Regularly Scheduled Oral Morphine for Post Surgical Orthopedic Pain
Bibliographic record
Abstract
ABSTRACT Post-surgical pain (PSP) is often poorly controlled despite the availability of many effective narcotic analgesics. Poor analgesia may be due to the use of inappropriate doses and dosing intervals rather than the type of analgesic agent used. Oral morphine administered on a regular schedule is a very effective therapy in patients with chronic pain but has not been actively investigated in the treatment of acute post-surgical pain in adults. We studied the use of regularly scheduled oral morphine given every four hours in 13 patients undergoing total hip arthroplasty. This was an open pilot study to determine if regularly dosed oral morphine was effective and safe in this patient population. All patients initially received 20 mg PO q4h regularly dosed oral morphine with an option to receive 10 mg PO morphine PRN for pain. Eleven of 13 patients completed the study and received oral morphine for an average of 48 hours. Of the two patients who did not complete the study, one withdrew due to inadequate pain control and one withdrew due to upper gastrointestinal discomfort. None of the 11 patients completing the study required any parenteral morphine for breakthrough pain, and only three patients requested additional doses of oral morphine. Vomiting occurred in six of the study patients. lt appears that regularly dosed oral morphine may be an effective means of administering narcotics to postsurgical orthopedic patients and should be compared in clinical trials to other methods of narcotic delivery. RESUME Les douleurs post-chirurgicales (DPS) sont souvent mal controlees, malgre la disponibilite d'un grand nombre d'analgesiques narcotiques efficaces. Il est possible que les problemes d'analgesie resultent plus d'une posologie et/ou d'intervalles entre les doses inadequates que du choix de l'analgesique. L'administration de morphine par voie orale a intervalles reguliers donne de bons resultats chez les patients qui eprouvent des douleurs chroniques, mais cette possibilite n'a pas ete examinee pour les douleurs post-chirurgicales aigues chez l'adulte. Les auteurs se sont penches sur l'administration de morphine par voie orale a l’intervalles reguliers, soit aux quatre heures, chez 13 patients ayant subi une arthroplastie complete de la hanche. L'etude pilote libre devait determiner l’efficacite et l'innocuite de l'administration reguliere d'une dose de morphhine par voie orale a cette population. Chaque patient a recu au depart 20 mg po q4h de morphine par voie orale sur une base reguliere. Les patients pouvaient en outre obtenir 10 mg po de morphine prn pour combattre la douleur. Onze des treize sujets ont completes l'etude et recu de la morphine par voie orale pendant 48 heures en moyenne. Un des deux patients qui ont abandonne le projet a donne comme raison un mauvais controle de la douleur tandis que le second a mentionne des malaises dans la partie superieure du systeme gastro-intestinal. Aucun des onze patients qui ont complete l'etude n'a eu besoin de morphine parenterale pour combattre la douleur et seuls trois d'entre eux ont reclame des comprimes supplementaires. Six on souffert de vomissements. Il semble que l'administration de morphine en doses regulieres par voie orale s'avere efficace chez les patients qui subissent une intervention chirurgicale orthopedique et cette methode devrait etre comparee a d'autres techniques d'administration des narcotiques dans le cadre d’essais cliniques.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".