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The purpose of this study is to improve IV-Patient Controlled Analgesia (IV-PCA) technique for postoperative analgesia. Investigators are comparing between patient re-education and the background morphine infusion among patients who fail to achieve satisfactory analgesia using IV-PCA Morphine after laparotomy.
In this study, investigators have a second inclusion criteria for subject recruitment. For subjects who meet this criteria meaning their dynamic pain (when blowing incentive spirometer) is ≥ 4/10 after starting on IV-PCA Morphine will be randomized in to 2 groups. One group will receive patient re--education with an additional background morphine infusion and the other group will receive re--education only.
The second highlight for this study is regarding the background morphine calculation. The background morphine is calculated according to this formula:
Total morphine requirement in the first 24 hours post surgery (mg) = 100 - Age (year) So, the background morphine infusion will be calculated based on subject's age and half of their 24 hours requirement will be infused over 24 hours.
This formula was published by Pamela Macintyre in her paper titled " Age is the Best Predictor of Postoperative Morphine Requirement".
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Background morphine infusion to IV-PCA Morphine | Active Comparator | Calculate based on patient's age, in mg/hour |
|
| Patient re-education to IV-PCA Morphine | Experimental | Using patient information leaflet |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| morphine | Drug | Investigators use the formula that was published by Pamela Macintyre in her paper entitled "Age is the Best Predictor of Postoperative Morphine Requirements." The estimation for the first 24-hour morphine requirement after surgery is calculated as: 100 - age (year). So, half of the total 24-hour morphine requirement will be infused over 24 hours. e.g. background morphine infusion= (100-Age)/ 2/ 24 (mg/hour) |
| Measure | Description | Time Frame |
|---|---|---|
| measure pain intensity at rest and when blowing incentive spirometer (dynamic pain) | use combination of Numerical Rating Scale(NRS) and Visual Analogue Scale(VAS) | 48 hours after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| respiratory rate | 48 hours after surgery | |
| total accumulative morphine consumption from IV-PCA pump | 48 hours after surgery | |
| sedation level |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Lee Choo Yeoh, Master | Contact | 047722625 | yeohlc55@yahoo.com |
| Name | Affiliation | Role |
|---|---|---|
| lee choo yeoh, master | CRC Malaysia | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Sultanah Bahiyah Hospital | Recruiting | Alor Seatr | Kedah | 05050 | Malaysia |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 8740614 | Result | Macintyre PE, Jarvis DA. Age is the best predictor of postoperative morphine requirements. Pain. 1996 Feb;64(2):357-364. doi: 10.1016/0304-3959(95)00128-X. |
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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| ID | Term |
|---|---|
| D009020 | Morphine |
| ID | Term |
|---|---|
| D009022 | Morphine Derivatives |
| D009019 | Morphinans |
| D053610 | Opiate Alkaloids |
| D000470 | Alkaloids |
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|
| Patient re-education | Behavioral | A similar leaflet will be used to re-educate patient at 4 hour after surgery. The correct method to initiate IV-PCA dose, possible side effects and addiction issue will be explained again and re-emphasized |
|
sedation score (0 to 3) |
| 48 hours after surgery |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D006571 |
| Heterocyclic Compounds |
| D006572 | Heterocyclic Compounds, Bridged-Ring |
| D006576 | Heterocyclic Compounds, 4 or More Rings |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D010616 | Phenanthrenes |
| D011084 | Polycyclic Aromatic Hydrocarbons |
| D011083 | Polycyclic Compounds |