The Effect of Interpleural Morphine on PostThoracotomy Pain Management


Department of Anesthesiology, NRITLD, Shaheed Beheshti University of Medical Sciences and Health Services, TEHRAN-IRAN


Background: Pain after thoracotomy is one of the most severe surgical pains, being the most fundamental inhibitor factor in chest wall movement after surgery. The effect of interpleural morphine on pain after thoracotomy was evaluated in a doubleblind and randomized study. Materials and Methods: In 16 patients, morphine sulfate 0.2 mg/Kg in 40 ml of 0.9% normal saline (N/S) was injected via interpleural (ip) catheter at the end of surgery. Meanwhile, 10 ml of 0.9% normal saline IV was administered [ipm group]. In 15 patients, 40cc of 0.9% N/S ip and concurrently morphine sulfate 0.05 mg/kg in 10cc of N/S IV were injected [ips group]. After first injection in the operating room, infusion of aforementioned solutions was continued every 4-hour, for 24 hours in ICU. The patients received supplementary doses of morphine IV in necessity to relief pain. By using facial pain scale (FPS), the degree of pain before and 30 min after drug injection was evaluated. The amount of supplementary morphine, side effects, sedation rate, and drainage of chest tubes were recorded over 24 hours. Results: In ipm group, FPS was significantly lower than that of ips group over 24 hours postoperatively (p <0.0.5). Mean of the required supplementary morphine in ipm group over 24 hours, was significantly less than that of ips group. Sedation rate in ips group was significantly higher than that of ipm group (p <0.05) Conclusion: Based on this study, we concluded that administration of adequate dose of interpleural morphine can cause effective and favorable analgesia after thoracotomy. Furthermore, it does not have a common systemic side effect. (Tanaffos 2003; 2(8): 31-39)