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Can single dose preoperative intrathecal morphine sulfate provide cost-effective postoperative analgesia and patient satisfaction during radical prostatectomy in the current era of cost containment?

Prostate Cancer and Prostatic Diseases volume 5, pages 226–230 (2002)Cite this article

Abstract

We retrospectively analyzed the analgesic efficacy and surgical outcomes of a single preoperative intrathecal long-acting morphine sulfate injection (0.25–0.5 mg) and postoperative intravenous (i.v.) ketorolac in 62 patients who underwent radical retropubic prostatectomy (RRP). Total postoperative analgesic requirement was documented along with assessment of length of hospital stay, pain control and time for resumption of normal activity. Postoperatively, 45% of patients required only nonsteroidal agents (ketorolac), whereas 55% needed a mean of 13.3 mg of supplemental i.v. morphine sulfate. Mean hospital stay was 2.3±0.3 days. Eighty-two per cent of patients felt the length of hospital stay adequate. Ninety-seven per cent of patients were satisfied with anesthesia selected and 95% of patients considered pain control on postoperative days 1 and 2 as effective. All patients resumed to full physical activity by 5.3±0.4 weeks after surgery. We conclude that a single preoperative injection of intrathecal morphine sulfate combined with i.v. ketorolac postoperatively results in effective analgesia, diminished supplemental narcotic requirement and high patient satisfaction during radical retropubic prostatectomy.

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References

  1. Behar M et al. Epidural morphine in the treatment of pain Lancet 1979 1: 527–529

    Article  CAS  Google Scholar 

  2. Wang JK, Nauss LA, Thomas JE . Pain relief by intrathecally applied morphine in man Anesthesiology 1979 50: 149–151

    Article  CAS  Google Scholar 

  3. Kalso E . Effects of intrathecal morphine injected with bupivacaine on pain after orthopaedic surgery Br J Anaesthiol 1983 55: 415–422

    Article  CAS  Google Scholar 

  4. Nordberg G et al. Pharmacokinetic aspects of intrathecal morphine analgesia Anesthesiology 1984 60: 448–454

    Article  CAS  Google Scholar 

  5. Chadwick HS, Ready LB . Intrathecal and epidural morphine sulfate for postcesarean analgesia: a clinical comparison Anesthesiology 1988 67: 137–143

    Google Scholar 

  6. Abboud TK et al. Mini-dose intrathecal morphine for the relief of post-cesarean section pain Anesth Analg 1988 67: 137–143

    Article  CAS  Google Scholar 

  7. Abouleish E et al. Combined intrathecal morphine and bupivacaine for cesarean section Anesth Analg 1988 67: 370–374

    Article  CAS  Google Scholar 

  8. Kirson LE, Goldman JM, Slover RB . Low-dose intrathecal morphine for postoperative pain control in patients undergoing transurethral resection of the prostate Anesthesiology 1989 71: 192–195

    Article  CAS  Google Scholar 

  9. Gustafsson LL, Schildt B, Jacobsen K . Adverse effects of extradural and intrathecal opiates: report of a nationwide survey in Sweden Br J Anaesthiol 1982 54: 479–486

    Article  CAS  Google Scholar 

  10. Gwirtz KH et al. The safety and efficacy of intrathecal opioid analgesia for acute postoperative pain: seven years' experience with 5969 surgical patients at Indiana University hospital Anesth Analg 1999 88: 599–604

    CAS  PubMed  Google Scholar 

  11. Walsh PC . Radical retropubic prostatectomy In: Walsh PC, Retik AB, Vaughan ED, Wein AJ (eds) Campbell's Urology 7th edn WB Saunders: Philadelphia 1998 pp 2565–2588

    Google Scholar 

  12. Fowler FJ Jr et al. Effect of radical prostatectomy for prostate cancer on patient quality of life: results from a Medicare survey Urology 1995 45: 1007–1015

    Article  Google Scholar 

  13. Litwin MS, Shpall AI, Dorey F . Patient satisfaction with short stays for radical prostatectomy Urology 1997 49: 898–906

    Article  CAS  Google Scholar 

  14. Worwag E, Chodak GW . Overnight hospitalization after radical prostatectomy: the impact of two clinical pathways on patient satisfaction, length of hospitalization, and morbidity Anesth Analg 1998 87: 62–67

    CAS  PubMed  Google Scholar 

  15. Palmer JS et al. Same day surgery for radical retropubic prostatectomy: is it an attainable goal? Urology 1996 47: 23–28

    Article  CAS  Google Scholar 

  16. Shir Y et al. Intraoperative blood loss during radical retropubic prostatectomy: epidural versus general anesthesia Urology 1995 45: 993–999

    Article  CAS  Google Scholar 

  17. Eastham JA, Scardino PT . Radical prostatectomy In: Walsh PC, Retik AB, Vaughan ED, Wein AJ (eds) Campbell's Urology 7th edn WB Saunders: Philadelphia 1998 pp 2547–2564

    Google Scholar 

  18. Allano C et al. Low dose spinal morphine for postop analgesia on surgical wards Br J Anethesiol 1999 82: 189

    Google Scholar 

  19. Chaney M . Side effects of intrathecal and epidural opioids (Review) Can J Anesth 1995 42: 891–903

    Article  CAS  Google Scholar 

  20. Johnson A et al. Influence of postoperative naloxone infusion on respiration and pain relief after intrathecal morphine Reg Anesth 1988 13: 146–151

    Google Scholar 

  21. Stoelting RK . Intrathecal morphine: an underused combination for postoperative pain management Anesth Analg 1989 68: 707–709

    Article  CAS  Google Scholar 

  22. Watts RW . A five-year prospective analysis of the efficacy, safety and morbidity of epidural anaesthesia performed by a general practitioner anaesthetist in an isolated rural hospital Anaesth Intensive Care 1992 20: 348–353

    CAS  PubMed  Google Scholar 

  23. Gerig HJ, Kern F . Success and failure rate in peridural anesthesia. A 1-year study Reg Anaesth 1985 8: 25–32

    CAS  PubMed  Google Scholar 

  24. Gerancher JC, Liu SS . Complications of neuraxial (spinal/epidural/caudal) anesthesia In: Benumof JL, Saidman LJ (eds) Anesthesia and Perioperative Complications 2nd edn Mosby: St. Louis, MO 1999 pp 50–65

    Google Scholar 

  25. Klein EA et al. Maintaining quality of care and patient satisfaction with radical prostatectomy in the era of cost containment Urology 1996 48: 269–276

    Article  CAS  Google Scholar 

  26. Gottschalk A et al. Preemptive epidural analgesia and recovery from radical prostatectomy JAMA 1998 279: 1076–1082

    Article  CAS  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Urology and Department of Anesthesiology, UC Davis Medical Center, Sacramento, California, USA

    J A Eandi, R W de Vere White, H S G R Tunuguntla, C H Bohringer & C P Evans

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  1. J A Eandi
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  2. R W de Vere White
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  3. H S G R Tunuguntla
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  4. C H Bohringer
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  5. C P Evans
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Correspondence to C P Evans.

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Eandi, J., de Vere White, R., Tunuguntla, H. et al. Can single dose preoperative intrathecal morphine sulfate provide cost-effective postoperative analgesia and patient satisfaction during radical prostatectomy in the current era of cost containment?. Prostate Cancer Prostatic Dis 5, 226–230 (2002). https://doi.org/10.1038/sj.pcan.4500584

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