The Effect of Intraoperative Diphenhydramine/Morphine on Acute Pain and Opioid Consumption after Spine Surgery
Background: One of the most common problems after spine surgery is very severe pain that usually affects outcome of patients after surgery and duration of hospital stay. Acute postoperative pain has several mechanisms, and multimodal analgesia by different mechanism of action will help control to it. In this study, we intend to investigate the effect of intravenous diphenhydramine injection during induction of anesthesia and morphine before incision on the control of acute pain in postoperative laminectomy.
Methods: 130 patients scheduled for spine surgeries were assigned to receive a single pre induction dose of diphenhydramine 0.4mg/kg IV (D group) and morphine 0.15mg/kg before incision in addition acetaminophen 1gr IV at the end of surgery and just morphine 0.15mg/kg and acetaminophen 1gr IV (C group) in a randomized, double-blind trial. Postoperative pain, analgesic requirements in recovery and 24 hr after surgery were assessed.
Results: The mean pain intensity in recovery was lower in the diphenhydramine group than in the control group (MD, 2.13; 95% confidence interval (CI), 1.72–2.53; P < .0001) and the need for analgesia was much lower in the diphenhydramine group than in the control group. P < 0.001. The severity of pain and the need for analgesics in the diphenhydramine group had a significant decrease in the ward compared to the control group.
Conclusion: Prophylactic diphenhydramine 0.4 mg/kg at induction of general anesthesia in combination with morphin0.15mg/kg before incision and acetaminophen1gr at the end of surgery reduced the postoperative severity of acute pain and opioids requirement in the early postoperative period after spine surgeries.
 Pendharkar AV, Shahin MN, Ho AL, Sussman ES, Purger DA, Veeravagu A, et al. Outpatient spine surgery: defining the outcomes, value, and barriers to implementation. Neurosurg Focus. 2018; 44(5):E11.
 Joshi GP, Kehlet H. Postoperative pain management in the era of ERAS: an overview. Best Pract Res Clin Anaesthesiol. 2019; 33(3):259-67.
 Bajwa SJ, Haldar R. Pain management following spinal surgeries: an appraisal of the available options. J Craniovertebr Junction Spine. 2015; 6(3):105.
 Khajavi M, Asadian M, Imani F, Etezadi F, Moharari R, Amirjamshidi A. General anesthesia versus combined epidural/general anesthesia for elective lumbar spine disc surgery: A randomized clinical trial comparing the impact of the two methods upon the outcome variables. Surg Neurol Int. 2013; 4:105.
 Etezadi F, Farzizadeh M, Sharifinia HR, Alimohammadi M, Khajavi MR. The Effect of Intraoperative Ketamine and Magnesium Sulfate on Acute Pain and Opioid Consumption After Spine Surgery. Acta Medica Iranica. 2020; 221-4.
 Obara I, Telezhkin V, Alrashdi I, Chazot PL. Histamine, histamine receptors, and neuropathic pain relief. Br J Pharmacol. 2020; 177(3):580-99.
 Khajavi MR, Saffarian A, Majidi F, Moharari RS, Pourfakhr P, Parhiz SA. Prophylactic administration of diphenhydramine/ paracetamol reduced emergence agitation and postoperative pain following maxillofacial surgeries: a randomized controlled trial. Eur Arch Otorhinolaryngol. 2021.
 Loftus RW, Yeager MP, Clark JA, Brown JR, Abdu WA, Sengupta DK, et al. Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery. Anesthesiology 2010; 113(3):639-46.
 Klimek M, Ubben JF, Ammann J, Borner U, Klein J, Verbrugge SJ. Pain in neurosurgically treated patients: A prospective observational study. J Neurosurg. 2006; 104(3):350-9.
 Obara I, Telezhkin V, Alrashdi I, Chazot PL. Histamine, histamine receptors, and neuropathic pain relief. Br J Pharmacol. 2020 Feb;177(3):580-99.
 Santiago-Palma J, Fischberg D, Kornick C, Khjainova N, Gonzales G. Diphenhydramine as an analgesic adjuvant in refractory cancer pain. J Pain Symptom Manage.2001; 22(2):699–703.
 Jones DB, Abu-Nuwar MR, Ku CM, Berk LA, Trainor LS, Jones SB. Less pain and earlier discharge after implementation of a multidisciplinary enhanced recovery after surgery (ERAS) protocol for laparoscopic sleeve gastrectomy. Surg Endosc. 2020: 34(12): 5574-5582.
 Simons KJ, Watson WT, Martin TJ, Chen XY, Simons FE. Diphenhydramine: pharmacokinetics and pharmacodynamics in elderly adults, young adults, and children. J Clin Pharmacol. 1990; 30(7):665-71.
 Panula P, Nuutinen S. The histaminergic network in the brain: basic organization and role in disease. Nat Rev Neurosci. 2013; 14(7):472-87.
 Simons FE. Advances in H1-antihistamines. N Engl J Med. 2004; 351(21):2203-17.
 Pourfakhr P, Aghabagheri M, Zabihi Mahmoudabadi H, Najjari K, Talebpour M, Khajavi MR. Prophylactic Administration of Diphenhydramine/Acetaminophen and Ondansetron Reduced Postoperative Nausea and Vomiting and Pain Following Laparoscopic Sleeve Gastrectomy: a Randomized Controlled Trial. Obes Surg. 2021; 31(10):4371-4375.
 Li YY, Zeng YS, Chen JY, Wang KF, Hsing CH, Wu WJ, et al. Prophylactic diphenhydramine attenuates postoperative catheter-related bladder discomfort in patients undergoing gynecologic laparoscopic surgery: a randomized double-blind clinical study. J Anesth. 2020; 34(2):232-237.
|Issue||Vol 8 No 1 (2022): Winter|
|Postoperative pain Multimodal analgesia Diphenhydramine Lumbar laminectomy surgery Acute pain|
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