperative morphine requirements. Pain. 1995;64:357-64.
26. Birnbaum A, Esses D, Bijur PE, Holden L, Gallagher EJ. Randomized double-blind placebo-controlled trial of two intravenous morphine dosages (0.10 mg/kg and 0.15 mg/kg) in emergency department patients with moderate to severe acute pain. Ann Emerg Med. 2007;49:445-53.
27. Pandit SK, Kothary S. Intravenous narcotics for premeditation in outpatient anaesthesia. Acta Anaesthesiol Stand. 1989;33:353-8.
28. Heine MF, Tillet E, Tseuda K, Loyd G, Schroeder J, Vogel R, et al. Intra-articular morphine after arthroscopic knee operation. Br J Anaesth. 1994;73:413-5.
29. Nishitateno K, Ngai SH, Fink AD, Berkowitz BA. Pharmacokinetics of morphine: concentration in the serum and brain of the dog during hyperventilation. Anesthesiology. 1979;50:520-3.
30. Ahmedzai S, Brooks D. Transdermal fentanyl versus sustained-release oral morphine in cancer pain: preference, efficacy, and quality of life. J Pain Symptom Manag. 1997;13:254-61.
31. Donner B, Zenz M, Tryba M, Strumpf M. Direct conversion from oral morphine to transdermal fentanyl: a multicenter study in patients with cancer pain. Pain. 1996;64:527-34.
32. Payne R, Mathias SD, Pasta DJ, Wanke LA, Williams R, Mahmoud R. Quality of life and cancer pain: satisfaction and side effects with transdermal fentanyl versus oral morphine. J Clin Oncol. 1998;16:1588-93.
33. Wong JO, Chiu GL, Tsao CJ, Chang CL. Comparison of oral controlled-release morphine with transdermal fentanyl in terminal cancer pain. Acta Anaesthesiol Sin. 1997;35:25-32.
34. Kamatth B, Curran J, Hawkey C, Beattie A, Gorbutt N, Guiblin H, et al. Anaesthesia movement and emesis. Br J Anaesth. 1990;64:728-30.
35. Mercadante S, Porzio G, Ferrera P, Fulfaro F, Aielli F, Verna L, et al. Sustained-release oral morphine versus transdermal fentanyl. Eur J Pain. 2008;12:1040-6.
36. Cepeda MS, Carr DB. Women experience more pain and require more morphine than men to achieve a similar degree of postoperative analgesia. Anesth Analg. 2003;97:1464-8.
37. Gear RW, Gordon NC, Heller PH, Paul S, Miaskowski C, Levine JD. Gender difference in analgesic response to the kappa-opioid pentazocine. Neurosci Lett. 1996;205:207-9.
2. Cardona E, Castaño M, Builes A, Castro G. Manejo del dolor postquirúrgico en el Hospital Universitario San Vicente de Paul de Medellín. Rev Colomb Anestesiol. 2003;31:111-6.
3. Machado JE, Machado ME, Calderón V, Gonzalez A, Cardona F, Ruiz R, et al. ¿Estamos controlando el dolor postquirúrgico? Rev Colomb Anestesiol. 2013;41:132-8.
4. Cadavid AM, Mendoza JM, Gómez ND, Berrío MI. Prevalencia de dolor agudo postoperatorio y calidad de la recuperación en el Hospital Universitario San Vicente de Paúl, Medellín, Colombia, 2007. Iatreia. 2009;22:11-5.
5. Martínez JM, Torres LM. Prevalencia del dolor postoperatorio. Alteraciones fisiopatológicas y sus repercusiones. Rev Soc Esp Dolor. 2000;7:465-76.
6. Fotiadis RJ, Badvie S, Weston MD, Allen-Mersh TG. Epidural analgesia in gastrointestinal surgery. Br J Surg. 2004;91:828-41.
7. Joshi GP, Ogunnaike BO. Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol Clin N Am. 2005;23:21-36.
8. Liu SS, Block BM, Wu CL. Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery. Anesthesiology. 2004;101:153-61. [ Links ]
9. Baig MK, Wexner SD. Postoperative ileus: a review. Dis Colon Rectum. 2004;47:516-26.
10. Chia YY, Kuo MC, Liu K, Sun GC, Hsieh SW, Chow LH. Does postoperative pain induce emesis? Clin J Pain. 2002;18:317-23.
11. Palazzo MGA, Strunin L. Anaesthesia and emesis I: etiology. Can Anaesth Soc J. 1984;31:178-87.
12. Ballantyne JC, Carr DB, de Ferranti S, Suarez T, Lau J, Chalmers TC, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg. 1998;86:598-612.
13. Desai PM. Pain management and pulmonary dysfunction. Crit Care Clin. 1999;15:151-66.
14. Cohen MJ, Schecter WP. Perioperative pain control: a strategy for management. Surg Clin N Am. 2005;85:1243-57.
15. American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting. Anesthesiology. 2012;116:248-73.
16. Aubrun F, Valade N, Riou B. Intravenous morphine titration. Ann Fr Anesth Reanim. 2004;23:973-85.
17. Aubrun F. Intravenous morphine titration. Ann Fr Anesth Reanim. 2009;28:33-7.
18. Fukuda K. Anestésicos Intravenosos Opioides. In: Miller R, Eriksson L, fleisher L, editors. Anestesia de Miller. 6th ed. Chicago: Churchill Livingstone; 2004. p. 379-437.
19. Torres LM, Calderón E, Rey RM. Fentanilo transdérmico (Durogesic®): características farmacológicas y aplicación clínica. Rev Soc Esp Dolor. 1999;6:121-31.
20. Grass JA. Patient-controlled analgesia. Anesth Analg. 2005;101:44-61.
21. Aubrun F, Monsel S, Langeron O, Coriat P, Riou B. Postoperative titration of intravenous morphine. Eur J Anaesthesiol. 2001;18:159-65.
22. Aubrun F, Mazoit J-X, Riou B. Postoperative intravenous morphine titration. Br J Anaesth. 2012;108:193-201.
23. Curtis KM, Henriques HF, Fanciullo G, Reynolds CM, Suber F. A fentanyl-based pain management protocol provides early analgesia for adult trauma patients. J Trauma. 2007;63:819-26.
24. Claxton AR, McGuire G, Chung F, Cruise C. Evaluation of morphine versus fentanyl for postoperative analgesia after ambulatory surgical procedures. Anesth Analg. 1997;84:509-14.
25. Macintyre PE, Jarvis DA. Age is the best predictor of postoperative morphine requirements. Pain. 1995;64:357-64.
26. Birnbaum A, Esses D, Bijur PE, Holden L, Gallagher EJ. Randomized double-blind placebo-controlled trial of two intravenous morphine dosages (0.10 mg/kg and 0.15 mg/kg) in emergency department patients with moderate to severe acute pain. Ann Emerg Med. 2007;49:445-53.
27. Pandit SK, Kothary S. Intravenous narcotics for premeditation in outpatient anaesthesia. Acta Anaesthesiol Stand. 1989;33:353-8.
28. Heine MF, Tillet E, Tseuda K, Loyd G, Schroeder J, Vogel R, et al. Intra-articular morphine after arthroscopic knee operation. Br J Anaesth. 1994;73:413-5.
29. Nishitateno K, Ngai SH, Fink AD, Berkowitz BA. Pharmacokinetics of morphine: concentration in the serum and brain of the dog during hyperventilation. Anesthesiology. 1979;50:520-3.
30. Ahmedzai S, Brooks D. Transdermal fentanyl versus sustained-release oral morphine in cancer pain: preference, efficacy, and quality of life. J Pain Symptom Manag. 1997;13:254-61.
31. Donner B, Zenz M, Tryba M, Strumpf M. Direct conversion from oral morphine to transdermal fentanyl: a multicenter study in patients with cancer pain. Pain. 1996;64:527-34.
32. Payne R, Mathias SD, Pasta DJ, Wanke LA, Williams R, Mahmoud R. Quality of life and cancer pain: satisfaction and side effects with transdermal fentanyl versus oral morphine. J Clin Oncol. 1998;16:1588-93.
33. Wong JO, Chiu GL, Tsao CJ, Chang CL. Comparison of oral controlled-release morphine with transdermal fentanyl in terminal cancer pain. Acta Anaesthesiol Sin. 1997;35:25-32.
34. Kamatth B, Curran J, Hawkey C, Beattie A, Gorbutt N, Guiblin H, et al. Anaesthesia movement and emesis. Br J Anaesth. 1990;64:728-30.
35. Mercadante S, Porzio G, Ferrera P, Fulfaro F, Aielli F, Verna L, et al. Sustained-release oral morphine versus transdermal fentanyl. Eur J Pain. 2008;12:1040-6.
36. Cepeda MS, Carr DB. Women experience more pain and require more morphine than men to achieve a similar degree of postoperative analgesia. Anesth Analg. 2003;97:1464-8.
37. Gear RW, Gordon NC, Heller PH, Paul S, Miaskowski C, Levine JD. Gender difference in analgesic response to the kappa-opioid pentazocine. Neurosci Lett. 1996;205:207-9.
How to Cite
1.
Cadavid-Puentes AM, Bermúdez-Guerrero FJ, Giraldo-Salazar O, Muñoz-Zapata F, Otálvaro-Henao J, Ruíz-Sierra J, et al. Comparison of the effectiveness of fentanyl versus morphine for severe postoperative pain management. A randomized, double blind, clinical trial. Colomb. J. Anesthesiol. [Internet]. 2017 Apr. 1 [cited 2024 Apr. 19];45(2):100-7. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/244
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2017-04-01
How to Cite
1.
Cadavid-Puentes AM, Bermúdez-Guerrero FJ, Giraldo-Salazar O, Muñoz-Zapata F, Otálvaro-Henao J, Ruíz-Sierra J, et al. Comparison of the effectiveness of fentanyl versus morphine for severe postoperative pain management. A randomized, double blind, clinical trial. Colomb. J. Anesthesiol. [Internet]. 2017 Apr. 1 [cited 2024 Apr. 19];45(2):100-7. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/244
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