Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-23T07:22:54.511Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of the pharmacokinetic profile and analgesic efficacy of oral morphine after total hip arthroplasty

Published online by Cambridge University Press:  24 May 2006

B. D. Manoir ,
P. Bourget ,
M. Langlois ,
B. Szekely ,
M. Fischler ,
M. Chauvin ,
A. Paci  and
D. Fletcher
B. D. Manoir
Affiliation:
Département d'Anesthésie Réanimation CHU Caen, Villejuif, France
P. Bourget
Affiliation:
Département de Pharmacie Clinique Institut Gustave Roussy, Villejuif, France
M. Langlois
Affiliation:
Département d'Anesthésie Réanimation CHU Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France
B. Szekely
Affiliation:
Département d'Anesthésie CMC Foch, Suresnes, France
M. Fischler
Affiliation:
Département d'Anesthésie CMC Foch, Suresnes, France
M. Chauvin
Affiliation:
Département d'Anesthésie Réanimation CHU Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France
A. Paci
Affiliation:
Département de Pharmacie Clinique Institut Gustave Roussy, Villejuif, France
D. Fletcher
Affiliation:
Département d'Anesthésie Réanimation CHU Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France
Get access

Abstract

Summary

Background and objective: Oral morphine may be useful for postoperative pain relief, but few studies have tested its use after in-hospital surgery. Methods: We evaluated clinical efficacy and the pharmacokinetic parameters of oral morphine after total hip arthroplasty. We recruited 60 patients who had total hip arthroplasty under general anaesthesia. The patients were randomized to receive placebo, 10 mg morphine sulphate or 20 mg morphine sulphate orally every 4 h for 24 h. The oral administration was started 3 h after the morphine-loading dose in the Post Anaesthesia Care Unit and then patients used intravenous morphine patient-controlled analgesia for 24 h. Pain score at rest (scored by patients on a visual analogue scale), sedation, nausea, vomiting and urinary retention were monitored. In 11 additional total hip arthroplasty patients, we determined the pharmacokinetics of morphine and its metabolites after oral administration of 20 mg morphine sulphate every 4 h for 16 h. Results: The amount of morphine administered via patient-controlled analgesia over 24 h was reduced in the 20-mg group compared with that in the placebo group (19.0 ± 2.7 mg vs. 33.0 ± 5.5 mg; P = 0.03). No significant morphine-sparing effect was observed in the 10-mg group. Pain scores and side-effects were similar in all groups. The pharmacokinetic study revealed a limited and slow absorption of morphine. Conclusion: Despite a limited absorption of oral morphine postoperatively, high doses of oral morphine have a significant analgesic effect after total hip arthroplasty.

Keywords

ANALGESICS, OPIOID, morphineDRUG ADMINISTRATION ROUTES, oralPOSTOPERATIVE PERIODPAIN ACUTE AND POSTOPERATIVEANALGESIA, PATIENT CONTROLLEDBIO-AVAILABILITY
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 9 , September 2006 , pp. 748 - 754
Copyright
2006 European Society of Anaesthesiology

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

Ballantyne JC, Carr DB, deFerranti Set al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg 1998; 86: 598–612.Google Scholar
Jacox A, Carr DB, Mahrenholz DM, Ferrell BM. Cost considerations in patient-controlled analgesia. Pharmacoeconomics 1997; 12: 109–120.Google Scholar
Jakobi P, Weiner Z, Solt Iet al. Oral analgesia in the treatment of post-Cesarean pain. Eur J Obstet Gyn R B 2000; 93: 61–64.Google Scholar
Monagle J, Molnar A, Shearer W. Oral medication for post-Caesarean analgesia. Aust NZ J Obstet Gyn 1998; 38: 169–171.Google Scholar
Flory DA, Fankhauser RA, McShane MA. Postoperative pain control in total joint arthroplasty: a prospective, randomized study of a fixed-dose, around-the-clock, oral regimen. Orthopedics 2001; 24: 243–246.Google Scholar
McCormack JP, Warriner CB, Levine M, Glick N. A comparison of regularly dosed oral morphine and on-demand intramuscular morphine in the treatment of postsurgical pain. Can J Anaesth 1993; 40: 819–824.Google Scholar
Slowey HF, Reynolds AD, Mapleson WW, Vickers MD. Effect of premedication with controlled-release oral morphine on postoperative pain. A comparison with intramuscular morphine. Anaesthesia 1985; 40: 438–440.Google Scholar
Banning AM, Schmidt JF, Chraemmer-Jorgensen B, Risbo A. Comparison of oral controlled release morphine and epidural morphine in the management of postoperative pain. Anesth Analg 1986; 65: 385–388.Google Scholar
Bourke M, Hayes A, Doyle M, McCarroll M. A comparison of regularly administered sustained release oral morphine with intramuscular morphine for control of postoperative pain. Anesth Analg 2000; 90: 427–430.Google Scholar
Cooper SA, Fitzmartin R, Slywka Jet al. Analgesic efficacy and safety of two oral controlled-release morphine preparations in orthopedic postoperative pain. Adv Ther 1994; 11: 213–227.Google Scholar
Derbyshire DR, Bell A, Parry PA, Smith G. Morphine sulphate slow release. Comparison with i.m. morphine for postoperative analgesia. Br J Anaesth 1985; 57: 858–865.Google Scholar
Fell D, Chmielewski A, Smith G. Postoperative analgesia with controlled-release morphine sulphate: comparison with intramuscular morphine. BMJ (Clin Res Ed) 1982; 285: 92–94.Google Scholar
Curtis GB, Johnson GH, Clark Pet al. Relative potency of controlled-release oxycodone and controlled-release morphine in a postoperative pain model. Eur J Clin Pharmacol 1999; 55: 425–429.Google Scholar
Brahams D. Death of patient participating in trial of oral morphine for relief of postoperative pain. Lancet 1984; 1: 1083–1084.Google Scholar
Striebel HW, Scheitza W, Philippi W, Behrens U, Toussaint S. Quantifying oral analgesic consumption using a novel method and comparison with patient-controlled intravenous analgesic consumption. Anesth Analg 1998; 86: 1051–1053.Google Scholar
Striebel HW, Romer M, Kopf A, Schwagmeier R. Patient controlled oral analgesia with morphine. Can J Anaesth 1996; 43: 749–753.Google Scholar
Fletcher D, Zetlaoui P, Monin S, Bombart M, Samii K. Influence of timing on the analgesic effect of intravenous ketorolac after orthopedic surgery. Pain 1995; 61: 291–297.Google Scholar
Bourget P, Lesne-Hulin A, Quinquis-Desmaris V. Study of the bioequivalence of two controlled-release formulations of morphine. Int J Clin Pharm Th 1995; 33: 588–594.Google Scholar
Bourget P, Delouis JM. Review of a technique for the estimation of area under the concentration curve in pharmacokinetic analysis. Therapie 1993; 48: 1–5.Google Scholar
Yamaoka K, Nakagawa T, Uno T. Statistical moments in pharmacokinetics. J Pharmacokinet Biop 1978; 6: 547–558.Google Scholar
Woodhouse A, Hobbes AF, Mather LE, Gibson M. A comparison of morphine, pethidine and fentanyl in the postsurgical patient-controlled analgesia environment. Pain 1996; 64: 115–121.Google Scholar
Woodhouse A, Ward ME, Mather LE. Intra-subject variability in post-operative patient-controlled analgesia (PCA): is the patient equally satisfied with morphine, pethidine and fentanyl? Pain 1999; 80: 545–553.Google Scholar
Dahlstrom B, Tamsen A, Paalzow L, Hartvig P. Patient-controlled analgesic therapy. Part IV: Pharmacokinetics and analgesic plasma concentrations of morphine. Clin Pharmacokinet 1982; 7: 266–279.Google Scholar
Graves DA, Arrigo JM, Foster TS, Baumann TJ, Batenhorst RL. Relationship between plasma morphine concentrations and pharmacologic effects in postoperative patients using patient-controlled analgesia. Clin Pharmacol 1985; 4: 41–47.Google Scholar
Yuan CS, Foss JF, O'Connor M, Roizen MF, Moss J. Effects of low-dose morphine on gastric emptying in healthy volunteers. J Clin Pharmacol 1998; 38: 1017–1020.Google Scholar
Elfant AB, Levine SM, Peikin SRet al. Bioavailability of medication delivered via nasogastric tube is decreased in the immediate postoperative period. Am J Surg 1995; 169: 430–432.Google Scholar
Lotsch J, Geisslinger G. Morphine-6-glucuronide: an analgesic of the future? Clin Pharmacokinet 2001; 40: 485–499.Google Scholar
Ellison NM, Lewis GO. Plasma concentrations following single doses of morphine sulfate in oral solution and rectal suppository. Clin Pharmacol 1984; 3: 614–617.Google Scholar
Hoskin PJ, Hanks GW, Aherne GWet al. The bioavailability and pharmacokinetics of morphine after intravenous, oral and buccal administration in healthy volunteers. Br J Clin Pharmacol 1989; 27: 499–505.Google Scholar
Westerling D, Frigren L, Hoglund P. Morphine pharmacokinetics and effects on salivation and continuous reaction times in healthy volunteers. Ther Drug Monit 1993; 15: 364–374.Google Scholar
Fisher AP, Fung C, Hanna M. Serum morphine concentrations after buccal and intramuscular morphine administration. Br J Clin Pharmacol 1987; 24: 685–687.Google Scholar
Sawe J. High-dose morphine and methadone in cancer patients. Clinical pharmacokinetic considerations of oral treatment. Clin Pharmacokinet 1986; 11: 87–106.Google Scholar
Sawe J, Dahlstrom B, Paalzow L, Rane A. Morphine kinetics in cancer patients. Clin Pharmacol Ther 1981; 30: 629–635.Google Scholar
Holte K, Kehlet H. Prevention of postoperative ileus. Minerva Anestesiol 2002; 68: 152–156.Google Scholar
Shelly MP, Taylor BL, Quinn KG, Park GR. The influence of anaesthetic technique on metabolism of oral morphine. Anaesthesia 1988; 43: 733–737.Google Scholar