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Latest & greatest articles for morphine
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Cost effectiveness analysis of intravenous ketorolac and morphine for treating pain after limb injury: double blind randomised controlled trial PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Determination of an effective dose of intrathecal morphine for pain relief after cesarean delivery Determination of an effective dose of intrathecal morphine for pain relief after cesarean delivery Determination of an effective dose of intrathecal morphine for pain relief after cesarean delivery Gerancher J C, Floyd H, Eisenach J Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary (...) of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Administering intrathecal (IT) morphine along with oral hydrocodone/acetaminophen and other commonly prescribed drugs for pain relief after cesarean delivery. The method of administration of IT morphine was up-down sequential allocation of doses. Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Study population
Injected morphine in postoperative pain: a quantitative systematic review Injected morphine in postoperative pain: a quantitative systematic review Injected morphine in postoperative pain: a quantitative systematic review McQuay H J, Carroll D, Moore R A Authors' objectives To compare the efficacy of single-dose subcutaneous, intramuscular or intravenous morphine with placebo in the control of post operative pain. Searching A number of different search strategies were conducted of MEDLINE (1966 (...) if they were full journal publications and reported data from which TOTPAR, SSPID, VASTOTPAR OR VASSPID could be calculated. Specific interventions included in the review Single doses of placebo were compared with single doses of morphine given intramuscularly or intravenously in doses of 5 mg, 8 mg, 10 mg, 12.5 mg and 20 mg. Participants included in the review Adult patients experiencing non-surgical pain (due to acute trauma) or undergoing the following types of surgery with baseline pain of moderate
A randomized comparison of ketorolac tromethamine and morphine for postoperative analgesia in critically ill children. PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Randomised trial of epidural bupivacaine and morphine in prevention of stump and phantom pain in lower-limb amputation. Epidural analgesia before limb amputation is commonly used to reduce postamputation pain. But there have been no controlled studies with large numbers of patients to prove such a pre-emptive effect. We investigated whether postamputation stump and phantom pain in the first year is reduced by preoperative epidural blockade with bupivacaine and morphine.In a randomised, double (...) -blind trial, 60 patients scheduled for lower-limb amputation were randomly assigned epidural bupivacaine (0.25% 4-7 mL/h) and morphine (0.16-0.28 mg/h) for 18 h before and during the operation (29 patients; blockade group) or epidural saline (4-7 mL/h) and oral or intramuscular morphine (31 patients; control group). All patients had general anaesthesia for the amputation and were asked about stump and phantom pain after 1 week and then after 3, 6, and 12 months by two independent examiners. Study
Randomised trial of oral morphine for painful episodes of sickle-cell disease in children. Oral controlled-release morphine can provide effective analgesia through a non-invasive route and may facilitate outpatient management of severe episodes of sickle-cell pain. We compared the clinical efficacy and safety of oral morphine with continuous intravenous morphine in children with severe episodes of sickle-cell pain, by a double-blind, randomised, parallel-group design.56 children aged 5-17 years (...) received loading doses of intravenous morphine of up to 0.15 mg/kg, followed by randomly assigned oral morphine 1.9 mg/kg every 12 h plus intravenous placebo (saline), or intravenous morphine 0.04 mg kg-1 h-1, plus placebo tablet. Breakthrough pain was treated with oral, immediate-release morphine 0.4 mg/kg every 2-3 h as required. Pain was assessed daily at 0900 h, 1300 h, 1700 h, and 2100 h with a picture face scale, a pictorial scale (Oucher), a behavioural-observational scale (CHEOPS
Pain relief from intra-articular morphine after knee surgery: a qualitative systematic review Pain relief from intra-articular morphine after knee surgery: a qualitative systematic review Pain relief from intra-articular morphine after knee surgery: a qualitative systematic review Kalso E, Tramer MR, Carroll D, McQuay HJ, Moore RA Authors' objectives To investigate the evidence for an analgesic effect of intra-articular morphine and to examine those features of trial methodology which influence (...) or with different doses of intra-articular morphine, were included. Specific interventions included in the review Intra-articular morphine, intravenous morphine, intramuscular morphine, intra-articular bupivacaine. Participants included in the review Patients, all of whom had undergone knee surgery. Outcomes assessed in the review Pain intensity was assessed during two time periods: early (up to six hours from intra-articular injection) and late (from six to 24 hours). The total consumption of rescue analgesics
Cost-effectiveness of long-term intrathecal morphine therapy for pain associated with failed back surgery syndrome Cost-effectiveness of long-term intrathecal morphine therapy for pain associated with failed back surgery syndrome Cost-effectiveness of long-term intrathecal morphine therapy for pain associated with failed back surgery syndrome de Lissovoy G, Brown R E, Halpern M, Hassenbusch S J, Ross E Record Status This is a critical abstract of an economic evaluation that meets the criteria (...) for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Use of intrathecal morphine therapy (IMT) administered via an implantable pump in patients suffering from intractable pain attributed to failed back surgery syndrome. Type of intervention Treatment and supportive care. Economic study type Cost-effectiveness analysis. Study
Epidural bolus clonidine/morphine versus epidural patient-controlled bupivacaine/sufentanil: quality of postoperative analgesia and cost-identification analysis Epidural bolus clonidine/morphine versus epidural patient-controlled bupivacaine/sufentanil: quality of postoperative analgesia and cost-identification analysis Epidural bolus clonidine/morphine versus epidural patient-controlled bupivacaine/sufentanil: quality of postoperative analgesia and cost-identification analysis Rockemann M G (...) followed-up until the fourth post-operative day (PO day). Five BOLUS and four PCEA patients dropped out because of inadequate analgesia with the pre-randomised regimen, occlusion or dislocation of the epidural catheter, or a systolic arterial pressure (SAP) greater than 80 mmHg. Analysis of effectiveness Drop-out patients were switched to intravenous patient-controlled opioid analgesia with morphine, and the recording of time and costs was continued; analgesia and side-effects were excluded from
A cost analysis of alfentanil + propofol vs morphine + midazolam for the sedation of critically ill patients A cost analysis of alfentanil + propofol vs morphine + midazolam for the sedation of critically ill patients A cost analysis of alfentanil + propofol vs morphine + midazolam for the sedation of critically ill patients Manley N M, Fitzpatrick R W, Long T, Jones P W Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each (...) abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Alfentanil with propofol versus morphine with midazolam for the sedation of critically ill patients. Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Study population Critically ill patients admitted to the intensive care unit (ICU) and expected to need mechanical ventilation
Randomised trial of oral morphine for chronic non-cancer pain. The use of opioid analgesics for chronic non-cancer pain is controversial. Some surveys report good pain relief and improvement in performance while others suggest a poor outcome with a propensity to psychological dependence or addiction.We undertook a randomised double-blind crossover study to test the hypothesis that oral morphine relieves pain and improves the quality of life in patients with chronic regional pain of soft tissue (...) or musculoskeletal origin who have not responded to codeine, anti-inflammatory agents, and antidepressants. Morphine was administered as a sustained-release preparation in doses up to 60 mg twice daily and compared with benztropine (active placebo) in doses up to 1 mg twice daily over three-week titration, six-week evaluation, and two-week washout phases. Pain intensity, pain relief, and drug liking were rated weekly and psychological features, functional status, and cognition were assessed at baseline
Morphine-augmented hepatobiliary scintigraphy: a meta-analysis Morphine-augmented hepatobiliary scintigraphy: a meta-analysis Morphine-augmented hepatobiliary scintigraphy: a meta-analysis Cabana M D, Alavi A, Berlin J A, Shea J A, Kim C K, Williams S V Authors' objectives To compare the sensitivity and specificity of morphine-augmented hepatobiliary scintigraphy (MA-HBS) with that of conventional hepatobiliary scintigraphy (C-HBS), in the diagnosis of acute cholecystitis. Searching MEDLINE (...) , or did not equal the sum of the patients in subgroups mentioned were excluded. Specific interventions included in the review Only studies of the diagnostic accuracy of MA-HBS and/or C-HBS were eligible for inclusion in the review. For MA-HBS a positive test had to be defined as non-visualisation of the gallbladder 20-30 min after morphine administration. For MA-HBS studies morphine augmentation had to be generally commenced 60 min after the start of the study if there was non-visualisation
Subcutaneous morphine for dyspnea in cancer patients. 8215003 1993 11 08 2013 11 21 0003-4819 119 9 1993 Nov 01 Annals of internal medicine Ann. Intern. Med. Subcutaneous morphine for dyspnea in cancer patients. 906-7 Bruera E E Edmonton General Hospital, Alberta, Canada. MacEachern T T Ripamonti C C Hanson J J eng Clinical Trial Journal Article Randomized Controlled Trial United States Ann Intern Med 0372351 0003-4819 142M471B3J Carbon Dioxide 76I7G6D29C Morphine S88TT14065 Oxygen AIM IM Ann (...) Intern Med. 1994 Apr 15;120(8):692-3 8192764 Carbon Dioxide physiology Dyspnea drug therapy etiology physiopathology Humans Injections, Subcutaneous Morphine administration & dosage Neoplasms complications Oxygen blood Respiration drug effects Terminal Care Tidal Volume 1993 11 1 1993 11 1 0 1 1993 11 1 0 0 ppublish 8215003
Randomised double-blind controlled trial of effect of morphine on catecholamine concentrations in ventilated pre-term babies. A sick premature baby who requires intensive care will undergo many uncomfortable procedures. It is now accepted that such babies perceive pain and need adequate analgesia, but little is known about the effects of sedation in these patients. We investigated the use of morphine to provide analgesia and sedation for ventilated preterm babies in a randomised, double-blind (...) , placebo-controlled trial. 41 mechanically ventilated babies who had been treated with surfactant (Curosurf) for hyaline membrane disease were randomly assigned morphine in 5% dextrose (100 micrograms/kg per h for 2 h followed by 25 micrograms/kg per h continuous infusion) or 5% dextrose (placebo). Plasma catecholamine concentrations were measured 1 h after the first dose of surfactant and 24 h later. Blood pressure was measured at study entry and after 6 h. The morphine and placebo groups showed
Preoperative morphine pre-empts postoperative pain. Postoperative analgesia is usually inadequate, perhaps because conventional approaches to pain relief do not take account of underlying mechanisms. Pre-emptive analgesia may prevent nociceptive inputs generated during surgery from sensitising central neurons and, therefore, may reduce postoperative pain. In a randomised, double-blind study, we compared the effect of parenteral morphine when given before or after total abdominal hysterectomy (...) in 60 patients. 10 mg of morphine were given intramuscularly 1 hour before operation (im pre), intravenously at induction of anaesthesia (iv pre), or intravenously at closure of the peritoneum (iv post). Response was assessed by morphine consumption from patient-controlled analgesia machines which was found to be significantly reduced in the iv pre group for 24 hours after operation compared with the iv post group. Pain sensitivity around the wound was reduced in both preoperative treatment groups
Morphine responsiveness of chronic pain: double-blind randomised crossover study with patient-controlled analgesia. There is controversy about whether the lack of response of some chronic pain to opioid treatment is absolute or relative. It is widely believed that nociceptive pain is responsive to opioids whereas neuropathic pain tends not to be. We have used a method of patient-controlled analgesia (PCA) with simultaneous nurse-observer measurement of analgesia, mood, and adverse effects (...) to address these issues. Ten patients with chronic pain were given morphine at two concentrations (10 and 30 mg/ml) by PCA in two separate sessions in a double-blind randomised crossover study. Before the study a clinical judgment was made as to whether each pain was nociceptive or neuropathic. Seven patients showed good analgesic responses (more than 70 mm pain relief on a visual-analogue scale) of pain at rest, two patients poor responses (less than 30 mm pain relief), and one a moderate response
Halothane-morphine compared with high-dose sufentanil for anesthesia and postoperative analgesia in neonatal cardiac surgery. Extreme hormonal and metabolic responses to stress are associated with increased morbidity and mortality in sick adults. We hypothesized that administering deep opioid anesthesia to critically ill neonates undergoing cardiac surgery would blunt their responses to stress and might improve clinical outcomes.In a randomized trial, 30 neonates were assigned to receive deep (...) intraoperative anesthesia with high doses of sufentanil and postoperative infusions of opiates for 24 hours; 15 neonates were assigned to receive lighter anesthesia with halothane and morphine followed postoperatively by intermittent morphine and diazepam. Hormonal and metabolic responses to surgery were evaluated by assay of arterial blood samples obtained before, during, and after the operations.The neonates who received deep anesthesia (with sufentanil) had significantly reduced responses of beta
Analgesic effect of intraarticular morphine after arthroscopic knee surgery. Opioids can produce potent antinociceptive effects by interacting with local opioid receptors in inflamed peripheral tissue. In this study we examined the analgesic effects of the intraarticular, as compared with intravenous, administration of morphine after arthroscopic knee surgery.In a double-blind, randomized trial, we studied 52 patients who had received one of four injections at the end of surgery. The patients (...) in group 1 (n = 18) received 1 mg of morphine intraarticularly and saline intravenously; those in group 2 (n = 15), saline intraarticularly and 1 mg of morphine intravenously; those in group 3 (n = 10), 0.5 mg of morphine intraarticularly and saline intravenously; and those in group 4 (n = 9), 1 mg of morphine and 0.1 mg of naloxone intraarticularly and saline intravenously. The volume of the intraarticular injections was 40 ml, and that of the intravenous injections was 1 ml. After 1, 2, 3, 4, 6
Epidural morphine decreases postoperative hypertension by attenuating sympathetic nervous system hyperactivity. Twenty-four adults who were undergoing operations on the abdominal aorta were enrolled in a randomized, double-blind, placebo-controlled study in which epidural morphine sulfate (6 mg) was employed to attenuate the sympathoadrenal response to surgery to evaluate the possible contribution of sympathetic nervous system hyperactivity to postoperative hypertension. Patients who received (...) epidural morphine required less parenteral morphine in the 24 hours following surgery, had lower analogue pain scores, and had markedly lower plasma norepinephrine levels when compared with patients in the control group who received an identical volume of saline in the epidural space. Epidural morphine had no effect on plasma epinephrine or arginine vasopressin levels. Fewer patients in the morphine group (4 of 12 vs 9 of 12 patients in the saline group) required treatment for hypertension (mean
Buccal morphine--a new route for analgesia? The analgesic effects of buccal and intramuscular morphine were compared in a prospective, double-blind, double-dummy study in forty patients who experienced pain after elective orthopaedic operations. Each patient simultaneously received a buccal tablet and an intramuscular injection, only one of which contained morphine sulphate (13.3 mg); the patients were randomly allocated to two equal groups so twenty patients received each active preparation (...) . The two preparations produced a similar degree of postoperative analgesia, assessed by the mean reduction in pain score and the pain relief score. Peak plasma morphine concentrations were slightly lower after buccal than after intramuscular administration but they declined more slowly; consequently, the drug's bioavailability was 40-50% greater after buccal than after intramuscular administration. The adverse effects of buccal morphine were generally less than those of intramuscular morphine.