Abstract
A randomised double-blind study compared the dose-response relationship of intrathecal diamorphine (0, 0.25, 0.75, 1.5, and 2.5 mg) for postoperative pain relief, in 35 subjects who underwent total knee replacement surgery. Assessments commenced 2 h after the opioid injection and continued for 20 h. Pain, analgesic effect, supplementary analgesic requirements and adverse effects were noted. Intrathecal diamorphine was unable to delay the initial perception of discomfort. It was, however, capable of postponing the onset of severe pain requiring analgesic supplementation (control 5.25 h vs approximately 8 h: P less than 0.05). There was no significant difference in the quality of analgesia between the groups. Pruritus was the only undesirable feature unique to intrathecal diamorphine administration. Intrathecal diamorphine was safe and was not associated with clinically apparent respiratory depression. Its effects were inconsistent and its use was associated with irritating side effects. Possible explanations for the erratic behaviour of the diamorphine are discussed.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bromage P. R. The price of intraspinal narcotic analgesia: basic constraints. Anesth Analg. 1981 Jul;60(7):461–463. [PubMed] [Google Scholar]
- Kaufman L. Intrathecal heroin. Lancet. 1981 Dec 12;2(8259):1341–1342. doi: 10.1016/s0140-6736(81)91357-x. [DOI] [PubMed] [Google Scholar]
- Kotob H. I., Hand C. W., Moore R. A., Evans P. J., Wells J., Rubin A. P., McQuay H. J. Intrathecal morphine and heroin in humans: six-hour drug levels in spinal fluid and plasma. Anesth Analg. 1986 Jul;65(7):718–722. [PubMed] [Google Scholar]
- Moore A., Bullingham R., McQuay H., Allen M., Baldwin D., Cole A. Spinal fluid kinetics of morphine and heroin. Clin Pharmacol Ther. 1984 Jan;35(1):40–45. doi: 10.1038/clpt.1984.6. [DOI] [PubMed] [Google Scholar]
- Paterson G. M., McQuay H. J., Bullingham R. E., Moore R. A. Intradural morphine and diamorphine. Dose response studies. Anaesthesia. 1984 Feb;39(2):113–117. doi: 10.1111/j.1365-2044.1984.tb09497.x. [DOI] [PubMed] [Google Scholar]
- Scott J., Huskisson E. C. Graphic representation of pain. Pain. 1976 Jun;2(2):175–184. [PubMed] [Google Scholar]
- Yaksh T. L., Rudy T. A. Analgesia mediated by a direct spinal action of narcotics. Science. 1976 Jun 25;192(4246):1357–1358. doi: 10.1126/science.1273597. [DOI] [PubMed] [Google Scholar]