Can immediate opioid requirements in the post-anaesthesia care unit be used to determine analgesic requirements on the ward?

Butscher, Karin; Mazoit, Jean Xavier; Samii, Kamran

doi:10.1007/bf03011681

Cited by 74 publications

(5 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Alternatively, the morphine loading dose may have been inadequate. Morphine loading doses were consistent with previous studies [4, 5]. Some patients may need more than 20 mg of morphine as an initial bolus; Macintyre and Jarvis [5] administered loading doses of up to 40 mg of morphine.…”

Section: Discussionsupporting

confidence: 83%

See 1 more Smart Citation

Responders and non-responders to post-operative pain treatment: the loading dose predicts analgesic needs

Stamer¹,

Grond²,

Maier³

1999

Eur J Anaesthesiol

View full text Add to dashboard Cite

The study compares responders and non-responders to post-operative patient-controlled analgesia (PCA) and evaluates factors that might differ between these two groups in order to identify non-responders during the early post-operative period. A prospective, randomized, double-blinded study design was used. Patients recovering from abdominal surgery were assigned to one of three treatment groups for a study period of 48 h. After titration of an individual loading dose, patients could self-administer 1 mL bolus doses (2 mg of morphine, 20 mg of tramadol or placebo) using a PCA device. Patients responding or not responding to the treatment were identified. In non-responders the escape medication was morphine. There were 96 responders and 65 non-responders. All responders showed similar pain scores, irrespective of the drug they received. Drug consumption of placebo responders was twice as high as that of opioid responders. Pain scores and analgesic consumption of non-responders were significantly higher compared with responders, although those patients received morphine. The loading dose correlated with subsequent analgesic consumption. Altogether, 89.2% of the non-responders were identified after the loading dose. Size of loading dose and pain scores during the first 30 min are useful for assessing the overall response to post-operative pain management. These factors may be valuable for predicting individual pain management.

show abstract

Section: Discussionsupporting

confidence: 83%

“…Butscher et al . [4] used the initial i.v. bolus dose to predict the patients’ need for intermittent intramuscular injections on the ward.…”

Section: Discussionmentioning

confidence: 99%

Responders and non-responders to post-operative pain treatment: the loading dose predicts analgesic needs

Stamer¹,

Grond²,

Maier³

1999

Eur J Anaesthesiol

View full text Add to dashboard Cite

show abstract

“…1), without any signi®cant increase in the incidence of adverse effects or the duration of stay in the PACU ( Table 2). Butscher and her colleagues [17] have tried to de®ne a morphine dosage regimen of intramuscular (i.m.) injections that enabled early and individually adapted postoperative analgesia, established using the i.v.…”

Section: Discussionmentioning

confidence: 99%

Postoperative intravenous morphine titration

Aubrun

Mazoit

Riou

2012

British Journal of Anaesthesia

132

View full text Add to dashboard Cite

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.

show abstract

“…1), without any significant increase in the incidence of adverse effects or the duration of stay in the PACU (Table 2). Butscher and her colleagues [17] have tried to define a morphine dosage regimen of intramuscular (i.m.) injections that enabled early and individually adapted postoperative analgesia, established using the i.v.…”

Section: Discussionmentioning

confidence: 99%