Postoperative titration of intravenous morphine.
OBJECTIVE
Intravenous morphine titration is used to obtain postoperative pain relief, but few studies have assessed the appropriate regimen. In a quality programme, we performed a prospective non-randomized study of morphine titration in a postanaesthesia care unit (PACU).


METHODS
Four regimens of morphine titration were studied: every 10 (group 1, n = 400) or 5 min (group 2, n = 400) with a maximum of five intravenous boluses; every 5 min, without any limitation in the number of boluses (groups 3 and 4, n = 400 each); in groups 1, 2, and 3, subcutaneous morphine was administered 4 h after titration. In group 4, administration of subcutaneous morphine was allowed only 2 h after titration. A visual analogue pain scale (VAPS) > 30 mm was required to administer morphine and pain relief was defined as a VAPS < or = 30 mm.


RESULTS
After morphine titration, VAPS was lower and the number of patients with pain relief was greater in patients from groups 3 and 4. Patients from group 4 had the lowest VAPS (26 +/- 17 mm) and the highest percentage of pain relief (73%) at the end of the PACU period. The number of sedated patients increased in groups 3 (62%) and 4 (61%) compared with group 1 (27%). No significant differences in morphine-related adverse effects were observed.


CONCLUSIONS
Intravenous morphine titration every 5 min with an unlimited number of boluses and early subcutaneous administration provided the best analgesic regimen.
Aubrun
F
F
Department of Anaesthesiology and Critical Care, Centre Hospitalier Universitaire Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France.
Monsel
S
S
Langeron
O
O
Coriat
P
P
Riou
B
B
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D016528:Postanesthesia Nursing; D011184:Postoperative Period; D011446:Prospective Studies
D000701:Analgesics, Opioid; D009020:Morphine