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  • Title: The effects of preemptive intravenous versus preemptive epidural morphine on postoperative analgesia and surgical stress response after orthopaedic procedures.
    Author: Kiliçkan L, Toker K.
    Journal: Minerva Anestesiol; 2000 Sep; 66(9):649-55. PubMed ID: 11070965.
    Abstract:
    BACKGROUND: The purpose of this study was to evaluate the effect of pre-emptive intravenous versus pre-emptive epidural morphine on both postoperative analgesic consumption and surgical stress response. METHODS: Sixty patients, ASA I or II, aged 18-85, undergoing total hip or knee replacement were randomly assigned to three groups of 20 patients. In group pre-emptive epidural, patients were administered an epidural injection of 75 micrograms.kg-1 morphine about 45 minute before dermal incision. In group pre-emptive intravenous, patients were administered 0.15 mg.kg-1 of intravenous morphine following induction before dermal incision. In group control, patients were administered intravenous saline following induction before dermal incision. RESULTS: The pre-i.v. group used significantly less morphine than the pre-epi group (p < 0.0003). In all groups, plasma cortisol levels increased as compared to pre-op values, but plasma cortisol increased more significantly in the pre-i.v. and control groups within 4 hrs of surgery and was still significantly elevated at 7 am of the first postoperative morning compared to the pre-epi group (p < 0.001) and the increase persisted to the next morning in patients pre-i.v. and control groups. CONCLUSIONS: Although pre-emptive epidural morphine has failed to decrease postoperative analgesic consumption, it has been able to suppress the surgical stress more significantly than intravenous morphine and a saline control.
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