Affiliation:
1. Staff Anesthesiologist.
2. Professor of Orthopedic Surgery and Chairman of the Department of Orthopedic Surgery and Trauma.
3. Professor of Anesthesiology and Chairman of the Department of Anesthesiology.
4. Professor of Anesthesiology and Chairman of the Department of Emergency Medicine and Surgery.
Abstract
Background
It has been suggested that the dose of intravenous morphine used during postoperative titration is not modified by aging. The authors therefore studied morphine requirements in patients undergoing total hip replacement.
Methods
Intravenous morphine titration was administered as boluses, then subcutaneous morphine was administered every 4 h over 24 h. Pain was assessed by use of the visual analog scale (0 to 100), and the threshold required to administer morphine was 30. Young and elderly (> or =70 yr old) patients were compared. Data are mean +/- SD or odds ratio (OR) [95% CI].
Results
Two hundred twenty-four patients (68%) were young and 105 (32%) were elderly. The initial visual analog scale was not significantly different between groups. The dose of intravenous morphine in the postanesthesia care unit was not significantly different between young and elderly patients (0.15 +/- 0.11 vs. 0.14 +/- 0.10 mg/kg, P = NS), in contrast to the dose of subcutaneous morphine (0.18 +/- 0.18 vs. 0.11 +/- 0.11 mg/kg, P < 0.001) in the ward. Only severe pain (visual analog scale of 70 or greater; OR, 10.5 [4.5-24.8]) was significantly associated with a high dose (greater than 0.15 mg/kg) of intravenous morphine, whereas severe pain (OR, 2.5 [1.6-4.0]), age less than 60 yr (OR, 2.3 [1.4-3.8]), and absence of a nonsteroidal antiinflammatory drug (OR, 1.9 [1.2-3.1]) were significantly associated with a high dose (greater than 0.12 mg/kg) of subcutaneous morphine.
Conclusions
The dose of intravenous morphine during titration is not modified in elderly patients, in contrast to the dose administered subcutaneously over a prolonged period.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Anesthesiology and Pain Medicine
Cited by
82 articles.
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