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Perioperative nimodipine and postoperative analgesia.
Anesth Analg. 2006 Feb; 102(2):504-8.A&A

Abstract

There is experimental evidence that nimodipine, an L-type dihydropiridine calcium channel blocker with relatively high blood-brain barrier penetration, enhances the antinociceptive properties of morphine. We tested the hypothesis that oral nimodipine taken preoperatively and 6 hourly for 48 h postoperatively would reduce visual analog scale pain scores and morphine consumption in morphine-naive patients with acute postoperative pain. Forty patients undergoing total knee replacement surgery (age 70 +/- 7 yr, 28 male) were randomized by computer-generated numbers to receive capsules containing either nimodipine 30 mg or placebo in a double-blind study design. All patients received 3 capsules (nimodipine 90 mg or placebo) 1-2 h before induction of anesthesia followed by oral nimodipine 30 mg or placebo 6 hourly for 48 hours postoperatively. Spinal anesthesia was induced with hyperbaric bupivacaine 0.5% (2.4-3.0 mL) and fluids and ephedrine were given at the discretion of the anesthesiologist. Morphine patient-controlled analgesia (PCA, bolus 1 mg, lockout 5 min) was given for postoperative analgesia. Primary outcome measures were visual analog pain scores at rest and on moving (sitting forward) and PCA morphine consumption. Morphine consumption was significantly larger in nimodipine patients at 12 h (39 +/- 18 versus 29 +/- 15; P = 0.04), 24 h (62 +/- 23 versus 45 +/- 24; P = 0.02), and 48 h (88 +/- 34 versus 61 +/- 27; P = 0.01). There were no significant differences in pain scores at rest or moving or in time to first use of morphine analgesia. This study has demonstrated increased morphine consumption after 12 h in postoperative patients receiving nimodipine, suggesting that, in patients undergoing knee replacement surgery, it has no adjunctive analgesic effect and may actually inhibit the analgesic effect of morphine.

Authors+Show Affiliations

Casey G
Department of Anaesthesia, University Hospitals of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK.
Nortcliffe SA
No affiliation info available
Sharpe P
No affiliation info available
Buggy DJ
No affiliation info available

MeSH

Administration, OralAdultAgedAged, 80 and overAnalgesia, Patient-ControlledAnalgesics, OpioidAnesthesia, GeneralArthroplasty, Replacement, KneeCalcium Channel BlockersDouble-Blind MethodDrug SynergismFemaleHumansMaleMiddle AgedMorphineNimodipinePain MeasurementPain, PostoperativePreoperative Care

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16428551

Citation

Casey, Gerri, et al. "Perioperative Nimodipine and Postoperative Analgesia." Anesthesia and Analgesia, vol. 102, no. 2, 2006, pp. 504-8.
Casey G, Nortcliffe SA, Sharpe P, et al. Perioperative nimodipine and postoperative analgesia. Anesth Analg. 2006;102(2):504-8.
Casey, G., Nortcliffe, S. A., Sharpe, P., & Buggy, D. J. (2006). Perioperative nimodipine and postoperative analgesia. Anesthesia and Analgesia, 102(2), 504-8.
Casey G, et al. Perioperative Nimodipine and Postoperative Analgesia. Anesth Analg. 2006;102(2):504-8. PubMed PMID: 16428551.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Perioperative nimodipine and postoperative analgesia. AU - Casey,Gerri, AU - Nortcliffe,Sally-Ann, AU - Sharpe,Paul, AU - Buggy,D J, PY - 2006/1/24/pubmed PY - 2006/2/24/medline PY - 2006/1/24/entrez SP - 504 EP - 8 JF - Anesthesia and analgesia JO - Anesth Analg VL - 102 IS - 2 N2 - There is experimental evidence that nimodipine, an L-type dihydropiridine calcium channel blocker with relatively high blood-brain barrier penetration, enhances the antinociceptive properties of morphine. We tested the hypothesis that oral nimodipine taken preoperatively and 6 hourly for 48 h postoperatively would reduce visual analog scale pain scores and morphine consumption in morphine-naive patients with acute postoperative pain. Forty patients undergoing total knee replacement surgery (age 70 +/- 7 yr, 28 male) were randomized by computer-generated numbers to receive capsules containing either nimodipine 30 mg or placebo in a double-blind study design. All patients received 3 capsules (nimodipine 90 mg or placebo) 1-2 h before induction of anesthesia followed by oral nimodipine 30 mg or placebo 6 hourly for 48 hours postoperatively. Spinal anesthesia was induced with hyperbaric bupivacaine 0.5% (2.4-3.0 mL) and fluids and ephedrine were given at the discretion of the anesthesiologist. Morphine patient-controlled analgesia (PCA, bolus 1 mg, lockout 5 min) was given for postoperative analgesia. Primary outcome measures were visual analog pain scores at rest and on moving (sitting forward) and PCA morphine consumption. Morphine consumption was significantly larger in nimodipine patients at 12 h (39 +/- 18 versus 29 +/- 15; P = 0.04), 24 h (62 +/- 23 versus 45 +/- 24; P = 0.02), and 48 h (88 +/- 34 versus 61 +/- 27; P = 0.01). There were no significant differences in pain scores at rest or moving or in time to first use of morphine analgesia. This study has demonstrated increased morphine consumption after 12 h in postoperative patients receiving nimodipine, suggesting that, in patients undergoing knee replacement surgery, it has no adjunctive analgesic effect and may actually inhibit the analgesic effect of morphine. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/16428551/Perioperative_nimodipine_and_postoperative_analgesia_ DB - PRIME DP - Unbound Medicine ER -
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