ObjectiveTo systematically review the efficacy and safety of oxycodone versus morphine for postoperative intravenous self-control analgesia (PCIA). MethodsWe searched databases including PubMed, EMbase, The Cochrane Library (Issue 8, 2015), CBM, CNKI, VIP, WanFang Data from inception to August 2015, to collect randomized controlled trials (RCTs) about oxycodone versus morphine for postoperative PCIA. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.ResultsSeven RCTs involving 826 patients were included. The results of meta-analysis showed that: there were no significant differences in postoperative analgesia at the points of 2 h, 3 h, 4 h, 8 h, 12 h, 24 h, 36 h and 48 h after surgery (2 h: MD=0.20, 95%CI –0.18 to 0.58, P=0.30; 3 hresting state: MD=–0.51, 95%CI –2.27 to 1.26, P=0.57; 3 hdynamic state: MD=–0.46, 95%CI –2.23 to 1.40, P=0.63; 4 h: MD=0.00, 95%CI –0.25 to 0.25, P=0.99; 8 h: MD=0.10, 95%CI –0.16 to 0.36, P=0.46; 12 h: MD=–0.34, 95%CI –0.85 to 0.17, P=0.19; 24 h: MD=–0.13, 95%CI –0.43 to 0.17, P=0.41; 36 h: MD=0.10, 95%CI –0.28 to 0.48, P=0.60; 48 h: MD=–0.13, 95%CI –0.36 to 0.09, P=0.25). The incidences of postoperative vomiting (OR=0.23, 95%CI 0.08 to 0.63, P=0.005), nausea (OR=0.27, 95%CI 0.08 to 0.86, P=0.03), respiratory depression (OR=0.15, 95%CI 0.04 to 0.53, P=0.003) and skin pruritus (OR=0.19, 95%CI 0.05 to 0.66, P=0.009) in the oxycodone group were lower than those in the morphine group. In addition, there were no significant differences of the incidences of headache, dizzy and shiver between two groups.ConclusionCompared with morphine, oxycodone has the same analgesia effect for PCIA, however, the incidences of adverse reactions are lower. Due to the limited quality and quantity of included studies, the above results are needed to be validated by more high quality studies.
ObjectivesTo systematically review the efficacy and safety of hydromorphone and morphine in post-cesarean section analgesia.MethodsThe Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMbase, CNKI, WanFang Data, VIP and SinoMed databases were electronically searched to identify randomized controlled trials (RCTs) of hydromorphone vs. morphine in the treatment of postoperative analgesia after cesarean section from the inception of the database to December 2017. Two reviewers independently screened literatures, extracted data and assessed risk of bias of the included trials. The meta-analysis was conducted with RevMan 5.3 software.ResultsSeven trials with 586 post-cesarean section patients were included. The results of the meta-analysis showed that, compared with the morphine group, the hydromorphone group had lower 6 h (MD=–0.23, 95%CI –0.38 to –0.08, P=0.003), 12 h (MD=–0.56, 95%CI –1.10 to –0.02, P=0.04), 24 h (MD=–0.37, 95%CI –0.65 to –0.09, P=0.01) and 48 h (MD=–0.41, 95%CI –0.74 to –0.08, P=0.01) postoperative VAS scores the with epidural anesthesia pump (PECA). There was no statistically significant difference of the postoperative Ramsay scores between the two groups. In terms of side effects, the incidence of skin pruritus (RR=0.27, 95%CI 0.09 to 0.81. P=0.02) and vomit (RR=0.15, 95%CI 0.03 to 0.65, P=0.01) of the hydromorphone group were lower than those of the morphine group.ConclusionsThe current evidence demonstrate that, compared with morphine, hydromorphone has better postoperative analgesia performance and less risk of exhibiting skin pruritus and vomit after cesarean section. Considering of the overall quality of evidence and the relatively small pooled sample size, more well-conducted randomized controlled trials are required to verify the above conclusion.
ObjectiveTo analyze the effect of mitochondrial ultrastructural changes caused by morphine toxicity on abnormal discharge of cat cerebral cortex, and to explore the possible mechanism of brain function damage caused by morphine dependence.MethodsTwelve domestic cats were divided into control group (3 cats) and morphine exposed group (9 cats) according to the method of random number table. After the model was successfully established by the method of dose increasing, the changes of mitochondrial ultrastructure of cortical neurons were observed under the electron microscope.ResultsElectroencephalogram (EEG) monitoring in morphine exposed group showed that the cortical EEG was widely abnormal, physiological waves were reduced, and abnormal discharges were frequent. And the electron microscopy showed that the number, morphology, internal membrane structure and the inclusion body in the matrix of neurons changed in various aspects. The EEG and electron microscopy of the control group were normal.ConclusionMorphine can damage neurons in the cerebral cortex and lead to abnormal discharge, which is closely related to the ultrastructural changes of neuron mitochondria. The toxicity of morphine mitochondria can be the initial mechanism of energy metabolism dysfunction of brain cells and eventually lead to the disorder of brain electrophysiological function.