Canadian Journal of Anaesthesia

, Volume 47, Issue 11, pp 1090–1093 | Cite as

Intraoperativevs post-operative morphine improves analgesia without increasing PONV on emergence from ambulatory surgery

  • Jean Wong
  • Ewen Ritchie
  • Frances Chung
  • Scott Marshall
  • Fiona McHardy
  • Joanne Fortier
Reports of Investigation

Abstract

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 1–11 patients were randomized to receive 0.1 mg·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·kg−1 morphineiv 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.

Résumé

Objectif: Vérifier si l’incidence de nausées et de vomissements postopératoires (NVPO), la qualité d’analgésie et le profil de récupération est différente selon le moment choisi pour l’administration de morphine lors d’une intervention chirurgicale ambulatoire algique.

Méthode: Une étude prospective et à double insu contre placebo a été menée auprès de 70 patients d’état physique ASA 1–11. On a procédé à l’administration peropératoire (PER) ou postopératoire (POST) de 0,1 mg·kg−1 (n=35 dans chaque groupe). La sévérité des nausées et des douleurs a été mesurée par l’échelle visuelle analogique (EVA).

Résultats: On n’a pas noté de différence intergroupe du score de nausées postopératoires ou d’incidence de NVPO. Au réveil, les patients du groupe POST, comparés à ceux du groupe PER, ont présenté des scores de douleurs plus élevés à l’EVA lors de mouvement (7,6±2 vs 5,4±3,P<0,003) et au repos (6.9±3 vs 5,1±3,P<0,013). Le nombre total de recours à l’ACP et de demandes d’analgésiques a été similaire. Les patients du groupe POST ont pu boire plus tôt que ceux du groupe PER (90±34 vs 111±38 min,P<0,05). Les autres étapes de la récupération étaient semblables et le congé a été accordé après un temps de récupération similaire pour tous.

Conclusion: L’administration peropératoire, comparée à l’administration postopératoire, de 0,1 mg·kg−1 de morphineiv améliore l’analgésie postopératoire au réveil d’une intervention chirurgicale ambulatoire algique sans augmenter l’incidence de NVPO.

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Copyright information

© Canadian Anesthesiologists 2000

Authors and Affiliations

  • Jean Wong
    • 1
  • Ewen Ritchie
    • 1
  • Frances Chung
    • 1
  • Scott Marshall
    • 1
  • Fiona McHardy
    • 1
  • Joanne Fortier
    • 1
  1. 1.From the Department of Anesthesia, Toronto Western HospitalUniversity Health Network, University of TorontoTorontoCanada

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