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Long-Acting Morphine Following Hip or Knee Replacement: A Randomized, Double-Blind, Placebo-Controlled Trial
Pain Research and Management ( IF 2.9 ) Pub Date : 2012 , DOI: 10.1155/2012/704932
Shirley L Musclow 1 , Tabatha Bowers 2 , Hanna Vo 3 , Mark Glube 4 , Thong Nguyen 5
Affiliation  

BACKGROUND: Patients undergoing total hip or knee replacement surgery experience unmanaged pain during postoperative physiotherapy sessions. It was theorized that a baseline opioid would improve pain management.OBJECTIVES: To examine the effectiveness of adding long-acting oral morphine to a routine postoperative regimen for total hip or knee replacement surgery.METHODS: The present study was a double-blind, randomized, placebo-controlled trial for patients undergoing total hip or knee replacement surgery. All patients received routine postoperative analgesia; in addition, the treatment group received long-acting oral morphine 30 mg orally twice daily for three days, while the control group received placebo capsules. The primary end point was a decrease in pain scores by two points on a 0- to 10-point pain rating scale. Secondary end points included adverse effects, acute confusion, pain-related interferences in function and sleep, length of stay and patient satisfaction.RESULTS: Two hundred patients were enrolled in the present study (March 2004 to March 2006). Although the groups were large enough to yield statistical significance, most pain scores did not reach the predetermined improvement for clinical significance. Additionally, there was an increase in opioid usage (P<0.0001), vomiting (P=0.0148) and oversedation (P=0.08). There were no statistically significant changes in function or sleep. Improved satisfaction with pain management was minimal (P=0.052).DISCUSSION: The present study was undertaken to determine the value of adding a long-acting opioid (morphine) to the usual care of patients undergoing total hip or total knee replacement surgery. The results yielded minimally improved pain scores and additional adverse effects (vomiting and oversedation). Published research in which long-acting opioids (oxycodone) were used for similar postoperative procedures did not robustly report improved pain scores. In addition, patients using a long-acting opioid (oxycodone) during the postoperative period reported somnolence, dizziness and confusion. Statistically, the patients in the present study showed higher confusion scores and no improvement for pain-related interferences with activity or walking. The treatment group did report increased satisfaction; however, the significance was weak.CONCLUSIONS: Thirty milligrams twice per day of long-acting morphine from days 1 to 3 following total hip and total knee replacement surgery provided minimal improvements in pain scores, and more adverse effects in the treatment group. The overall strength of evidence for improved outcomes is minimal and thus not supported.

中文翻译:

髋关节或膝盖置换后长效吗啡:一项随机,双盲,安慰剂对照的试验

背景:进行全髋关节置换术或膝关节置换术的患者在术后理疗期间经历了无法控制的疼痛。从理论上讲,基线阿片类药物可改善疼痛管理。目的:研究在常规术后全髋关节或膝关节置换手术方案中添加长效口服吗啡的有效性。方法:本研究是双盲,随机一项针对接受全髋关节或膝关节置换手术的患者的安慰剂对照试验。所有患者均接受常规术后镇痛。此外,治疗组每天口服两次长效口服吗啡30 mg,持续三天,而对照组则接受安慰剂胶囊。主要终点是疼痛评分在0至10分的疼痛等级量表上降低了2分。次要终点包括不良反应,急性精神错乱,与疼痛有关的功能和睡眠障碍,住院时间和患者满意度。结果:本研究纳入了200名患者(2004年3月至2006年3月)。尽管这些组足够大以产生统计学意义,但大多数疼痛评分仍未达到临床意义上的预定改善。此外,阿片类药物的使用量增加(P <0.0001),呕吐(P = 0.0148)和镇静作用增加(P = 0.08)。在功能或睡眠方面没有统计学上的显着变化。改善疼痛管理的满意度微乎其微(P = 0.052)。讨论:本研究旨在确定在全髋关节置换术或全膝关节置换术患者的常规护理中添加长效阿片类药物(吗啡)的价值。结果产生的疼痛评分得到最小程度的改善,并产生了其他不良反应(呕吐和镇静作用)。使用长效阿片类药物(羟考酮)进行类似术后手术的已发表研究没有强有力地报告疼痛评分得到改善。此外,术后使用长效阿片类药物(羟考酮)的患者报告有嗜睡,头晕和神志不清。从统计学上讲,本研究中的患者表现出更高的意识模糊评分,并且对疼痛相关的活动或步行干扰没有改善。治疗组确实报告满意度增加。结论:结论:全髋关节置换术和全膝关节置换术后第1至3天,每天两次服用30毫克长效吗啡,对疼痛评分的改善很小,在治疗组中有更多的不良反应。改善结果的综合证据极少,因此不被支持。
更新日期:2020-09-25
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