Antiemetic and analgesic-sparing effects of diphenhydramine added to morphine intravenous patient-controlled analgesia |
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Authors: | Lin T-F Yeh Y-C Yen Y-H Wang Y-P Lin C-J Sun W-Z |
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Institution: | Department of Anesthesiology, National Taiwan University Hospital, 7 Chung San South Road, Taipei, Taiwan |
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Abstract: | Background. This study was designed to examine the analgesicand dose-related antiemetic efficacy of diphenhydraminemorphinemixture for intravenous patient-controlled analgesia (PCA). Methods. Healthy women, undergoing abdominal total hysterectomywere recruited to this double-blinded randomized placebo-controlledstudy. Patients were randomly allocated to one of three groups(n=40 each). In group 1, patients received saline at inductionand morphine 1 mg ml1 alone for postoperative PCA. Patientsin groups 2 and 3 received diphenhydramine 30 mg i.v. at inductionand were given a 1.2:1 or a 4.8:1 ratio, respectively, of diphenhydraminemorphinemixture for postoperative PCA. Results. A total of 112 patients completed the study. The incidenceof postoperative nausea (31.6% vs 67.6%, P<0.01) and vomiting(15.8% vs 40.5%, <0.05) was significantly lower in group3 than in group 1. Furthermore, the incidence of severe nauseawas significantly lower in group 3 than in group1 (2.6% vs 24.3%,P<0.05). The rescue antiemetic requirements were also significantlyless in group 3 than in group 1 (5.3% vs 24.3%, P<0.05).However, there was no significant difference between group 2and group 1 in any of the comparisons. Pain intensity, 24-hmorphine consumption and diphenhydramine-related side-effects,such as sedation or dry mouth, did not differ among the threegroups. Conclusion. An initial bolus of diphenhydramine 30 mg at anaestheticinduction followed by postoperative PCA with a 4.8:1, but not1.2:1, diphenhydraminemorphine mixture provides an effectiveantiemetic efficacy without morphine-sparing effects. |
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Keywords: | analgesia patient-controlled antiemetic diphenhydramine complications postoperative nausea and vomiting |
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