title: Preoperative intravenous morphine sulfate with postoperative osteopathic manipulative treatment reduces patient analgesic use after total abdominal hysterectomy.
abstract: BACKGROUND
  Administration of opioids for treatment of pain after total abdominal hysterectomy (TAH) is a common postoperative procedure, providing an excellent parameter for evaluating the efficacy of postsurgical osteopathic manipulative treatment (OMT).
  
  
  OBJECTIVE
  To determine whether a combination of preemptive morphine sulfate and postoperative OMT could provide improved analgesic effects.
  
  
  METHODS
  Randomized double-blind controlled trial.
  
  
  METHODS
  Thirty-nine hospitalized patients assigned to one of four treatment groups: (1) preoperative saline and postoperative sham manipulative treatment; (2) preoperative saline and postoperative OMT; (3) preoperative morphine and postoperative sham manipulative treatment; or (4), preoperative morphine and postoperative OMT.
  
  
  METHODS
  Saline (control) or morphine, 10 mg, delivered intravenously (IV) 10 minutes before surgical incision. All patients received a postoperative patient-controlled IV analgesia pump containing morphine. At specified intervals following preoperative IV injections, blood was drawn and analyzed for morphine concentrations. Subjects were also asked to rate their postoperative levels of pain, nausea, and vomiting.
  
  
  RESULTS
  There were no differences in either pain, or nausea and vomiting scores among the four study groups. Patients in Group 4 used less morphine than those in the Group 3 for the first 24 hours (P=.02) and from 25-48 hours (P=.01) after elective TAH. Morphine blood concentrations were lower after 24 hours in Group 4 compared with Group 2 (P=.04).
  
  
  CONCLUSIONS
  Administration of postoperative OMT enhanced pre- and postoperative morphine analgesia in the immediate 48-hour period following elective TAH, demonstrating that OMT can be a therapeutic adjunct in pain management following this procedure.
authors.affiliation: Philadelphia College of Osteopathic Medicine, 4170 City Avenue, Philadelphia, PA 19131-1610, USA. fredg@pcom.edu
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Goldstein
authors.forename: Saul
authors.initials: S
authors.lastname: Jeck
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Nicholas
authors.forename: Marvin J
authors.initials: MJ
authors.lastname: Berman
authors.forename: Marilyn
authors.initials: M
authors.lastname: Lerario
mesh_terms: D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007262:Infusions, Intravenous; D026301:Manipulation, Osteopathic / Q000379:methods*; D009020:Morphine / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D011184:Postoperative Period; D011300:Preoperative Care
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine