Journal of Korean Academy of Nursing (대한간호학회지)

Korean Society of Nursing Science (한국간호과학회)
권호 표지

The Effects of Preemptive Analgesia of Morphine and Ketorolac on Postoperative Pain, Cortisol, $O_2$ Saturation and Heart Rate

Morphine과 Ketorolac의 선행진통법이 수술 후 통증, 코티졸, 산소포화도 및 심박동 수에 미치는 효과

  • 서윤주 (가천의과대학교 길병원 마취과) ;
  • 윤혜상 (가천의과대학교 간호학과)
  • Published : 2008.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study investigated the preemptive analgesic effects of Morphine and Ketorolac on postoperative pain, cortisol, $O_2$ saturation and heart rate for the first 24 hr after abdominal surgery. Methods: Data collection was performed from April 1 to September 30, 2006. Forty patients undergoing a gastrectomy under general anesthesia were randomly allocated to the experimental or control group. The experimental group (20 patients) was administered Morphine and Ketorolac approximately 1 hr prior to skin incision, but the control group (20 patients) was administered Morphine and Ketorolac at peritoneum closure through a patient-controlled analgesia (PCA) pump. Postoperative pain, blood pressure, heart rate, cortisol, $O_2$ saturation, frequency of the PCA button pressed and doses of additional analgesics were observed through post operative 24 hr. Collected data was analyzed using t-test, $X^2$ test, repeated measures ANOVA, and Bonferroni methods. Results: Postoperative pain, cortisol, the frequency of PCA button pressed, and dose of additional analgesics of the experimental group were significantly lower than the control group. There were no statistical differences in blood pressure, heart rate and $O_2$ saturation between the experimental group and control group. Conclusions: We concluded that administration of morphine and ketorolac at 1 hr prior to skin incision resulted in decreasing postoperative pain, but it didn't affect blood pressure, heart rate or $O_2$ saturation for 24 hr after abdominal surgery.

Keywords

References

  1. Ahn, E. K., Yoon, D. M., Kim, J. H., Lee, Y. W., Kim, J. R., & Seouk, M. J. (1996). Effect of preemptive analgesia on post-operative pain. Korean Journal of Anesthesiology, 30, 479-486
  2. Ashburn, M. A., Love, G., & Pace, N. L. (1994). Respiratory-related critical events with intravenous patient-controlled analgesia. Clinical Journal of Pain, 10, 52-56
  3. Aubrun, F., Langeron, O., Quesnel, C., Coriat, P., & Riou, B. (2003). Relationships between measurement of pain using visual analog score and morphine requirements during postoperative intravenous morphine titration. Anesthesiology, 98, 1415-1421 https://doi.org/10.1097/00000542-200306000-00017
  4. Bai, S. J., Nam, S. H., Lee, Y. W., Nam, Y. T., & Kim, W. J. (1998). The effect of preemptive intravenous ketorolac for total hip replacement patients. Korean Journal of Anesthesiology, 35, 511-517
  5. Cho, G. T., Sohn, H. J., Kim, S. B., Shin, Y. D., Bae, J. H., Kim, S. T., et al. (2001). The effect of the IV-PCA (Intravenous Patient Controlled Analgesia) on the recovery index. Korean Journal of Anesthesiology, 41, 318-323
  6. Collis, R., Brandner, B., Bromley, L. M., & Woolf, C. J. (1995). Is there any clinical advantage of increasing the pre-emptive dose of morphine or combining pre-incisional with postoperative morphine administration? British Journal of Anaesthesia, 74, 396-399 https://doi.org/10.1093/bja/74.4.396
  7. Fiedler, M. A. (1997). Clinical implications of ketorolac for postoperative analgesia. Journal of Perianesthesia Nursing, 12, 426-433 https://doi.org/10.1016/S1089-9472(97)90006-X
  8. Filos, K. S., & Vagianos, C. E. (1999). Pre-emptive analgesia: How important is it in clinical reality? European Surgical Research, 31, 122-132 https://doi.org/10.1159/000008630
  9. Fleming, B. M., & Coombs, D. W. (1992). A survey of complications documented in a quality-control analysis of patient-controlled analgesia in the postoperative patient. Journal of Pain and Symptom Management, 7, 463-469 https://doi.org/10.1016/0885-3924(92)90132-2
  10. Grass, J. A. (2005). Patient-controlled analgesia. Anesthesia and Analgesia, 101, S44-S61 https://doi.org/10.1213/01.ANE.0000153504.05295.15
  11. Hagle, M. E., Lehr, V. T., Brubakken, K., & Shippee, A. (2004). Respiratory depression in adult patients with intravenous patient-controlled analgesia. Orthopaedic Nursing, 23, 18-27 https://doi.org/10.1097/00006416-200401000-00007
  12. Huh, Y. J., Jung, C. W., Joh, J. Y., & Kim, Y. L. (2004). The effect of the initiating time of patient controlled analgesia on the onset of postoperative analgesic effect. Korean Journal of Anesthesiology, 47, 101-105
  13. Kaufman, E., Epstein, J. B., Gorsky, M., Jackson, D. L., & Kadari, A. (2005). Preemptive analgesia and local anesthesia as a supplement to general anesthesia: A review. Anesthesia Progress, 52, 29-38 https://doi.org/10.2344/0003-3006(2005)52[29:PAALAA]2.0.CO;2
  14. Kim, H. Y., & Yoon, H. S. (2006). The effects of ketamine preemptive analgesia on postoperative pain in patients undergoing hysterectomy. Journal of Korean Academy of Nursing, 36, 114-126
  15. Kim, S. J., Oh, S. W., Park, S. G., & Koo, G. H. (1998). The effects timing of connection with intravenous PCA. Chung-Ang Journal of Medicine, 23, 145-153
  16. Kissin, I. (1996). Preemptive analgesia: Why its effect is not always obvious. Anesthesiology, 84, 1015-1019 https://doi.org/10.1097/00000542-199605000-00001
  17. Kissin, I. (2000). Preemptive analgesia. Anesthesiology, 93, 1138-1143 https://doi.org/10.1097/00000542-200010000-00040
  18. Lee, E. O., Lim, N. Y., & Park, H. A. (1998). Nursing medical research and statistical analysis. Seoul: Soomoonsa
  19. Marret, E., Kurdi, O., Zufferey, P., & Bonnet, F. (2005). Effects of nonsteroidal antiinflammatory drugs on patient-controlled analgesia morphine side effects: Meta-analysis of randomized controlled trials. Anesthesiology, 102, 1249-1260 https://doi.org/10.1097/00000542-200506000-00027
  20. Mansfield, M., Meikle, R., & Miller, C. (1994). A trial of pre-emptive analgesia. Influence of timing of peroperative alfentanil on postoper-ative pain and analgesic requirements. Anaesthesia, 49, 1091-1093 https://doi.org/10.1111/j.1365-2044.1994.tb04363.x
  21. Norman, P. H., Daley, M. D., & Lindsey, R. W. (2001). Preemptive analgesic effects of ketorolac in ankle fracture surgery. Anesthesiology, 94, 599-603 https://doi.org/10.1097/00000542-200104000-00012
  22. Ochroch, E. A., Mardini, I. A., & Gottschalk, A. (2003). What is the role of NSAIDs in pre-emptive analgesia? Drugs, 63, 2709-2723 https://doi.org/10.2165/00003495-200363240-00002
  23. Oh, S. W., Woo, Y. C., Jung, Y. H., & Koo, G. H. (1999). Does pretreated NSAIDs decrease the postoperative consumption of morphine? Korean Journal of Anesthesiology, 36, 462-468
  24. Pasqualucci, A., de Angelis, V., Contardo, R., Colo, F., Terrosu, G., Donini, A., et al. (1996). Preemptive analgesia: Intraperitoneal local anesthetic in laparoscopic cholecystectomy. A randomized, double-blind, placebo-controlled study. Anesthesiology, 85, 11-20 https://doi.org/10.1097/00000542-199607000-00003
  25. Parke, T. J., Lowson, S. M., Uncles, D. R., Daughtery, M. O., & Sitzman, B. T. (1995). Pre-emptive versus post-surgical administration of ketorolac for hysterectomy. European Journal of Anaesthesiology, 12, 549-553
  26. Rang, H. P., Dail, M. M., Rirrer, J. M., & Moore, E. E. (2003). Pharmacology (5th ed.). New York, NY: Churchill Livingstone
  27. Rogers, J. E., Fleming, B. G., Macintosh, K. C., Johnson, B., & Morgan-Hughes, J. O. (1995). Effect of timing of ketorolac administration on patient-controlled opioid use. British Journal of Anaesthesia, 75, 15-18
  28. Sato, C., Tanaka, H., Kawamoto, M., Yugo, O., & Ogawa, R. (2004). Low oxygen saturation during early postoperative period in adult patients receiving opioids by intravenous patient-controlled analgesia. Masui, 53, 659-663
  29. Varrassi, G., Panella, L., Piroli, A., Marinangeli, F., Varrassi, S., Wolman, I., et al. (1994). The effects of perioperative ketorolac infusion on postoperative pain and endocrine-metabolic response. Anesthesia and Analgesia, 78, 514-519
  30. Vander, A. J., Shermar, J. H., & Luciano, D. S. (2004). Human physiology: The mechanisms of body function (8th ed.). New York, NY: McGraw-Hill Inc.
  31. Wall, P. D. (1988). The prevention of postoperative pain. Pain, 33, 289-290 https://doi.org/10.1016/0304-3959(88)90286-2
  32. White, P. F. (2005). The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesthesia and Analgesia, 101, S5-S22 https://doi.org/10.1213/01.ANE.0000177099.28914.A7
  33. Woolf, C. J., & Chong, M. S. (1993). Preemptive analgesia-treating postoperative pain by preventing the establishment of central sensitization. Anesthesia and Analgesia, 77, 362-379 https://doi.org/10.1213/00000539-199377020-00026