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Intraoperative vs postoperative morphine improves analgesia without increasing PONV on emergence from ambulatory
1Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada.
Purpose:
To compare the timing of administration of morphine in patients undergoing painful ambulatory surgical procedures to determine whether there was a difference in postoperative nausea or vomiting (PONV), quality of analgesia, and recovery profile.
Methods:
In a double-blinded, placebo-controlled, prospective study, 70 ASA I-II patients were randomized to receive 0.1 mg x kg(-1) morphine intraoperatively (lop) (n=35), or postoperatively (Pop) (n=35). The severity of nausea and pain were measured using visual analog scales (VAS).
Results:
There was no difference between the groups in postoperative nausea scores or the incidence of PONV. Upon awakening, patients who received Pop morphine had higher pain VAS scores with movement (7.6 +/- 2 vs 5.4 +/- 3, P < 0.003) and at rest (6.9 +/- 3 vs 5.1 +/- 3, P < 0.013) than the lop morphine group. The total number of PCA attempts and analgesic requirements were similar. Patients who received Pop morphine were able to drink sooner than the lop group (90 +/- 34 vs 111 +/- 38 min, P < 0.05). All other recovery milestones were similar. Times to discharge from hospital were similar.
Conclusions:
Administration of 0.1 mg x kg(-1) morphine iv intraoperatively improves postoperative analgesia upon emergence from painful ambulatory surgical procedures without increasing the incidence of PONV There was no increase in PONV when morphine was administered intraoperatively rather than postoperatively.
Insights
Administering morphine intraoperatively improves pain relief after surgery without increasing nausea or vomiting. This timing strategy enhances postoperative analgesia for patients undergoing ambulatory procedures.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Postoperative nausea and vomiting (PONV) and pain are common after ambulatory surgery.
- Optimizing pain management while minimizing side effects is crucial for patient recovery.
Purpose of the Study:
- To compare intraoperative versus postoperative morphine administration.
- To evaluate the impact on postoperative nausea, vomiting, pain control, and recovery.
Main Methods:
- A double-blinded, placebo-controlled study randomized 70 patients.
- Morphine (0.1 mg/kg) was given intraoperatively (IOP) or postoperatively (POP).
- Pain and nausea were assessed using Visual Analog Scales (VAS).
Main Results:
- No significant difference in PONV incidence or nausea scores between groups.
- Intraoperative morphine (IOP) resulted in lower pain VAS scores upon awakening compared to postoperative morphine (POP).
- Patients receiving POP morphine could drink sooner, but other recovery milestones and discharge times were similar.
Conclusions:
- Intraoperative morphine administration improves early postoperative analgesia after painful ambulatory surgery.
- This approach does not increase the incidence of PONV.
- Timing of morphine administration impacts pain management without compromising safety or significantly altering recovery timelines.