title: Late antinociception and lower untoward effects of concomitant intrathecal morphine and intravenous buprenorphine in humans.
abstract: OBJECTIVE
  To evaluate the perioperative antinociceptive effect of intrathecal morphine (a pure mu agonist), intravenous (IV) buprenorphine (a partial mu agonist) or their combination.
  
  
  METHODS
  Randomized, double-blind, placebo-controlled study.
  
  
  METHODS
  Anesthesiology department of a university-affiliated public hospital.
  
  
  METHODS
  45 ASA physical status I, II, and III patients undergoing hysterectomy with general anesthesia.
  
  
  METHODS
  Preoperative and postoperative regimens consisted of intrathecal morphine 4.3 microg.kg(-1) plus IV 0.9% saline (Group 1), IV buprenorphine 1.3 microg.kg(-1) plus intrathecal saline (Group 2), and intrathecal morphine 4.3 microg.kg(-1) plus IV buprenorphine 1.3 microg.kg(-1) (Group 3; postoperative supplements consisting of IV buprenorphine 1.3 microg.kg(-1) plus intrathecal saline).
  
  
  RESULTS
  Group 2 and 3 patients were given three analgesic dosings compared with two dosings in Group 1 (p < 0.001). The duration of action in Group 2 was significantly shorter (p = 0.001) than in the other two groups. The 12-hour postoperative pain intensity and sedation in Group 3 was significantly lower (p < 0.05) than in the other groups. Side effects (mainly pruritus and nausea and vomiting) were significantly fewer (p < 0.05) in Groups 2 and 3 (26% and 28%, respectively) than in Group 1 (46%).
  
  
  CONCLUSIONS
  The concomitant administration of intrathecal morphine and IV buprenorphine alleviates pain sensation and minimizes sedation more effectively than when given after the administration of either drug separately. In addition, IV buprenorphine affords a reduction in side effects.
authors.affiliation: Department of Anesthesia, S. Spirito Hospital, Alba-Bra, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Beltrutti
authors.forename: David
authors.initials: D
authors.lastname: Niv
authors.forename: Ron
authors.initials: R
authors.lastname: Ben-Abraham
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Santo
authors.forename: Avi A
authors.initials: AA
authors.lastname: Weinbroum
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000768:Anesthesia, General; D002047:Buprenorphine / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007275:Injections, Intravenous; D007278:Injections, Spinal; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine; D009020:Morphine