بررسي افزودن تركيب كلروپرومازين، پرومتازين، و ميدازولام به پمپ مرفين PCA بر درد بعد از عمل بيماران معتاد

aluation of adding chlorpromazine, promethazine and midazolam to morphine in patient-controlled analgesia (PCA) on postoperative pain in addicted patients

Background: Acute postoperative pain management is challenging in patients with preoperative narcotic dependency. Opioids are cornerstone drugs for this purpose, but even large doses of opioids to these patients does not always provide adequate postoperative analgesia. Therefore, some adjuvant drugs were administrered to provide sufficient analgesia. This prospective randomized study was designed to assess analgesic effect of added chlorpromazine, promethazine and midazolam as adjuncts to IV patient-controlled analgesia (PCA) morphine for postoperative pain management in addicted patients. Materials and methods: Eigthy opioid tolerant patients candidated for postoprative pain management by PCA were divided in two groups (M and P groups). The patients were started on PCA with a 5 ml/h basal infusion and the daily drug administration in M group was morphine 40 mg, and in P group was chlorpromazine 50 mg, promethazine 50 mg, and midazolam 10 mg added to morphine 20 mg. Visual analogue pain scale (VAS), sedation score, average morphine administrered, and side effects were evaluated for 72 hours. Statistic analysis were done by Friedmann, Chi- square, Kruskal-Wallis and Mann-Whitney U tests. Results: Demographic data were not different between two groups. The pain score in M group was more than P group (3.2±1.8 vs 2.4±1.2) (p<0.05). Furthermore, sedation score was lower in group M than P group (1.2±0.3 vs 2.3±0.4) that the difference was significant (p<0.05). Although, the average additional morphine consumption was not different between two groups (21±8.5 vs 20.5±6.5 mg), the total morphine administered was significantly higher in M than P group (140±15.9 vs 81.2±12.6 mg) (p<0.01). There were not observed any considerable side effects in both groups. Conclusion: In opioid tolerant patients, combination of chlorpromazine, promethazine and midazolam added to PCA morphine caused better postoperative analgesia and lower analgesics requirement