Postoperative intravenous morphine titration

Abstract

Relief of acute pain during the immediate postoperative period is an important task for anaesthetists. Morphine is widely used to control moderate-to-severe postoperative pain and the use of small i.v. boluses of morphine in the post-anaesthesia care unit allows a rapid titration of the dose needed for adequate pain relief. The essential principle of a titration regimen must be to adapt the morphine dose to the pain level. Although morphine would not appear to be the most appropriate choice for achieving rapid pain relief, this is the sole opioid assessed in many studies of immediate postoperative pain management using titration. More than 90% of the patients have pain relief using a protocol of morphine titration and the mean dose required to obtain pain relief is 12 (7) mg, after a median of four boluses. Sedation is frequent during i.v. morphine titration and should be considered as a morphine-related adverse event and not evidence of pain relief. The incidence of ventilatory depression is very low when the criteria to limit the dose of i.v. morphine are enforced. Morphine titration can be used with caution in elderly patients, in children, or in obese patients. In practice, i.v. morphine titration allows the physician to meet the needs of individual patients rapidly and limits the risk of overdose making this method the first step in postoperative pain management.

Acute pain management with intravenous 0.10mg/kg versus 0.15mg/kg morphine sulfate in limb traumatized patients: A randomized double-blinded placebo-controlled trial

“…In some studies, a loading dose is administered followed by intravenous morphine titration every 5 minutes. [10,14,15] Other studies suggest starting treatment with a titration regimen in order to monitor and minimize adverse effects. [15,16] Morphine and fentanyl are among the most widely used and studied analgesics for trauma patients in the ED.…”

“…[10,14,15] Other studies suggest starting treatment with a titration regimen in order to monitor and minimize adverse effects. [15,16] Morphine and fentanyl are among the most widely used and studied analgesics for trauma patients in the ED. A randomized double-blinded study comparing morphine and fentanyl in a prehospital setting demonstrated the two drugs were comparable in treating severe, acute pain in a prehospital setting during the first 30 minutes in spontaneous breathing patients.…”

Pemberian Magnesium Sulfat Intravena Meningkatkan Efek Analgesia Pascaoperasi pada Bedah Mayor Menggunakan Anestesi Umum

“…memungkinkan penanganan nyeri yang cepat dan membatasi risiko overdosis. 1 American Society of Anestesiologists (ASA) menyatakan analgesia multimodal adalah kunci penanganan nyeri pascaoperasi. Penanganan nyeri yang baik akan meningkatkan hasil akhir pembedahan dengan mengurangi morbiditas dan mempercepat waktu pemulihan.…”

Response to Voepel‐Lewis and Malviya's comment ‘pain score guided morphine titration is risky and inappropriate’

“…This also makes a 5-min bolus interval safe in the PACU setting. Bearing this in mind, will help gauge when best to administer the second dose of morphine (2). Importantly, no case of respiratory depression following PACU discharge was identified in postoperative rounds designed to assess analgesia and identify complications.…”

“…Prior to insertion, catheters may be trimmed to length, reducing the flow resistance and eliminating the need for coiling of excess catheter on the patient's skin surface. Our journal Pediatric Anesthesia has published case reports (1,2) where the length of line inserted has produced clinical complications, but there appears to be little guidance for prediction of length measurement in children.…”