Patient-controlled intranasal diamorphine for postoperative pain: an acceptability study

A patient acceptability study was conducted using patient-controlled intranasal diamorphine. Patients undergoing nonemergency orthopaedic or gynaecological surgery self-administered intranasal diamorphine for 24 h postoperatively. Pain, pain relief, sedation, respiratory rate, nausea and vomiting were assessed regularly. After 24 h, patients and their attending nurses completed a questionnaire assessing satisfaction and practical aspects of the technique. Satisfaction was reported as good or complete by 69% of patients and 69% of nurses. Pain relief was assessed as better than expected by 45% of patients and better than normal by 50% of nurses. Seventy-nine per cent of patients would be pleased to use patient-controlled intranasal diamorphine again and 89% of nurses would be happy for their patients to use it again. Sedation was uncommon and mild and there were no episodes of significant respiratory depression. Fifty-three per cent of patients reported no nausea and 74% did not vomit at any stage. There were seven withdrawals, four due to problems with the device and three due to therapeutic problems. The nasal spray may need modification to improve reliability. However, we found patient-controlled intranasal analgesia an effective technique, which was well tolerated by patients and nurses and was without unpleasant side-effects. Further work to determine how it performs compared with intramuscular or intravenous analgesia is now needed.     

Non-neuraxial analgesia in labour

Pain in labour is often described as one of the most severe pains experienced. Neuraxial techniques provide the most effective form of labour analgesia. However, not all women wish to have this or indeed want complete pain relief in labour. There are also subgroups of women in whom neuraxial techniques are contraindicated or attempted placement is unsuccessful. Therefore delivery units must be able to offer a range of non-neuraxial analgesia options for labour.     

A pain service for children

The development of an acute pain service has enabled hospital staff to improve postoperative analgesia. Patient protocols have been coordinated to ensure consistent and safe management throughout the hospital. Patient satisfaction has been very high with consistently over 90% of patients having good pain relief. High quality analgesia highlights side effects especially urinary retention with extradural opioids. Further research is needed to diminish the incidence of these complications.     

The effects of intrathecal diamorphine on gastric emptying after elective Caesarean section

This study investigated whether intrathecal diamorphine affects gastric emptying following elective Caesarean section. Forty women were randomly allocated to receive either diamorphine 300 microg or 0.9% saline as part of a standard spinal anaesthetic. Gastric emptying was measured in the immediate postoperative period using paracetamol absorption. Paracetamol concentrations were measured by enzymatic assay method using a Beckman CX-7 automated analyser. The time to maximum concentration (Tmax) was statistically longer in the diamorphine group (control 41.8, SD 20.8 min; diamorphine 72.6 SD 41.9 min; p < 0.01). During the 2-h study period, mean morphine consumption via a patient controlled analgesia device was significantly higher in the control group (control 9.3, SD 3.6 mg; diamorphine 2.1, SD 2.1 mg; p < 0.01). We conclude that intrathecal diamorphine may contribute to the delay in gastric emptying that occurs immediately following elective spinal Caesarean section.     

Premixed solutions of diamorphine in ropivacaine for epidural anaesthesia: a study on their long-term stability

Background. Local anaesthetics and opioid mixtures are commonlyused to provide anaesthesia or analgesia during the perioperativeperiod. In order to facilitate their preparation and storageit is necessary to establish the stability of such solutions. Methods. In our study, diamorphine was added to ropivacaine0.2% 200-ml polybags to give a concentration of 25 µg ml^–1and to ropivacaine 1% 50-ml syringes to give a concentrationof 45 µg ml^–1. The polybags and syringeswere stored at 40°C, 21°C and 4°C for up to 120days. Samples were taken during this period for measurementof diamorphine and ropivacaine content and pH of the solutions. Results. We found that the storage temperature and the initialconcentration influenced the rate of degradation of diamorphinein both the polybags and the syringes. In the syringes, 10%degradation of diamorphine [T (0.9)] was: 6 days at 40°C,16 days at 21°C and 30 days at 4°C. In the polybags,diamorphine T (0.9) was 6 days at 40°C, 28 days at 21°Cand 70 days at 4°C. Conclusions. It is feasible to manufacture such solutions inpharmacy aseptic units and to store them for up to 1 month forroutine use in epidural infusions. Br J Anaesth 2003; 90: 179–82     

二醋吗啡成瘾者红细胞阿片受体与G蛋白耦联状态的改变

用功能大分子复合体表观靶体积幅射失活法,比较二醋吗啡(海洛因)成瘾者,非吸毒志愿者及成功戒毒3个月以上者,其红细胞阿片受体与G蛋白耦联状态的异同. 结果表明,对照组,成瘾组和康复组的阿片μ-受体复合体的大小(表观分子量)依次为： (347±2) u(n=11); (228±5) u(n=16)和(279±11) u(n=9). 成瘾组明显低于对照组(P<0.01); 值得注意的是康复组虽然明显低于对照组(P<0.01),但明显高于成瘾组(P<0.01). 上述3组的阿片δ-受体复合体的大小(表观分子量)则分别为：(308±4) u(n=11), (224±4) u(n=16)和(299±7) u(n=9). 成瘾组明显低于对照组(P<0.01); 同样值得注意的是康复组明显高于成瘾组(P<0.01), 而且非常接近对照组(P>0.05). 结果提示：(1) 二醋吗啡成瘾时红细胞阿片μ-和δ-受体均可能与G蛋白发生解耦联现象; (2) 这种现象在红细胞是可逆转的.     

Changes in the states of opioid receptors coupled to G proteins in the erythrocytes of diamorphine addicts 1

用功能大分子复合体表观靶体积幅射失活法,比较二醋吗啡（海洛因）成瘾者,非吸毒志愿者及成功戒毒３个月以上者,其红细胞阿片受体与Ｇ蛋白耦联状态的异同．结果表明,对照组,成瘾组和康复组的阿片μ－受体复合体的大小（表观分子量）依次为：（３４７±２）ｕ（ｎ＝１１）;（２２８±５）ｕ（ｎ＝１６）和（２７９±１１）ｕ（ｎ＝９）．成瘾组明显低于对照组（Ｐ＜０．０１）;值得注意的是康复组虽然明显低于对照组（Ｐ＜０．０１）,但明显高于成瘾组（Ｐ＜０．０１）．上述３组的阿片δ－受体复合体的大小（表观分子量）则分别为：（３０８±４）ｕ（ｎ＝１１）,（２２４±４）ｕ（ｎ＝１６）和（２９９±７）ｕ（ｎ＝９）．成瘾组明显低于对照组（Ｐ＜０．０１）;同样值得注意的是康复组明显高于成瘾组（Ｐ＜０．０１）,而且非常接近对照组（Ｐ＞０．０５）．结果提示：（１）二醋吗啡成瘾时红细胞阿片μ－和δ－受体均可能与Ｇ蛋白发生解耦联现象;（２）这种现象在红细胞是可逆转的．     

Myoclonic spasms after epidural diamorphine infusion

A case is presented in which myoclonus occurred after epidural diamorphine infusion. Reports of this phenomenon following other epidural drugs and possible mechanisms are discussed.     

An isobolographic analysis of diamorphine and levobupivacaine for epidural analgesia in early labour

Background: Few data describe the pharmacological interactions between localanaesthetics and opioids. The aim of this study was to measurethe median effective concentration (MEC) of diamorphine andlevobupivacaine when given separately and as mixtures for epiduralanalgesia, and determine whether the combination is additiveor synergistic. Methods: One hundred and twenty patients were enrolled in this prospectiverandomized, two-phase, double-blind study. In the first phase,60 women were randomized to receive a fixed 20 ml volumeof either levobupivacaine or diamorphine epidurally . Dosingwas determined using up-down sequential allocation with testingintervals, respectively, of 0.01%w/v and 12.5 µg ml^–1.After estimations of the MEC of levobupivacaine and diamorphine,a further 60 patients were randomized in the second phase toone of the three mixtures: (a) diamorphine 70 µg ml^–1(fixed) and levobupivacaine (testing interval 0.004%w/v, startingat 0.044%w/v); (b) levobupivacaine 0.044%w/v (fixed) and diamorphine(testing interval 7 µg ml^–1, startingat 70 µg ml^–1); and (c) bivariate diamorphineand levobupivacaine (testing intervals of 7 µg ml^–1and 0.004%w/v starting at 70 µg ml^–1 and0.044% w/v respectively). Results: The MEC estimates from the first phase were 143.8 µg ml^–1(95% CI 122.2–165.3) for diamorphine and 0.083%w/v (95%CI 0.071–0.095) for levobupivacaine. In the second phase,the MEC and interaction index () of the three combinations were:diamorphine 65.5 µg ml^–1 (56.8–74.2), = 0.99; levobupivacaine 0.041%w/v (0.037–0.049), = 0.98;and for the fixed combination diamorphine 69.5 µg ml^–1(60.5–78.5) and levobupivacaine 0.044%w/v (0.039–0.049), = 1.02. Conclusion: The combination of diamorphine and levobupivacaine is additiveand not synergistic when used for epidural analgesia in thefirst stage of labour.     

上海地区海洛因注射者的HIV高危性行为分析

目的 我国爱滋病感染者中43%是海洛因注射者（IDUs），既往研究多关其高危注射行为，本研究将对IDUs中的高危性行为情况进行分析。方法 收集了上海141名住院戒毒者的临床资料、HIV、HBV、HCV感染情况、性行为、艾滋病毒/艾滋病（HIV/AIDS）相关知识和态度及其他社会心理学因素，并分析了海洛因注射者高危性行为的影响因素。结果 IDUs中高危性行为非常普遍：77%不能坚持使用避孕套，25.5%有多个性伙伴，48.2%有IDUs性伙伴，75.9%不了解对方HIV感染情况；首次吸毒年龄小、注射过量次数多、对避孕套的否定态度、共用不洁注射工具与不安全性行为有关的因素有，而未婚、继续使用避孕套意愿、自愿HIV检测等与安全性行为有关。结论 上海地区IDUs中高危性行为普遍存在，不能忽视对IDUs中高危行为的研究。