Pethidine versus morphine in postoperative pain relief of opioid-dependent patients in Zagazig University Hospital, Asharqia, Egypt
Postoperative pain management is a challenge in opioid-dependent patients as this patient group is often undertreated for pain. An appropriate dose of an appropriate opioid should be administered to these patients to control the pain and prevent the development of withdrawal symptoms.
The aim of this study was to evaluate the analgesic and adverse effects of pethidine versus morphine in postoperative pain relief in opioid-dependent patients after major surgery.
Eighty opioid-dependent patients undergoing major surgical operations were included in our study. Forty patients received intravenous morphine (up to 0.15 mg/kg) or intramuscular pethidine (up to 1.5 mg/kg) for 48 h postoperatively. Withdrawal symptoms were recorded using the Clinical Opioid Withdrawal Scale (COWS) at 30 and 60 min after drug administration. The effectiveness and tolerability profile of pethidine was compared with that of morphine at 6, 12, 24 and 48 h after the initiation of treatment. Analgesic efficacy was recorded using a visual analogue scale (VAS), and drug safety was estimated using sedation scores and adverse drug reactions.
Pethidine and morphine had similar analgesic effects at 6 and 12 h postoperatively, but morphine had better analgesic effects at 24 and 48 h. Morphine was associated with fewer adverse reactions and less prominent withdrawal symptoms than pethidine.
Morphine is a more effective and better tolerated analgesic than pethidine in the management of postoperative pain in opioid-dependent patients.
Compliance with ethical standards
Conflict of Interest
Dalia M. Amin and Ahmed M. El Teliti declare no conflict of interests in relation to this article.
No financial support was received for this study.
This study was approved by the local ethical committee of the Faculty of Medicine, Zagazig University Hospital, Zagazig, Egypt.
- 4.Kuehn BM. Opioid prescriptions soar: increase in legitimate use as well as abuse. JAMA. 2017;297(3):249–51.Google Scholar
- 8.Farsinejad M, Sanaei-Zadeh H. Methadone detoxification versus traditional gradual decrease in the consumed amount of refined opium dross (Shireh): the preferred method for controlling withdrawal syndrome. Iran J Toxicol. 2016;7(17):638–41.Google Scholar
- 12.Cork RC, Isaac I, Elsharydah A, et al. A comparison of the verbal rating scale and the visual analog scale for pain assessment. Internet J Anesthesiol. 2014;8:50–2.Google Scholar
- 13.Hossain MS. Comparative study between intramuscular ketorolac and intramuscular diclofenac for management of post-operative pain. Comilla BMA Med J. 2003;10:58–62.Google Scholar
- 15.Abbas SM, Kamal RS, Afshan G. Effect of ketorolac on post-operative pain relief in dental extraction cases a comparative study with pethidine. J Pak Med Assoc. 2014;54:319–22.Google Scholar
- 17.Macintyre PE, Schug SA, Scott DA, et al.; Working Group of the Australian and New Zealand College of Anaesthetists (ANZCA) and Faculty of Pain Medicine (FPM). Acute pain management: scientific evidence. 3rd ed. Melbourne, VIC: ANZCA and FPM; 2010. https://www.nhmrc.gov.au/guidelines-publications/cp104. Accessed Feb 2016.
- 19.Schumacher MA, Besbaum AI, Way WL. Opioid analgesics and antagonists. In: Ketzung BG, editor. Basic and clinical pharmacology. 9th ed. Singapore: McGraw Hill; 2004. p. 497–516.Google Scholar
- 20.Aitkenhead AR, Rowbotham DJ, Smith G. Analgesic drugs. In: Aitkenhead A, Rowbotham D, Smith G, editors. Textbook of anesthesia. 4th ed. Spain: Churchill Livingstone; 2008. p. 211–22.Google Scholar
- 22.James D, Justins D. Acute post-operative pain. In: Healy TEJ, Knight PR, editors. Wyllie and Churchill Davidson’s: a practice of anesthesia. 7th ed. India: Arnold; 2013. p. 1213–34.Google Scholar