• The Korean Journal of Pain
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• v.8 no.2
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• pp.386-389
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• 1995

Combined infusion of local anesthetics and opioids has been a common method for providing postoperative analgesia. Complications that can occur with this method include pruritus, nausea and vomiting, urinary retention, hypotension, and both early and late respiratory depression. Late respiratory depression is a rare but feared complication to epidural opioid therapy. We experienced a case of respiratory arrest during epidural infusion of bupivacaine and morphine.

• The Korean Journal of Pain
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• v.18 no.1
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• pp.10-14
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• 2005

Background: Previous studies have suggested synergistic analgesic drug interactions between NSAIDs and opioids in neuropathic and inflammatory pain models. The aim of this study was to investigate the analgesic drug interaction between intraperitoneal (IP) ketorolac and morphine in radiant thermal stimulation rat. Methods: Initially, we assessed the withdrawal latency time of the hindpaw to radiant thermal stimulation every 15 min for 1 hour and every 30 min for next 1 hour after IP normal saline 5 ml (control group). The latency time was changed into percent maximal possible effect (%MPE). Next, IP dose response curves were established for the %MPE of morphine (0.3, 1, 3, 10 mg/kg) and ketorolac (3, 10, 30 mg/kg) to obtain the $ED_{50}$ for each agent. And we confirmed that the IP morphine effect was induced by opioid receptor through IP morphine followed by IP naloxone. At last, we injected three doses of IP ketorolac (3, 10, 30 mg/kg) mixed with one dose of morphine (2 mg/kg) for fixed dose analysis. Results: IP morphine delayed the paw withdrawal latency time dose dependently, but not ketorolac. $ED_{50}$ of IP morphine was 2.1 mg/kg. And the IP morphine effect was reversed to control level by IP naloxone. IP ketorolac + morphine combination showed no further additional effects on paw withdrawal latency time over morphine only group. Conclusions: IP ketorolac did not produce antinociceptive effect during radiant thermal stimulation. There was neither additional nor synergistic analgesic interaction between IP morphine and ketorolac in thermal stimulation rat.

• Journal of Yeungnam Medical Science
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• v.10 no.2
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• pp.445-450
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• 1993

Recent studies have shown that opiods can produce potent antinociceptive effects by interacting with opioid receptors in peripheral tissues. This study sougt to compare the effects of morphine with those of bupivacaine administered intraarticularly upon pain after arthroscopic knee surgery. In a ramdomized manner, 60 healthy patients received either morphine(3 mg in 20 ml NaCl ; n=20), bupivacaine(20 ml, 0.25% ; n=20) intraarticularly at the completion of surgery, and others were not administered(n=20) under general anesthesia after 1, 2, 4, 6, 12 and 24h of postoperative day, pain was assessed by a visual analogue pain scales, time to first analgesic use were recorded. Pain scores were significantly greater in the morphine group than two groups at 1h. From 4th until the end of the study period, pain scores were significantly greater in the bupivacaine group than in the other two group. Anagesic requirements were significantly greater in the morphine group than two groups at 1h but were significantly greater in the bupivacaine group than in the other groups throughout the remainder of the study period. The results suggest that intraarticular morphine produces an analgesic effect of delayed onset but of remarkably long duration.

• YAKHAK HOEJI
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• v.58 no.4
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• pp.268-276
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• 2014

Background: World Health Organization considers opioid analgesic use as an important measure in the treatment of pain relief. However, there are limited data about the pattern of opioid analgesic use in tertiary care hospitals in Korea. The aim of this study was to describe the trends in the prescribed amount of the opioid for 13 years from 2000 to 2012 in a single tertiary care hospital. Methods: The data from the prescribed amount of opioid use in patients aged over 18 years were retrieved from medical charts and longitudinal pharmacy records of Seoul National University Hospital. Yearly prescribed amount of opioids were calculated using defined daily dose adjusted by hospital stay (DDD/1000${\bullet}$HS). Results: Over the 13 years of the study period, overall use of opioid has increased by 64.1%. Although, the opioid use by hospitalized patients comprised 98%~99% of total amount of opioid use, the proportions of opioid use by outpatient and by cancer patient increased from 1.1% to 2.2% and from 60.5% to 69.3%, respectively. The use of non-injectable opioids has increased by 47% and that of injectables has increased by 70%. While the amount of codeine and morphine use has decreased, the use of both transdermal and injection formulation of fentanyl has increased dramatically. Also, the use of oxycodone has increased, especially in outpatient setting. Conclusion: This longitudinal study showed that opioid analgesic use in tertiary hospital, especially in outpatient is continuously increasing. Improvement in pain management in tertiary care hospital can be cautiously inferred based on this results.

• The Korean Journal of Pain
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• v.13 no.2
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• pp.259-262
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• 2000

There are many difficulties in the management of terminal cancer pain. We often encounter difficulties when nerve blocks or epidural injection of drugs do not produce good results. Local anesthetics, opioids and adjunctives, were administered to two patients intrathecally. The results were very satisfactory. It has complications such as hypotension or infection due to intrathecal route. In the first case, the pancreatic cancer patient complicated with severe epigastic pain but unfortunately no management was effective in pain control. Intrathecal injection of bupivacaine and morphine mixture was successful even if syncope which was relieved by bed rest. In the second case, the patient complicated with lower abdominal pain due to ovarian cancer who very well controlled by epidural injection of morphine and clonidine mixture but morphine demand was greatly increased. Intrathecal injection of morphine and ketamine were tried. The patient had comportable analgesic effect. CSF leakage to subcutaneous occurred but resolved by change of the catheter position or retunnelling. There were no significant complications reported in two cases.

• The Korean Journal of Pain
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• v.11 no.2
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• pp.321-325
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• 1998

Most of the patients with pain resulting from advanced cancer need opioid for adequate analgesia. Various Methods of drug administration to control the pain have been developed. One of them, continuous administration of intravenous morphine is used for more effective pain control in the patient with severe pain that cannot be satisfactorily controlled by other Methods of morphine administration. But this is not a suitable method at home because of the possibility of serious infectious complications and the difficulty in managing intravenous access by untrained personnel. Continuous subcutaneous adminstration of drugs can not only overcome such disadvantages of continuous intravenous infusion but also get almost the same effect of pain control as continuous intravenous infusion, and allows opportunity to move freely and return home, improving quality of life. We used continuous subcutaneous morphine and metoclopramide in the patients with cancer pain via a portable PCA device, and accomplished satisfactory pain relief without significant side effect.

• The Korean Journal of Pain
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• v.24 no.1
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• pp.22-30
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• 2011

Background: Pregabalin has been shown to have analgesic effect in acute pain models. The primary objective was to examine the efficacy a single dose of pregabalin, would have on morphine consumption following lumbar discectomy. Methods: With ethical approval a randomized, placebo-controlled prospective trial was undertaken in 32 patients (ASA I-II, 18-65 years) with radicular low back pain for > 3 months undergoing elective lumbar discectomy. Patients received either oral pregabalin 300 mg (PG Group) or placebo (C Group) one hour before surgery. Pain intensity, the accumulative morphine consumption and adverse effects were recorded for 24 hours following surgery. Functional, psychological and quantitative sensory testing were also assessed. Results: Fourteen patients out of the 32 recruited were randomized to receive pregabalin. Morphine consumption was reduced (absolute difference of 42.3%) between groups with medium effect size. (Mann-Whitney; U =52.5, z-score= 2.84, P = 0.004, r = 0.14). This was not associated with a significant difference in the incidence of adverse effects between the two groups. The median pain intensity (VAS) on movement was not significantly different between groups. Conclusions: A single pre-operative dose of pregabalin (300 mg) did not result in a reduction in pain intensity compared to placebo in this patient cohort but the significant reduction in morphine consumption suggests that a fixed peri-operative dosing regime warrants investigation.

• Biomolecules & Therapeutics
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• v.7 no.3
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• pp.278-284
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• 1999

DK1001 is a thebain derivative, which is newly synthesized as an alkaloid analgesic. This study was designed to study effects of DK1001 on the ligands binding to the opioid receptor subtypes, and general pharmacology of DK1001. DK1001 inhibited the binding of [$^3H$]DAMGO, a selective mu-subtype agonist, to the opioid receptor of rat forebrain in a concentration-dependent manner. $EC_{50}$ of DK1001 was significantly lower than that of morphine. DK1001 inhibited the binding of 〔$^3$H〕DPDPE, a selective delta-subtype agonist concentration-dependently. DK1001(0.5 mg/kg) had no effects on behavior, body temperature, blood pressure. respiratory rate, and intestinal charcoal propulsion of mice. In addition, DK1001 did not affect on the contractilities of isolated muscle strips of aorta, ileum, and trachea of rats. These results suggest that DK1001 might be a potent analgesic without serious side effects.

• Journal of Oral Medicine and Pain
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• v.38 no.2
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• pp.161-174
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• 2013

This study was designed to evaluate the pain control effect by morphine injection to masticatory muscle pain patients. Patients with masticatory muscle pain visited the Department of Oral Medicine, Kyung Hee University Dental Hospital were recruited to this study and diagnosed by RDC/TMD. Experimental group were divided into four group; saline injection group (n=10), lidocaine injection group (n=10), morphine 1.5 mg injection group (n=10) and morphine 3 mg injection group (n=10). Evaluation list was the subjective pain evaluation(visual analogue scale, Mc Gill pain questionnaire, pain drawing) and the objective pain evaluation(pressure pain threshold, pressure pain tolerance) and evaluation time was injection before, after 1 hour, 24 hour, 48 hour and then it was analyzed statistically. The results were as follows : 1. The subjective pain evaluation were significantly different statistically in morphine 3 mg group after 48 hour. (VAS: p<0.01, MGQ: p<0.001, PD: p<0.05) 2. The objective pain evaluation were significantly different statistically in morphine 1.5 mg group after 1 hour. (PPT: p<0.01, PPTol: p<0.05) 3. The morphine 3 mg group were more significantly different than lidocaine group and morphine 1.5 mg group statistically in the McGill pain questionnaire evaluation. (1h: p<0.01, 24h: p<0.01, 48h: p<0.001) Therefore, it was revealed that the morphine 3 mg injection was effective to pain control for masticatory muscle pain patients within 48 hours and more effect than lidocaine injection.

• Biomolecules & Therapeutics
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• v.19 no.1
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• pp.45-51
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• 2011

These experiments were designed to use typical makers from behaviors and molecular basis in addicted animals of morphine and cocaine. Morphine has been widely abused with a high physical dependence liability. Morphine withdrawal activates the intracellular cAMP signaling pathway and further leads to changes in the expression of the cAMP response element binding protein (CREB), which may be important to the development and expression of morphine dependence. From these experiments, repeated morphine (10 mg/kg, twice per day for 7 days) developed physical dependence. Withdrawal signs were precipitated by naloxone and also increased the expression of the CREB. In addition, repeated exposure of cocaine (15 mg/kg) to mice develops locomotor sensitization and produced lasting behavioral sensitivity. Cocaine- and amphetamine-regulated transcript peptide (CART) peptide was up-regulated by repeated administration of cocaine in the striatum. Therefore, repeated morphine induced the development of physical dependence and increased pCREB. In addition, repeated cocaine induced locomotor sensitization and over-expressed CART peptide. In conclusion, the development of physical dependence and pCREB for morphine, and locomotor sensitization and CART peptide over-expression for cocaine would be useful markers to predict the abuse potential of opioid analgesics and pychostimulant drugs in animals, respectively.