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      Postoperative analgesic effect of hydromorphone in patients undergoing single-port video-assisted thoracoscopic surgery: a randomized controlled trial

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          Objective: To study the general efficacy of hydromorphone as a systemic analgesic in postoperative pain management following single-port video-assisted thoracoscopic surgery (VATS) and to explore the optimal administration regimen.

          Methods: A prospective, randomized, double-blind study was designed and conducted in a tertiary hospital. In total, 157 valid patients undergoing single-port VATS were randomly allocated into three groups. A total of 53 patients received morphine bolus only for postoperative analgesia (Group Mb); 51 patients received a hydromorphone background infusion plus bolus (Group Hb + i), and 53 patients received a hydromorphone bolus only (Group Hb). The primary outcomes were patient-reported static and dynamic pain levels; the secondary outcomes included side effects, sleep quality, and recovery indexes.

          Results: Patients in Group Hb + i experienced lower pain intensity (approximately 10 out of 100 on the visual analog scale) in both static pain and dynamic pain in the days following surgery ( P<0.01), better sleep quality during the first night only ( P=0.002), and a higher satisfaction level than those in the other two groups ( P=0.006). A comparison of these variables in Group Mb and Group Hb resulted in no significant differences. Lastly, side effects and recovery indexes remained the same among bolus-only groups and bolus-plus-background-infusion groups.

          Conclusion: There is no advantage to administering hydromorphone over morphine using bolus only mode. Within 24 h after surgery, a background infusion should be considered as a part of a standard protocol for patient-controlled intravenous analgesia. At 24 h after surgery, the background infusion should be adjusted in accordance with patient preferences and pain intensity.

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          Most cited references 35

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          Quality of sleep and its daily relationship to pain intensity in hospitalized adult burn patients.

          Sleep disturbances are frequently reported in victims following burn injuries. This prospective study was designed to assess sleep quality and to examine its daily relationship to pain intensity within the first week of hospitalization. Twenty-eight non-ventilated patients were interviewed during 5 consecutive mornings (number of observations=140) to collect information about perceived quality of sleep (visual analogue scale, number of hours, number of awakenings, presence of nightmares). Pain intensity was assessed at rest (nighttime, morning, during the day) and following therapeutic procedures using a 0-10 numeric scale. Seventy-five percent of patients reported sleep disturbances at some point during the study although, in most patients, sleep quality was not consistently poor. Pooled cross-section regression analyses showed significant temporal relationships between quality of sleep and pain intensity such that a night of poor sleep was followed by a significantly more painful day. Pain during the day was not found to be a significant predictor of poor sleep on the following night. These results support previous findings that perceived quality of sleep following burn injury is poor. Moreover, they show a daily relationship between quality of sleep and acute burn pain in which poor sleep is linked to higher pain intensity during the day.
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            Dose ratio between morphine and hydromorphone in patients with cancer pain: a retrospective study.

            Morphine (M) and hydromorphone (HM) are commonly used opioid analgesics for cancer pain. Opioid rotation is often necessary in the event of toxicity and/or inadequate analgesia. Equianalgesic reference tables based on single dose comparisons are possibly inadequate for patients on chronic treatment and developing tolerance. This retrospective study of opioid rotation involving M and HM sought to determine the equianalgesic dose ratio for 91 rotations in 74 consecutively evaluable cancer pain patients. Only rotations involving subcutaneous (s.c.-s.c.) and oral (p.o.-p.o.) routes were evaluated. There were 44 rotations from M-HM (34: s.c.-s.c., 10: p.o.-p.o.) and 47 rotations from HM-M (35: s.c.-s.c., 12: p.o.-p.o.). Expressing all ratios as M/HM, the median dose ratios (lower-upper quartiles) for s.c. and p.o. rotations were 4.92 (4.1-5.9) vs. 5.76 (4.9-5.8) for M-HM (P = 0.28, NS) and 4.0 (3.1-4.8) vs. 3.45 (2.8-4.2) for HM-M (P = 0.4, NS), respectively. Pain intensity, as measured on a visual analogue scale (VASP), showed no significant difference between mean values pre- and post-rotation. A unified overall median dose ratio of 4.29 (3.3-5.3, lower-upper quartiles) was calculated by expressing all of the HM-M dose ratios as M/HM and combining them with the dose ratios for all of the M-HM rotations. This suggests a potency ratio of approximately 4.3:1 between M and HM. When expressed as M/HM for dose ratio comparison, the median dose ratio for all HM-M rotations was 3.7 (2.9-4.5, lower-upper quartiles) vs. 5 (4.2-5.9) for M-HM rotations (P = 0.0001), suggesting that the opioid to which rotation is taking place is more potent than our proposed unified overall median dose ratio of 4.29:1 would predict. Our data suggests that HM is 5 times more potent than M when given second (M-HM), but is only 3.7 times more potent when given first (HM-M). We therefore recommend a ratio of 5 for M/HM in rotating from M to HM and ratio of 3.7 for M/HM when rotating from HM to M in patients exposed to chronic dosing of these opioids. There was no correlation observed between M-HM and HM-M dose ratios and the level of previous opioid dose, in contrast to HM to methadone rotation where the dose ratio was higher in patients receiving higher doses of HM.
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              Sleep disturbances, pain and analgesia in adults hospitalized for burn injuries.

              Sleep disturbances are frequently reported in hospitalized patients. We have recently shown significant daily relationships between poor sleep and acute burn pain during the first week of hospitalization, where poor sleep leads to reports of higher pain intensity and in return, greater pain affects quality of sleep. This prospective study was designed to objectively evaluate sleep disturbances in hospitalized burn patients and further evaluate their relationships with pain intensity and administered medication.

                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                27 March 2019
                : 12
                : 1091-1101
                [1 ]Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine , Hangzhou 310009, People’s Republic of China
                [2 ]Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University , Xuzhou 221004, People’s Republic of China
                [3 ]Department of Thoracic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine , Hangzhou 310009, People’s Republic of China
                Author notes
                Correspondence: Min YanDepartment of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine , Hangzhou310009, People’s Republic of ChinaTel +86 571 8776 7223Fax +86 571 8778 3638Email zryanmin@ 123456zju.edu.cn
                © 2019 Bai et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 1, Tables: 8, References: 40, Pages: 11
                Original Research


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