Original researchA randomized controlled trial of early oral analgesia in gynecologic oncology patients undergoing intra-abdominal surgery
Section snippets
Materials and methods
This trial was approved by the Institutional Review Boards at the State University of New York at Stony Brook, and informed consent was obtained from all patients. All gynecologic oncology patients undergoing nonlaparoscopic intra-abdominal surgery were eligible to participate. Patients who were either unable to use a PCA pump or intolerant of morphine were excluded. After induction of general anesthesia, patients were randomized using a computer-generated random number list.
All surgical
Results
Between July 1, 1997 and January 25, 2000, 227 patients enrolled in this trial, representing 43% of eligible patients. Each of the remaining patients declined to participate for personal reasons. Seven patients were non-evaluable, four in the early oral analgesia group and three in the traditional parenteral analgesia group. These seven patients were transferred to the intensive care unit postoperatively and were unable to receive any oral intake.
Table 2, Table 3 summarize the demographic and
Discussion
The management of the postoperative patient has been dominated by surgical dogma derived without the benefit of scientific inquiry. Because of fears that early initiation of oral intake would lead to serious adverse consequences, patients have been prohibited from taking anything orally until they provided satisfactory evidence of bowel function by passing flatus and/or having a bowel movement. Consequently, administration of postoperative pain medication has been limited to parenteral routes.
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Cited by (19)
Rhythmic pattern of PCA opioid demand in adults with cancer pain
2010, European Journal of PainCitation Excerpt :Investigation has been more vigorous for out-patients on PCA, with the majority of patients being at the end of their life (Citron et al., 1992; Kerr et al., 1988; Meuret and Jocham, 1996; Schiessl et al., 2007, 2008a,b; Swanson et al., 1989; Wagner et al., 1989). Other studies on PCA use in cancer patients have been restricted to dose finding (Zech et al., 1992; Baumann et al., 1986; Grond et al., 1997; Kornick et al., 2001; Radbruch et al., 1999), or postoperative pain control (Pearl et al., 2002). More recently there has been literature (Junker and Ludwig, 2007; Bruguerolle and Labrecque, 2007) on the rhythmic pattern of opioid use in individuals and Kelly et al. (2006) have discussed changes to the background infusion rate or the dose of opioid administered prior to bed so as to allow for improved sleep.
Oral opioids and postoperative pain management
2009, Annales Francaises d'Anesthesie et de ReanimationPreoperative analgesia with local lidocaine infiltration for abdominal hysterectomy pain management
2008, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :A possible alternative to overcome these limitations and drawbacks is the treatment of postoperative pain by oral analgesia. Oral analgesic treatment has been reported to be satisfactory following various gynecological and obstetrical procedures, such as episiotomies, cesarean sections, and even surgery for gynecological cancer [3–5]. In our department, postoperative pain management is mainly based on non-narcotic oral analgesia.
Recent developments in patient-controlled analgesia
2005, Journal of Pain and Symptom ManagementCitation Excerpt :It should be mentioned that the advantage of including a fast-acting intravenous step into the titration procedure has been questioned several times in the past. Recently, Pearl et al. provided evidence that early oral analgesia in gynecologic oncology patients undergoing intra-abdominal surgery is as safe and efficacious as intermediate intravenous PCA.109 On the other hand, one must always keep in mind that some cancer patients with a long history of opioid use can develop serious postoperative problems if their previous opioid consumption is not taken into consideration, as demonstrated in a case report by Heid et al., where early PCA revealed a daily intravenous morphine need of 600–800 mg.110