He was an employee or consultant for CeNeS Ltd. (now PAION UK Ltd.) until August 2008.
A randomised controlled trial on the efficacy and side-effect profile (nausea/vomiting/sedation) of morphine-6-glucuronide versus morphine for post-operative pain relief after major abdominal surgery*
Version of Record online: 13 JAN 2012
2011 European Federation of Chapters of the International Association for the Study of Pain
European Journal of Pain
Volume 15, Issue 4, pages 402–408, April 2011
How to Cite
Binningl, A. R., Przesmyckil, K., Sowinskil, P., Morrisonl, L. M.M., Smithl, T. W., Marcusl, P., Leesl, J. P. and Dahanl, A. (2011), A randomised controlled trial on the efficacy and side-effect profile (nausea/vomiting/sedation) of morphine-6-glucuronide versus morphine for post-operative pain relief after major abdominal surgery. European Journal of Pain, 15: 402–408. doi: 10.1016/j.ejpain.2010.09.007
For the M6G022 Investigator Study Group (see acknowledgements).
- Issue online: 13 JAN 2012
- Version of Record online: 13 JAN 2012
- Received 27 August 2010; accepted 20 September 2010
- Morphine 6-glucronide;
Morphine is the first choice of treatment of severe post-operative pain, despite the occurrence of often discomforting (post-operative nausea or vomiting (PONV)) and sometimes dangerous (sedation, respiratory depression) side effects. Literature data indicate that morphine's active metabolite, morphine-6-glucuronide (M6 g), is a powerful analgesic with a possibly more favourable side-effect profile.
In this multi-centre randomised controlled clinical trial patients undergoing major abdominal surgery were randomised to M6 g or morphine treatment. Treatment started 30–60 min prior to the end of surgery and was continued postoperatively, after patients were titrated to comfort, via patient-controlled analgesia (PCA) for 24–48h. Pain intensity, nausea, vomiting and sedation scores were collected at regular intervals.
In the study 268 patients were randomised to M6 g and 249 to morphine. Withdrawal due to insufficient pain relief occurred predominantly just after surgery and was higher in the M6 g group (16.8%) than in the morphine group (8.8%), suggesting a slower onset of analgesia for M6 g compared to morphine. Subjects who continued on PCA remained equi-analgesic throughout the study.
During the first 24 h, nausea levels showed a 27% difference in favour of M6 g which narrowly failed to reach statistical significance (P =0.052). Sub-analysis showed a significant reduction in nausea levels in females on M6 g (30% difference, P =0.034). In all patients, similar reductions of 30–35% were observed in anti-emetic use, vomiting, PONV (a combined measure of nausea and vomiting) in favour of M6 g, persisting for the first 24 h postoperatively. Reductions in sedation were observed in the first 4 h post-operative period for M6 g patients.