Randomised double-blind comparison of morphine vs a morphine-alfentanil combination for patient-controlled analgesia
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Date
2002-04
Authors
Alias, Anita
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
Patient-controlled analgesia (PCA) has been used for the past 30 years as an alternative
method to administer postoperative analgesia. Patient-Controlled Analgesia allows
patients to self-administer small boluses of opioids, providing better dose titration and
regulation. The quantity of analgesic available to the patient is limited by the prescribed
patient-controlled analgesia variables; demand dose size, lockout period and hourly or
4-hourly limits.
In a randomized, double-blind study, I compared a combination of morphine and
alfentanil with morphine alone for patient-controlled analgesia after Caesarean section
under spinal anesthesia. After surgery, patients were randomly allocated to receive
patient-controlled analgesia with a bolus dose of either morphine 0.75 mg plus
alfentanil 0.125 mg (Group MA, n= 40) or morphine 1.5 mg alone (Group M, n=40)
with a lockout interval of 8 minute and no hourly dose limit or basal infusion. Clinical
assessments were made in the first 24 hours, after which patients completed a written
questionnaire. There was a significance difference between groups in patient-controlled
analgesia usage with the mean of patient-controlled analgesia boluses received by group
MA bigger (41.0) as compared to group M (27.4) but the visual analogue scale scores of
pain measured at 2, 4, 6 and 24h were not significant.
There was a low incidence of side-effects in both groups. In the questionnaires, there
were no differences in grading for speed of onset, effectiveness of analgesia, duration of
analgesia and overall patient satisfaction. Addition of alfentanil to morphine does not
have any advantages for patient-controlled analgesia.
Description
Keywords
Patient-controlled analgesia (PCA)