British Journal of Anaesthesia, 2002, Vol. 89, No. 5 697-701
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia
Clinical Investigations |
Is morphine-induced sedation synonymous with analgesia during intravenous morphine titration?
1 Department of Anaesthesiology and Critical Care and 2 Department of Emergency Medicine and Surgery, Centre Hospitalier Universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie, Paris, France*Corresponding author: Département d’Anesthésie et de Réanimation, Centre Hospitalier Universitaire Pitié-Salpêtrière, 47 Boulevard de l’Hôpital, F-75651 Paris Cedex 13, France
Background. Postoperative morphine titration frequently induces sedation. The assumption is made that patients sleep when their pain is relieved. Some patients complain of persistent pain when they awake. We studied the time-course of sedation and analgesia to understand the determinants of patients’ sleep during morphine titration.
Methods. Seventy-three patients requiring morphine titration in a post-anaesthetic care unit after major surgery, were studied. Fifty-two patients slept (Sleep group) and 21 did not (Awake group). When a patient slept during titration, morphine was discontinued. Visual analogue pain scale (VAS), Ramsay score (RS), and the bispectral index (BIS) were recorded at the beginning of titration (STonset), at sleep onset (STsleep), then 5, 10, 20, and 30 min afterwards (ST4).
Results. In the Sleep group, mean (SD) RS increased from 1.7 (0.4) to 2.4 (0.6) (P<0.05 vs STonset) and BIS decreased from 95 (5.0) to 89.8 (10.2) between STonset and STsleep (P<0.05), RS remained stable thereafter. Conversely, RS and BIS remained unaltered in the Awake group. The reduction in VAS was comparable between groups (from 78 (17) to 39 (21), and from 64 (16) to 30.4 (11), respectively). Even though mean (SD) VAS was 39 (21) at ST4 in the Sleep group, 13 patients (25%) maintained a VAS above 50 mm.
Conclusion. We observed dissociated effects of morphine on the time-course of sedation and analgesia with sedation occurring first, followed by analgesia. Therefore, morphine-induced sedation should not be considered as an indicator of an appropriate correct level of analgesia during i.v. morphine titration.
Br J Anaesth 2002; 89: 697–701
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