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Preemptive Analgesia: No Relevant Advantage of Preoperative Compared With Postoperative Intravenous Administration of Morphine, Ketamine, and Clonidine In Patients Undergoing Transperitoneal Tumor Nephrectomy
  1. Holger Holthusen, M.D.,
  2. Peter Backhaus, M.D.,
  3. Frank Boeminghaus, M.D.,
  4. Maria Breulmann, M.D. and
  5. Peter Lipfert, M.D.
  1. From the Department of Anesthesiology, Heinrich-Heine-University (H.H., P.L.), Duesseldorf, Germany; and the Departments of Anesthesiology (P.B., M.B.) and Urology (F.B.), Lukaskrankenhaus, Staedtische Kliniken, Neuss, Germany.
  1. Reprint requests: Priv.-Doz. Dr. Holger Holthusen, Klinik für Anaesthesiologie, Heinrich-Heine-Universität, Postfach 10 10 07, D-40001 Düsseldorf, Germany. E-mail: holthusen@med.


Background and Objectives Preemptive analgesia often failed in the clinical arena because application of a single intravenously applied drug may not prevent nociceptive input and spinal pain processing sufficiently. We therefore used an intravenous (IV), multireceptor approach and tested the preemptive analgesic effect of the antinociceptive drugs morphine, ketamine, and clonidine given before or immediately after surgery.

Methods A double-blind, randomized, prospective study was performed in 30 patients undergoing transperitoneal tumor nephrectomy (via median laparotomy). Standard general anesthesia procedure without opioids was used. After induction, patients were randomly allocated to receive 150 μg · kg−1 of morphine, 150 μg · kg−1 of ketamine, and 5 μg · kg−1 of clonidine intravenously via a motor-driven pump within 15 minutes, either before or immediately after surgery. Patient-controlled analgesia (PCA) with the opioid piritramide (IV) was used for postoperative analgesia. Postoperative pain at rest and during induced cough was quantified by analgesic requirement and pain scores (visual analog scale [VAS]) within 48 hours.

Results There was no significant difference in analgesic requirement of piritramide and pain scores at rest or during induced cough.

Conclusions In contrast to encouraging observations on the combination of antinociceptive drugs, the multireceptor approach tested here failed to exert a clinically relevant effect.

  • Clonidine
  • Ketamine
  • Morphine
  • Preemptive analgesia

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  • Supported in part by grants of the Rheinisch-Westfälische Gesellschaft für Urologie and the Dr. Karl Thomae GmbH, Biberach, Germany.

    Presented in part as a poster at 9th World Congress on Pain, August 22-27, 1999, Vienna, Austria.