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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: hawa.keita@lmr.aphp.fr; Tel: +33 1 47 60 61 62; Fax : +33 1 47 60 60 59
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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

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