Prevention of Hyperalgesia With Epidural Morphine

Study Overview
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Brief Summary
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American Society of Anaesthesiologist physical status (ASA) I-III 105 patients who undergoing major abdominal surgery in obstetric and gynaecology clinic were recruited to this study. Patients were randomized into the 3 groups. Lumbar epidural catheter will be inserted to the all patients. After than anaesthesia induction will provide with 2 mg/kg propofol and 0.6 mg/kg rocuronium. Desflurane and azot protoxit (N2O)-O2 will use for anaesthesia maintenance. During surgical operation, 0.3 microgram/kg/h remifentanil infusion will continuous till the end of surgery. In group I, 2 ml serum physiologic (0.9 NaCL)will apply from epidural catheter before surgical incision. In group II, 1 mg morphine will apply from epidural catheter before surgical incision. In group III, 1 mg morphine will apply from epidural catheter at the time point of peritoneum is closed. Epidural patient controlled analgesia will provide with bupivacaine for postoperative analgesia. Postoperative pain will be assessed with numerical pain scale. Postoperative analgesic requirement will be calculated. Hyperalgesia will detect with algometer and von Frey ligaments.

Detailed Description
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This randomized, double blind, controlled study will perform after obtaining informed consent and ethics approval. American Society of Anaesthesiologist physical status (ASA) I-III 105 patients who undergoing major abdominal surgery in obstetric and gynaecology clinic were recruited to this study. Patients were randomized into the 3 groups with computerized randomization programme. Lumbar epidural catheter will be inserted to the all patients. After than anaesthesia induction will provide with 2 mg/kg propofol and 0.6 mg/kg rocuronium. Desflurane and N2O-O2 will use for anaesthesia maintenance. During surgical operation, 0.3 microgram/kg/h remifentanil infusion will continuous till the end of surgery. In group I, 2 ml serum physiologic (0.9 NaCL)will apply from epidural catheter before surgical incision. In group II, 1 mg morphine will apply from epidural catheter before surgical incision. In group III, 1 mg morphine will apply from epidural catheter at the time point of peritoneum is closed. Epidural patient controlled analgesia will provide with bupivacaine for postoperative analgesia. Postoperative pain will be assessed with numerical pain scale. Postoperative analgesic requirement will be calculated. Hyperalgesia will detect with algometer and von Frey ligaments.

Official Title
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Does Preemptive Epidural Morphine Prevent Remifentanil Induced Hyperalgesia

Conditions
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Hyperalgesia

Intervention / Treatment
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* Drug: Morphine
* Drug: Serum physiologic


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA I-III patients Patients who undergoing major abdominal surgery Exclusion Criteria: ASA IV and up Coagulopathy

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: serum physiologic<br>2 ml serum physiologic will apply via epidural catheter before surgical incision. | Drug: Serum physiologic<br>* For placebo, serum physiologic will use<br>* Other names: Group III;|
| Active Comparator: Preemptive Morphine<br>1 mg morphine will apply via epidural catheter before surgical incision. | Drug: Morphine<br>* Prevention of remifentanil induced hyperalgesia<br>* Other names: Group I-II;|
| Active Comparator: Morphine<br>1 mg morphine will apply via epidural catheter before at the time point of the peritoneum closed. | Drug: Morphine<br>* Prevention of remifentanil induced hyperalgesia<br>* Other names: Group I-II;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative analgesic requirement | Calculation of epidural bupivacain consumption | Till the postoperative 24th hour. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Algometer values | Postoperative pain will detect with algometer | Till the postoperative 24th hour. |