British Journal of Anaesthesia, 2003, Vol. 91, No. 2 218-223
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia
Clinical Investigations |
Emetic effects of morphine and piritramide
1 Klinik für Anästhesiologie und Intensivmedizin and 2 Apotheke, Universitätsklinikum Essen, Hufelandstr. 55, D-45122 Essen, Germany
Corresponding author. E-mail: juergen.peters@uni-essen.de 
Declaration of interest. The authors performed an investigator-initiated trial. The department received a grant from Mundipharma solely for staff requirement. Mundipharma did not influence or participate in generation of the hypothesis, planning of the study design, analysis or interpretation of data or preparation of the manuscript.
Background. Successful management of postoperative pain requires that adequate analgesia is achieved without excessive adverse effects. Opioid-induced nausea and vomiting is known to impair patients’ satisfaction, but there are no studies providing sufficient power to test the hypothesis that the incidence of opioid-induced nausea and vomiting differs between µ-opioid receptor agonists. Thus, we tested the hypothesis that the incidence of vomiting and nausea differs between morphine and piritramide.
Methods. In a prospective, randomized, double-blind fashion, we administered either morphine (n=250) or piritramide (n=250) by patient-controlled analgesia (PCA) for postoperative pain relief. We used a bolus dose of 1.5 mg with a lockout time of 10 min. Incidence and intensity (numerical rating scale) of postoperative nausea, vomiting, pain, patient satisfaction (score 0–10), side-effects (score 0–3) and drug consumption were measured.
Results. Mean drug consumption did not differ between the piritramide and morphine groups (30.8 (SD 22.4) mg day–1 vs 28.4 (21.8) mg day–1) during the first postoperative day and there were no significant differences in the overall incidence of nausea (30% vs 27%) and vomiting (19% vs 15%). Intensity of nausea correlated inversely (P=0.01) with morphine consumption but not with piritramide consumption. Pain scores both at rest (2.2 (1.9) vs 2.6 (2)) and during movement (4.4 (2.2) vs 4.9 (2.3)) were slightly but significantly less with morphine.
Conclusions. Opioid-induced emesis was observed in about one-third of the patients using morphine and piritramide for PCA and the incidence of vomiting was one-half of that. Potential differences in the incidence of vomiting during PCA therapy between these µ-opioid receptor agonists can be excluded.
Br J Anaesth 2003; 91: 218–23
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