Preoperative intravenous morphine sulfate with postoperative osteopathic manipulative treatment reduces patient analgesic use after total abdominal hysterectomy

Frederick J. Goldstein, Philadelphia College of Osteopathic Medicine
Saul Jeck, Philadelphia College of Osteopathic Medicine
Alexander S. Nicholas, Philadelphia College of Osteopathic Medicine
M. J. Berman
M. Lerario

This article was published in Journal of the American Osteopathic Association, Volume 105, Issue 6, Pages 273-279.

The published version is available at .

Copyright © 2005.


Context: Administration of opioids for treatment of pain after total abdominal hysterectomy (TAH) is a common postoperative procedure, providing an excellent parameter for evaluating the efficacy of postsurgical osteopathic manipulative treatment (OMT). Objective: To determine whether a combination of pre-emptive morphine sulfate and postoperative OMT could provide improved analgesic effects. Design: Randomized double-blind controlled trial. Setting and Patients: Thirty-nine hospitalized patients assigned to one of four treatment groups: (1) preoperative saline and postoperative sham manipulative treatment; (2) preoperative saline and postoperative OMT; (3) preoperative morphine and postoperative sham manipulative treatment; or (4), preoperative morphine and postoperative OMT. Intervention: Saline (control) or morphine, 10 mg, delivered intravenously (IV) 10 minutes before surgical incision. All patients received a postoperative patient-controlled IV analgesia pump containing morphine. At specified intervals following preoperative IV injections, blood was drawn and analyzed for morphine concentrations. Subjects were also asked to rate their postoperative levels of pain, nausea, and vomiting. Results: There were no differences in either pain, or nausea and vomiting scores among the four study groups. Patients in Group 4 used less morphine than those in the Group 3 for the first 24 hours (P=.02) and from 25-48 hours (P=.01) after elective TAH. Morphine blood concentrations were lower after 24 hours in Group 4 compared with Group 2 (P=.04). Conclusion: Administration of postoperative OMT enhanced pre- and postoperative morphine analgesia in the immediate 48-hour period following elective TAH, demonstrating that OMT can be a therapeutic adjunct in pain management following this procedure.