title: A prospective randomized clinical trial on pain control after major abdominal surgery.
abstract: This study was conducted in order to investigate the advantages and limitations of four analgesic modalities: a) epidural morphine; b) intravenous morphine; c) patient controlled intravenous morphine (patient-controlled analgesia); and d) non-steroidal anti-inflammatory drugs. Eighty patients undergoing major abdominal surgical procedures were prospectively and randomly treated with one of the above-mentioned analgesic methods. Evaluation of pain perception was done using the visual analogue pain score and the simple descriptive scale 4 hours after the procedure, in the early morning on postoperative day 1 and in the afternoon on postoperative days 1, 2 and 3. The need for supplementary analgesia and the onset of complications, if any, were also evaluated for each patient. Patient-controlled intravenous morphine yielded the best analgesic effect over the entire period. Epidural morphine was more effective in the very early postoperative period compared to modalities (b) and (d). Non-steroidal anti-inflammatory drugs, on the other hand, were more effective on the later postoperative days. None of the patients in group C needed supplementary analgesia, as against 20% in group A, 55% in group B and 40% in group D. Patients with hypochondriasis scores > 70 or depression scores > 70 required supplementation of analgesia more often. Morphine proved to be the drug of choice. Drug titration may be modulated in relation to the psychological characteristics of the patient. The best drug titration modality, in fact, is patient-controlled analgesia.
authors.affiliation: Department of Surgery, Catholic University, School of Medicine, Rome, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Ceriati
authors.forename: Giovanni Domenico
authors.initials: GD
authors.lastname: Tebala
authors.forename: Germano
authors.initials: G
authors.lastname: De Cosmo
authors.forename: Carlo
authors.initials: C
authors.lastname: Saraceni
authors.forename: Claudio
authors.initials: C
authors.lastname: Coco
authors.forename: Francesco
authors.initials: F
authors.lastname: Bosco
authors.forename: Luigi
authors.initials: L
authors.lastname: Mariani
authors.forename: Emanuela
authors.initials: E
authors.lastname: Ceriati
authors.forename: Antonella
authors.initials: A
authors.lastname: Zumbo
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009020:Morphine