Preemptive Effect of Adding Morphine to Topical lidocaine on Pain Intensity after Mastoidectomy-Tympanoplasty and Comparison with the Control Group

Authors

1 1- Associate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Associate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 2- Resident, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Due to the need to prevention of postoperative pain after mastoidectomy-tympanoplasty, the
present study was performed to evaluate the preemptive effect of adding morphine to topical lidocaine on
postoperative pain intensity.
Methods: In this double-blind clinical trial study, 80 patients who were candidates for elective mastoidectomytympanoplasty surgery were randomly divided into two groups of 40; the first group underwent local anesthesia
with lidocaine, and the second group underwent local anesthesia with lidocaine with morphine. Patients were
evaluated for hemodynamic parameters, postoperative pain intensity during surgery and recovery and 24 hours
after surgery, and the findings were compared between the two groups.
Findings: Evaluation of patients' pain intensity in recovery and ward showed that at the time of patients'
recovery and two hours after surgery, the intervention group had a lower intensity; but in 12 and 24 hours after
surgery, no significant difference was seen between the two groups. In the intragroup study, pain intensity
significantly reduced in both groups, but the rate of pain reduction in the intervention group was significantly
higher. The trend of changes in hemodynamic parameters during surgery and length stay in recovery was not
significantly different between the two groups.
Conclusion: Addition of morphine to topical lidocaine reduces the postoperative mastoidectomy-tympanoplasty
surgery, while topical use of this drug has no effect on patients' hemodynamics, longer recovery, and extubating time.

Keywords

References

Mamishi N, Behroozishad F, Mohagheghi MA, Eftekhar Z, Shahabi Z. The study of nurses’ knowledge and attitudes regarding cancer pain management. Hayat 2006; 12(2): 23-32.
Hurley RW, Wu CL. Acute postoperative Pain. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish J, Young WL, editors. Miller's Anesthesia.7th ed. Philadelphia, PA: Churchill Livingstone; 2010. p. 2729-62.
Shakeri MR, Derakhshan P, Sheykholvaezin F, Koleini Z. The comparison between postoperative analgesic effect of Morphine-Apotel and Ketorolac alone with intravenous patient control analgesia in patients candidate for plating surgery. J Anesth Pain 2016; 7(2): 1-8. [In Persian].
Birnbach DJ, Ingrid M. Anesthesia for obstetrics. In: Miller RD, editor. Text book of anesthesia. Philadelphia, PA: Churchill Livingstone; 2010. pp. 2215–9.
Wang W, Gao X, Ma Y, Di X, Xiao K, Zhou L, et al. Regional vs general anesthesia for retrograde intrarenal surgery: A systematic review and meta-analysis. J Endourol 2020; 34(11): 1121-8.
Hirabayashi M, Imamachi N, Sakakihara M, Saito Y. Treatment of intrathecal fentanyl-induced itch with pentazocine: A case report. Masui 2014; 63(6): 696-9. [In Japanese].
Mehrvarzfar P, Pourhashemi A, Khodaei F, Bohlouli B, Sarkarat F, Kalantar MM, et al. The effect of adding fentanyl to epinephrine-containing lidocaine on the anesthesia of maxillary teeth with irreversible pulpitis: A randomized clinical trial. Iran Endod J 2014; 9(4): 290-4.
Koppert W, Ostermeier N, Sittl R, Weidner C, Schmelz M. Low-dose lidocaine reduces secondary hyperalgesia by a central mode of action. Pain 2000; 85(1-2): 217-24.
Dirks J, Fabricius P, Petersen KL, Rowbotham MC, Dahl JB. The effect of systemic lidocaine on pain and secondary hyperalgesia associated with the heat/capsaicin sensitization model in healthy volunteers. Anesth Analg 2000; 91(4): 967-72.
Mahoori A, Hassani E, Motarjemizadeh G, Mojtahedi S. The Effect of Intravenous Lidocaine on Postoperative Pain, Sedation and Nausea & Vomiting after Strabismus Surgery. J Anesth Pain2014; 4(4): 22-7. [In Persian].
Chiu LYL, Sun T, Ree R, Dunsmuir D, Dotto A, Ansermino JM, et al. The evaluation of smartphone versions of the visual analogue scale and numeric rating scale as postoperative pain assessment tools: A prospective randomized trial. Can J Anaesth 2019; 66(6): 706-15.
Entezari S, Alebouyeh M, Mohseni M, Faiz H, Rahimzadeh P, safari s. Pain control and ACTH changes in postoperative intravenous analgesia versus epidural analgesia in limb orthopedic surgery patients. J Anesth Pain2012; 2(4): 3-10. [In Persian].
Guimaraes Alves IP, Montoro NG, Diniz MS, Alves Rocha TL, Prada KG, Navarro CR. Analgesic comparison of systemic lidocaine, morphine or lidocaine plus morphine infusion in dogs undergoing fracture repair. Acta Cir Bras 2014; 29(4): 245-51.
Cepeda MS, Delgado M, Ponce M, Cruz CA, Carr DB. Equivalent outcomes during postoperative patient-controlled intravenous analgesia with lidocaine plus morphine versus morphine alone. Anesth Analg 1996; 83(1): 102-6.
Firouzian A, Alipour A, Rashidian DH, Zamani KA, Gholipour BA, Emami ZA, et al. Does lidocaine as an adjuvant to morphine improve pain relief in patients presenting to the ED with acute renal colic? A double-blind, randomized controlled trial. Am J Emerg Med 2016; 34(3): 443-8.
Cabral SA, Carraretto AR, Brocco MC, Abreu Baptista JF, Gomez RS. Effect of clonidine added to lidocaine for sub-Tenon's (episcleral) anesthesia in cataract surgery. J Anesth 2014; 28(1): 70-5.
Journal of Isfahan Medical School
Volume 39, Issue 656
November and December 2022
Pages 1010-1016

Files

History

  • Receive Date: 03 April 2022
  • Accept Date: 03 April 2022

Share

How to cite

Statistics