Postoperative Effects of Opioid Analgesics Administered via Continuous Perfusion and Patient Controlled Analgesia after Open Heart Surgery

Critical care nurses and physicians are familiar with the principles of patient controlled analgesia and the opioid analgesics' regimens and observations necessary for pain control in the postoperative cardiac surgical patients. The objective of the study was to compare the effects of morphine,...

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Published in:	YAKUGAKU ZASSHI Vol. 126; no. 7; pp. 499 - 504
Main Authors:	OZTEKIN, Deniz Seher, ÖZTEKIN, Ilhan, ISSEVER, Halim, GÖKSEL, Onur, CINAR, Bayer, CANIK, Sevim
Format:	Journal Article
Language:	English
Published:	Japan The Pharmaceutical Society of Japan 01-07-2006 Pharmaceutical Society of Japan
Subjects:	Adult Aged Analgesia, Patient-Controlled Analgesics, Opioid - administration & dosage Analgesics, Opioid - adverse effects Cardiac Surgical Procedures Female fentanyl Fentanyl - administration & dosage Fentanyl - adverse effects Humans Infusions, Intravenous Male meperidine Meperidine - administration & dosage Meperidine - adverse effects Middle Aged morphine Morphine - administration & dosage Morphine - adverse effects opioid Pain, Postoperative - drug therapy Patient Education as Topic Piperidines - administration & dosage Piperidines - adverse effects Prospective Studies Remifentanil Sternum - surgery tramadol Tramadol - administration & dosage Tramadol - adverse effects
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Abstract	Critical care nurses and physicians are familiar with the principles of patient controlled analgesia and the opioid analgesics' regimens and observations necessary for pain control in the postoperative cardiac surgical patients. The objective of the study was to compare the effects of morphine, fentanyl, meperidine, remifentanil and tramadol which were administered by patient controlled analgesia and continuous intravenous infusion combination on the various parameters. This study was designed as prospective randomised trial. Fifty patients undergone open heart surgery with sternotomy were entered equally into five randomized groups. Visual analog scale was used by researcher nurse to assess the patient' pain status. Respiratory rate, heart rate and blood gases (pO2, pCO2, SaO2), radial arterial blood pressures were measured in the first 24 hrs postoperatively. Bolus requirements were determined by physicians and side effects of the analgesics were documented. Fentanyl group showed statistically higher levels of mean pO2 (p=0.002). Meperidine had the lowest number of bolus doses (p=0.001). There were no significant differences between the groups for pain management except higher visual analog scales on tramadol. Headache, stomachache and, palpitations were observed in our patients. Remifentanil, meperidine, fentanyl and morphine showed similar effect with each other for pain relief except tramadol.
AbstractList	Critical care nurses and physicians are familiar with the principles of patient controlled analgesia and the opioid analgesics' regimens and observations necessary for pain control in the postoperative cardiac surgical patients. The objective of the study was to compare the effects of morphine, fentanyl, meperidine, remifentanil and tramadol which were administered by patient controlled analgesia and continuous intravenous infusion combination on the various parameters. This study was designed as prospective randomised trial. Fifty patients undergone open heart surgery with sternotomy were entered equally into five randomized groups. Visual analog scale was used by researcher nurse to assess the patient' pain status. Respiratory rate, heart rate and blood gases (pO2, pCO2, SaO2), radial arterial blood pressures were measured in the first 24 hrs postoperatively. Bolus requirements were determined by physicians and side effects of the analgesics were documented. Fentanyl group showed statistically higher levels of mean pO2 (p=0.002). Meperidine had the lowest number of bolus doses (p=0.001). There were no significant differences between the groups for pain management except higher visual analog scales on tramadol. Headache, stomachache and, palpitations were observed in our patients. Remifentanil, meperidine, fentanyl and morphine showed similar effect with each other for pain relief except tramadol. Critical care nurses and physicians are familiar with the principles of patient controlled analgesia and the opioid analgesics' regimens and observations necessary for pain control in the postoperative cardiac surgical patients. The objective of the study was to compare the effects of morphine, fentanyl, meperidine, remifentanil and tramadol which were administered by patient controlled analgesia and continuous intravenous infusion combination on the various parameters. This study was designed as prospective randomised trial. Fifty patients undergone open heart surgery with sternotomy were entered equally into five randomized groups. Visual analog scale was used by researcher nurse to assess the patient' pain status. Respiratory rate, heart rate and blood gases (pO2, pCO2, SaO2), radial arterial blood pressures were measured in the first 24 hrs postoperatively. Bolus requirements were determined by physicians and side effects of the analgesics were documented. Fentanyl group showed statistically higher levels of mean pO2 (p=0.002). Meperidine had the lowest number of bolus doses (p=0.001). There were no significant differences between the groups for pain management except higher visual analog scales on tramadol. Headache, stomachache and, palpitations were observed in our patients. Remifentanil, meperidine, fentanyl and morphine showed similar effect with each other for pain relief except tramadol. [LITERATURE REVIEW] The expected outcome for a postoperative cardiac surgical patient is complete relief of pain such that the patient indicates that he or she is comfortable. Critically ill patient in early postoperative period of open heart surgery is not always able to communicate expressions of pain. A major challenge to the critical care nurse (CCN) is assessment of the presence and amount of pain as well as the effectiveness of treatment for the pain. Since the subjective expression of pain by the cardiac surgical patient is not always possible, the nurse must anticipate pain, interpret pain signals, and rely on less reliable objective indicators of pain. 1-8) Pain relief must be achieved without any adverse and side effects of treatment. It is important for the CCN to establish a regular routine of pain medication administration while the cardiac surgical patient is still in critical care unit (CCU). This will encourage the patient to be aware of his or her nursing care and to be an active participant in activities to help in convalescence. Critical care nurses and physicians are familiar with the principles of patient controlled analgesia and the opioid analgesics' regimens and observations necessary for pain control in the postoperative cardiac surgical patients. The objective of the study was to compare the effects of morphine, fentanyl, meperidine, remifentanil and tramadol which were administered by patient controlled analgesia and continuous intravenous infusion combination on the various parameters. This study was designed as prospective randomised trial. Fifty patients undergone open heart surgery with sternotomy were entered equally into five randomized groups. Visual analog scale was used by researcher nurse to assess the patient' pain status. Respiratory rate, heart rate and blood gases (pO2, pCO2, SaO2), radial arterial blood pressures were measured in the first 24 hrs postoperatively. Bolus requirements were determined by physicians and side effects of the analgesics were documented. Fentanyl group showed statistically higher levels of mean pO2 (p=0.002). Meperidine had the lowest number of bolus doses (p=0.001). There were no significant differences between the groups for pain management except higher visual analog scales on tramadol. Headache, stomach-ache and, palpitations were observed in our patients. Remifentanil, meperidine, fentanyl and morphine showed similar effect with each other for pain relief except tramadol.
Author	OZTEKIN, Deniz Seher GÖKSEL, Onur CANIK, Sevim CINAR, Bayer ISSEVER, Halim ÖZTEKIN, Ilhan
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BackLink	https://www.ncbi.nlm.nih.gov/pubmed/16819272$$D View this record in MEDLINE/PubMed
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CitedBy_id	crossref_primary_10_1016_j_bjan_2014_09_003 crossref_primary_10_1053_j_jvca_2011_08_001 crossref_primary_10_1016_j_ajem_2009_01_016 crossref_primary_10_1016_j_bjane_2014_09_013 crossref_primary_10_4097_kjae_2007_53_6_740
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SubjectTerms	Adult Aged Analgesia, Patient-Controlled Analgesics, Opioid - administration & dosage Analgesics, Opioid - adverse effects Cardiac Surgical Procedures Female fentanyl Fentanyl - administration & dosage Fentanyl - adverse effects Humans Infusions, Intravenous Male meperidine Meperidine - administration & dosage Meperidine - adverse effects Middle Aged morphine Morphine - administration & dosage Morphine - adverse effects opioid Pain, Postoperative - drug therapy Patient Education as Topic Piperidines - administration & dosage Piperidines - adverse effects Prospective Studies Remifentanil Sternum - surgery tramadol Tramadol - administration & dosage Tramadol - adverse effects
Title	Postoperative Effects of Opioid Analgesics Administered via Continuous Perfusion and Patient Controlled Analgesia after Open Heart Surgery
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