Preemptive morphine suppository for postoperative pain relief after laparoscopic cholecystectomy

Authors

Department of Anesthesia and Critical Care, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Postoperative pain is a major problem following laparoscopic cholecystectomy, and there is no general agreement on the effective method of pain relief. Rectal morphine suppositories are one of the newly released morphine forms. The aim of this study is to compare the impact of suppository morphine with placebo on pain relief after laparoscopic cholecystectomy.
Materials and Methods: Seventy patients scheduled for elective laparoscopic cholecystectomy under general anesthesia, were randomly allocated to two groups according to the drug used for postoperative analgesia: Group morphine suppository (MS - 10 mg) just before induction of anesthesia And Group placebo suppository (PS) (the pills were made from cocoa butter, physically similar to the real drug). Pain intensity based on visual analog scale (VAS) and opioid consumption were assessed 30 and 60 min, and 2, 4, 8, 16, and 24 h after arrival of the patient to the recovery room.




Results: VAS scores were significantly lower in MS group (from 3.8 ± 1 to 5.3 ± 1.6) compared with PS group (from 4.9 ± 0.9 to 6.7 ± 1) from 30 min after arrival to the recovery room until 16 h postoperatively (P < 0.05). There were no additional analgesic requirements in the first 2 h after the entrance of the patient to the recovery room in MS group. The number of patients requiring pethidine was significantly different between two groups (P < 0.05) in all periods except for 24 h postoperatively.
Conclusion: Suppository morphine administration is more effective than placebo to reduce pain and analgesic requirements after laparoscopic cholecystectomy.

Keywords

1.
Argo CE. Recent management advances in acute postoperative pain. Pain Pract 2014;14:477-87.  Back to cited text no. 1
    
2.
Joshi GP, Ogunnaike BO. Consequences of Inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol Clin North America 2005;23:21-36.  Back to cited text no. 2
    
3.
Miller RD, Hurely RW, Murphy JD, Wu CL. Postoperative pains, Millers Anesthesia. 8th ed. Vol. 98. Philadelphia, Pennsylvania: Churchill Livingstone; 2014. p. 2975.  Back to cited text no. 3
    
4.
Bhardwaj N, Sharma V, Chari P. Bupivacaine installation for postoperative pain relief after laparoscopic cholecystectomy. Indian J Anesth 2002;40:49-52.  Back to cited text no. 4
    
5.
Hynninen MS, Cheng DC, Hossain I, Carroll J, Aumbhagavan SS, Yue R, et al. Non-steroidal anti-inflammatory drugs in treatment of postoperative pain after cardiac surgery. Can J Anesth 2000;47:1182-7.  Back to cited text no. 5
    
6.
Rees BI, Williams HR. Laparoscopic cholecystectomy: The first 155 patients. Ann R Coll Surg Engl 1992;74:233-6.  Back to cited text no. 6
    
7.
Oberhofer D, Skok J, Nesek-Adam V. Intravenous ketoprofen in postoperative pain treatment after major abdominal surgery. World J Surg 2005;29:446-9.  Back to cited text no. 7
    
8.
Miller RD, Hurely RW, Murphy JD, Wu CL. Postoperative pains, Millers Anesthesia. 8th ed., Vol. 98. Philadelphia, Pennsylvania: Churchill Livingstone; 2014. p. 2974.  Back to cited text no. 8
    
9.
Miller RD, Hurely RW, Murphy JD, Wu CL. Postoperative pains, Millers Anesthesia. 8th ed., Vol. 98. Philadelphia, Pennsylvania: Churchill Livingstone; 2014. p. 2978.  Back to cited text no. 9
    
10.
Branch R, Coley K, Holimon T. Mosby's GenRx. 10th ed. Vol. 3. London: Mosby; 2000. p. 1170-6.  Back to cited text no. 10
    
11.
Kundra P, Gurnani A, Bhattacharya A. Preemptive epidural morphine for postoperative pain relief after lumbar laminectomy. Anesth Analg 1997;85:135-8.  Back to cited text no. 11
    
12.
Bonnet MP, Mignon A, Mazoit JX, Ozier Y, Marret E. Analgesic efficacy and adverse effects of epidural morphine compared to parenteral opioids after elective caesarean section: A systematic review. Eur J Pain 2010;14:894.e1-9.  Back to cited text no. 12
    
13.
Cole L, Hanning CD, Robertson S, Quinn K. Further development of a morphine hydrogel suppository. Br J Clin Pharmacol 1990;30:781-6.  Back to cited text no. 13
    
14.
Beaver WT, Feise GA. A comparison of the analgesic effect of oxymorphone by rectal suppository and intramuscular injection in patients with postoperative pain. J Clin Pharmacol 1977;17:276-91.  Back to cited text no. 14
[PUBMED]    
15.
Bourke M, Hayes A, Doyle M, McCarroll M. A comparison of regularly administered sustained release oral morphine with intramuscular morphine for control of postoperative pain. Anesth Analg 2000;90:427-30.  Back to cited text no. 15
    
16.
Roberts-Thomson IC, Jonsson JR, Frewin DB. Sympathetic suppression attenuates anomalous responses to morphine in unexplained pain after cholecystectomy. Clin Auton Res 1994;4:185-8.  Back to cited text no. 16
    
17.
Gourlay GK, Boas RA. Fatal outcome with use of rectal morphine for postoperative pain control in an infant. BMJ 1992;304:766-7.  Back to cited text no. 17
    
18.
Fukuda K. Intravenous opioid anesthetics. In: Miller RD. Miller's Anesthesia: 6th ed. Philadelphia, Pennsylvania: Elsevirer Churchill Livingstons; 2005. p. 415.  Back to cited text no. 18
    
19.
Miller RD, Hurely RW, Murphy JD, Wu CL. Postoperative pains, Millers Anesthesia. 8th ed. Vol. 98. Philadelphia, Pennsylvania: Churchill Livingstone; 2014. p. 2976.  Back to cited text no. 19
    
20.
Aubrun F, Mazoit JX, Riou B. Postoperative intravenous morphine titration. Br J Anaesth 2012;108:193-201.  Back to cited text no. 20
    
21.
Aubrun F, Monsel S, Langeron O, Coriat P, Riou B. Postoperative titration of intravenous morphine. Eur J Anaesthesiol 2001;18:159-65.  Back to cited text no. 21
    
22.
Aubrun F, Monsel S, Langeron O, Coriat P, Riou B. Postoperative titration of intravenous morphine in the elderly patient. Anesthesiology 2002;96:17-23.  Back to cited text no. 22
    
23.
Aubrun F, Amour J, Rosenthal D, Coriat P, Riou B. Effects of a loading dose of morphine before i.v. morphine titration for postoperative pain relief: A randomized, double-blind, placebo-control study. Br J Anaesth 2007;98:124-30.  Back to cited text no. 23