title: Postoperative titration of intravenous morphine in the elderly patient.
abstract: BACKGROUND
  Intravenous morphine titration is used to obtain rapid and complete postoperative pain relief. Whether this titration can be safely administered in the elderly patients remains a matter for debate.
  
  
  METHODS
  Intravenous morphine titration was administered as a bolus of 2 (body weight < or = 60 kg) or 3 (body weight > 60 kg) mg. The interval between each bolus was 5 min. There was no limitation in the number of boluses given until pain relief or severe adverse effect occurred. The visual analog scale threshold required to administer morphine was 30 mm, and pain relief was defined as a visual analog scale score of 30 mm or less. Patients were divided into two groups: young and elderly (age > or = 70 yr) patients. Data were expressed as mean +/- SD.
  
  
  RESULTS
  Eight hundred seventy-five patients (83%) were young and 175 patients (17%) were elderly. At the end of morphine titration, the visual analog scale score and the number of patients with pain relief were not significantly different between groups. The total dose of morphine per kilograms of body weight administered was not significantly different between groups (0.15 +/- 0.10 vs. 0.14 +/- 0.09 mg/kg, not significant). No significant differences were observed in the incidence of morphine-related adverse effects (13 vs. 14%, not significant), the number of sedated patients (60 vs. 60%, not significant), and the number of patients whose titration had to be stopped (2 vs. 2%, not significant).
  
  
  CONCLUSIONS
  Intravenous morphine titration can be safely administered to elderly patients. Because titration is adapted to individual pain, the same protocol can be applied to young and elderly patients.
authors.affiliation: Department of Anesthesiology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, France. frederic.aubrun@psl.ap-hop.paris.fr
authors.forename: Frédéric
authors.initials: F
authors.lastname: Aubrun
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Monsel
authors.forename: Olivier
authors.initials: O
authors.lastname: Langeron
authors.forename: Pierre
authors.initials: P
authors.lastname: Coriat
authors.forename: Bruno
authors.initials: B
authors.lastname: Riou
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016058:Analgesia, Patient-Controlled; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*
chemical_list: D009020:Morphine