Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-22T23:49:25.488Z Has data issue: false hasContentIssue false
  • English
  • Français

Age-adapted morphine titration produces equivalent analgesia and adverse effects in younger and older patients

Published online by Cambridge University Press:  01 May 2008

H. Keïta ,
F. Tubach ,
J. Maalouli ,
J.-M. Desmonts  and
J. Mantz
H. Keïta*
Affiliation:
Assistance Publique Hôpitaux de Paris, Hospital Louis Mourier, Department of Anaesthesia, Colombes; Hospital Bichat, Paris, France
F. Tubach
Affiliation:
Assistance Publique Hôpitaux de Paris, Department of Epidemiology and Biostatistic, Paris, France
J. Maalouli
Affiliation:
Assistance Publique Hôpitaux de Paris, Department of Anaesthesia, Paris, France
J.-M. Desmonts
Affiliation:
Assistance Publique Hôpitaux de Paris, Department of Anaesthesia, Paris, France
J. Mantz
Affiliation:
Assistance Publique Hôpitaux de Paris, Hospital Louis Mourier, Department of Anaesthesia, Colombes; Hospital Bichat, Paris, France
*
Hawa Keita, Department of Anaesthesia, 178 rue des Renouillers, 92701 Colombes, France. E-mail: [email protected]; Tel: +33 1 47 60 61 62; Fax : +33 1 47 60 60 59
Get access

Summary

Background

To determine the efficacy and safety of intravenous postoperative morphine titration in the elderly compared with younger patients.

Methods

In the post-anaesthesia care unit, patients complaining of pain received morphine until adequate pain relief. Intravenous morphine was titrated as 3 mg boluses in young (age ⩽65 yr) and 2 mg in elderly patients (>65 yr) every 5 min.

Results

We studied 350 young and 68 elderly patients. There were no significant differences between the two age groups for pain intensity at the onset of titration (numerical rating scale, 7.4 ± 1.7 in young vs. 7.5 ± 1.7 in elderly patients), area under the curve of numerical rating scale vs. morphine boluses (97.7 ± 59.6 vs. 98.2 ± 62), number of boluses required to obtain pain relief (3 ± 1.3 vs. 3 ± 1.3), percentage of titration failures (10% vs. 9%) and incidence of excessive sedation (18% vs. 21%). Renal clearance was significantly reduced in elderly compared with young patients (55 ± 21 vs. 85 ± 15 mL min−1; P < 0.0001).

Conclusion

Using lower bolus doses, pain relief in the immediate postoperative period with morphine was as efficacious and safe in elderly patients as in younger patients. The decrease in renal clearance of morphine in the elderly justifies the reduction of intravenous morphine boluses for the treatment of postoperative pain.

Keywords

POSTOPERATIVE PERIODPAIN POSTOPERATIVEMORPHINEAGEDAGE GROUPS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 5 , May 2008 , pp. 352 - 356
Copyright
Copyright © European Society of Anaesthesiology 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Clergue, F, Auroy, Y, Péquignot, F, Jougla, E, Lienhart, A, Laxemarie, MC. French survey of anaesthesia in 1996. Anesthesiology 1999; 91: 1509–1520.Google Scholar
2.Rooke, GA, Reves, JG, Rosow, C. Anesthesiology and geriatric medicine (editorial). Anesthesiology 2002; 96: 2–4.CrossRefGoogle Scholar
3. Berry HB, Chapman CR, Covington EC et al. Pain: current understanding of assessment, management, and treatments. National Pharmaceutical Council, Inc. Joint Commission on Accreditation of Healthcare Organizations, December 2001.Google Scholar
4.Ferrell, BR, Shaffner, M. Pharmacoeconomics and medical outcomes in pain management. Semin Anesth 1997; 16: 152–159.Google Scholar
5.Karani, R, Meier, DE. Systemic pharmacologic postoperative pain management in the geriatric orthopaedic patient. Clin Orthop 2004; 425: 26–34.CrossRefGoogle Scholar
6.Edward, WT, Breed, RJ. The treatment of acute postoperative pain in postanesthesia care unit. Anesthesiol Clin 1990; 8: 235–265.Google Scholar
7.Dahmani, S, Dupont, H, Mantz, J, Desmonts, JM, Keita, H. Predictive factors of early morphine requirements in the post-anaesthesia care unit (PACU). Br J Anaesth 2001; 87: 385–389.CrossRefGoogle ScholarPubMed
8.Aubrun, F, Monsel, S, Langeron, O, Coriat, P, Riou, B. Postoperative titration of intravenous morphine. Eur J Anaesthesiol 2001; 18: 159–165.CrossRefGoogle ScholarPubMed
9.Aubrun, F, Monsel, S, Langeron, O, Coriat, P, Riou, B. Postoperative titration of intravenous morphine in the elderly patient. Anesthesiology 2002; 96: 17–23.Google Scholar
10.Paqueron, X, Lumbroso, A, Mergoni, P et al. Is morphine-induced sedation synonymous with analgesia during intravenous morphine titration? Br J Anaesth 2002; 89: 697–701.Google Scholar
11.Gagliese, L, Jakson, M, Ritvo, P, Wowk, A, Katz, J. Age is not an impediment to effective use of patient-controlled analgesia by surgical patients. Anesthesiology 2000; 93: 601–610.CrossRefGoogle Scholar
12.Macintyre, PE, Jarvis, DA. Age is the best predictor of postoperative morphine requirements. Pain 1995; 64: 357–364.CrossRefGoogle Scholar
13.Keita, H, Geachan, N, Dahmani, S et al. Comparison between patient-controlled analgesia and subcutaneous morphine in elderly patients after total hip replacement. Br J Anaesth 2003; 90: 53–57.Google Scholar
14.Pico, L, Hernot, S, Zlotine, N, Nègre, I, Samii, K, Fletcher, D. Peroperative titration of morphine for postoperative analgesia after total hip arthroplasty. Can J Anaesth 2000; 47: 309–314.CrossRefGoogle ScholarPubMed
15.Owen, JA, Sitar, DS, Berger, L, Brwnell, L, Duke, PC, Mitenko, PA. Age-related morphine kinetics. Clin Pharmacol Ther 1983; 34: 364–368.CrossRefGoogle ScholarPubMed
16.Burns, JW, Hodsman, NBA, McLintock, TTC, Gillies, GWA, Kenny, GNC, McArdle, CS. The influence of patient characteristics on the requirements for postoperative analgesia. Anaesthesia 1989; 44: 2–6.Google Scholar
17.Wall, RT. Use of analgesics in the elderly. Clin Geriatr Med 1990; 6: 345–364.Google Scholar
18.Kaiko, RF. Age and morphine analgesia in cancer patients with postoperative pain. Clin Pharmacol Ther 1980; 28: 823–826.CrossRefGoogle ScholarPubMed
19.Kaiko, RF, Wallenstein, SL, Rogers, AG, Grabinski, PY, Houde, RW. Narcotics in the elderly. Med Clin North Am 1982; 66: 1079–1089.Google Scholar
20.Belleville, JW, Forrest, WH, Miller, E, Brown, BW. Influence of age on pain relief from analgesics. JAMA 1971; 217: 1835–1841.CrossRefGoogle Scholar
21.Muravchick, S. Anesthesia for the elderly. In: Miller, RD, ed. Anesthesia, 4th edn. New York, NY: Churchill Livingstone, 1994: 2143–2156.Google Scholar
22.Osborne, R, Joel, S, Grbenik, K, Trew, D, Slevin, M. The pharmacokinetics of morphine and morphine glucuronides in kidney failure. Clin Pharmacol Ther 1993; 54: 158–167.Google Scholar
23.Chauvin, C, Sandouk, P, Scherrmann, JM, Farinotti, R, Strumza, P, Duvaldestin, P. Morphine pharmacokinetics in renal failure. Anesthesiology 1987; 66: 327–331.Google Scholar
24.Kalkman, CJ, Visser, K, Moen, J, Bonsel, GJ, Grobbee, DE, Moons, KG. Preoperative prediction of severe postoperative pain. Pain 2003; 105: 415–423.CrossRefGoogle ScholarPubMed
25.Bisgaard, T, Klarskov, B, Rosenberg, J, Kehlet, H. Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain 2001; 90: 261–269.CrossRefGoogle ScholarPubMed
26.Gagliese, L, Katz, J. Age differences in postoperative pain are scale dependent: a comparison of measures of pain intensity and quality in younger and older surgical patients. Pain 2003; 103: 11–20.CrossRefGoogle ScholarPubMed
27.Gagliese, L, Weizblit, N, Ellis, W, Chan, VWS. The measurement of postoperative pain: a comparison of intensity scales in younger and older surgical patients. Pain 2005; 117: 412–420.Google Scholar
28.Aubrun, F, Salvi, N, Coriat, P, Riou, B. Sex- and age-related differences in morphine requirements for postoperative pain relief. Anesthesiology 2005; 103: 156–160.Google Scholar