Intravesical Morphine Analgesia after Bladder Surgery

This is the authors' abstract. We don't add key points for this paper.

No AccessJournal of UrologyPediatric Urology: Review Article1 Apr 1997Intravesical Morphine Analgesia after Bladder Surgery J.W. Duckett, T. Cangiano, M. Cubina, C. Howe, and D. Cohen J.W. DuckettJ.W. Duckett , T. CangianoT. Cangiano , M. CubinaM. Cubina , C. HoweC. Howe , and D. CohenD. Cohen View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)65001-8AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: A recent demonstration of peripheral opioid receptors suggested the possibility of delivering morphine locally into the bladder after reimplantation for ameliorating the discomfort of postoperative bladder irritation with spasms. Since we do not use bladder drainage after reimplantation, dripping a morphine solution into the bladder permits contact with the urothelium between voidings. A pilot trial using an arbitrary concentration was subjectively beneficial for treating these patients postoperatively. We now report a prospective randomized study evaluating the effectiveness and dosage of various concentrations of intravesical morphine infusions. Materials and Methods: A total of 52 children undergoing ureteral reimplantation was randomized to receive 1 of 3 concentrations of intravesical morphine (0.05, 0.375 or 0.5 mg./ml.). A small feeding tube remained in the bladder to drip a continuous infusion postoperatively. Subsequent postoperative pain was treated with meperidine, acetaminophen and codeine, and/or a belladonna and opium suppository. During each shift a nurse assisted the child in assessing pain using a Baker-Wong faces scale. Bladder infusion was discontinued after day 3 postoperatively and plasma morphine levels were measured on the first morning postoperatively. Kruskal-Wallis and paired t tests were used to evaluate significance. Results: Patients reported greater pain in the group infused with 0.05 mg./ml. on 4 of 6 shifts on the first 2 days postoperatively. No difference was noted on postoperative day 3. Plasma morphine was undetectable by high pressure liquid chromatography. Conclusions: This study offers objective evidence that bladder morphine infusion is effective for ameliorating postoperative pain in the first 48 hours after intravesical ureteral reimplantation. The dose given today is 0.5 mg./ml. delivered at 0.04 ml./kg. per hour. References 1 : Continuous epidural anasthesia after ureteroneocystostomy in children. J. Urol.1995; 154: 791. Abstract, Google Scholar 2 : The Cohen reimplantation technique. In: Urinary Systems Malformations in Children. Edited by . New York: Alan R. Liss Inc.1977: 391. Google Scholar 3 : Postoperative hospitalization of children undergoing cross-trigonal ureteroneocystostomy. J. Urol.1995; 154: 794. Link, Google Scholar 4 : Central and peripheral motor effects of morphine on the rat urinary bladder. Acta Physiol. Scand.1986; 126: 181. Google Scholar 5 : Q. U. E. S. T.: a process of pain assessment in children. Orthopaed. Nurs.1987; 6: 11. Google Scholar 6 : Peripheral mechanisms of opioid analgesia. Anaesth. Analg.1993; 76: 182. Google Scholar 7 : Opioid analgesia at peripheral sites: a target for opioids released during stress and inflammation? Anaesth. Analg.1987; 66: 1277. Google Scholar 8 : Intraarticular morphine, bupivacaine, and morphine/bupivacaine for pain control after knee videoarthroscopy. Anesthesiology1992; 77: 263. Google Scholar 9 : Comparison of postoperative analgesic effects of intraarticular bupivacaine and morphine following arthroscopic knee surgery. Anesthesiology1992; 77: 1143. Google Scholar 10 : Voiding efficiency after ureteral reimplantation: a comparison of extravesical and intravesical techniques. J. Urol.1995; 153: 1972. Link, Google Scholar 11 : Extravesical ureteral reimplantation: results in 128 patients. J. Urol.1996; 155: 1721. Link, Google Scholar 12 : Results of the renewed extravesical reimplant for surgical correction of vesicoureteral reflux. J. Urol.1992; 148: 359. Link, Google Scholar 13 : Extravesical nondismembered ureteroplasty with detrusorrhaphy: a renewed technique to correct vesicoureteral reflux in children. J. Urol.1992; 148: 704. Link, Google Scholar From the Department of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania© 1997 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byEl-Ghoneimi A, Deffarges C, Hankard R, Jean-Eudes F, Aigrain Y and Jacqz-Aigrain E (2018) Intravesical Morphine Analgesia Is Not Effective After Bladder Surgery in Children: Results of A Randomized Double-Blind StudyJournal of Urology, VOL. 168, NO. 2, (694-697), Online publication date: 1-Aug-2002. Volume 157Issue 4April 1997Page: 1407-1409 Advertisement Copyright & Permissions© 1997 by American Urological Association, Inc.MetricsAuthor Information J.W. Duckett More articles by this author T. Cangiano More articles by this author M. Cubina More articles by this author C. Howe More articles by this author D. Cohen More articles by this author Expand All Advertisement PDF downloadLoading ...