Dosage of epidural morphine analgesia after lower abdominal cancer surgery: a randomized clinical trial among the older adults
Authors' conclusion
Epidural morphine 3 mg as a bolus every 24 h with add on IV patient control analgesia (PCA) morphine, set to deliver 1.5 mg boluses on demand without background infusion with a lockout period of 45 min, could achieve effective and adequate analgesia lasting up to 72 h postoperatively without increasing in the level of sedation or other side effects in older adults after a lower abdominal cancer surgery.
Study context
- Population
- Older adults after lower abdominal cancer surgery102 assessed for allocation
- Participants
- 22 / 22 / 22 / 22
- Comparison
- Epidural morphine 1.5 mg, 3 mg or 4.5 mg vs placebo
- Morphine 0n = 22reference
- Morphine 1.5n = 22
- Morphine 3n = 22
- Morphine 4.5n = 22
- Primary endpoint
- Adequate pain relief (VAS pain scores at activity)
- Follow-up
- Up to 72 h
Methodological detailsplacebo-controlled, dose-finding
- Placebo-controlled
- Dose-finding
Primary result
As reported in the abstract
Morphine 0
4.3
± 1.1
Morphine 1.5
4
± 1
Morphine 3
2
± 0.8
Morphine 4.5
1.7
± 1
Morphine 3 and Morphine 4.5 vs Morphine 0 and Morphine 1.5: P = 0.000 · Morphine 3 vs Morphine 4.5: P > 0.05
Further findings
Total IV-PCA morphine consumption — Morphine 0 vs Morphine 1.5, Morphine 3 and Morphine 4.5 · significantly higher
P = 0.000
| Outcome | P value |
|---|---|
| Total IV-PCA morphine consumptionMorphine 3 vs Morphine 4.5 · not statistically significant | P > 0.05 |
Safety
| Outcome | Morphine 0 | Morphine 1.5 | Morphine 3 | Morphine 4.5 | P value |
|---|---|---|---|---|---|
| Sedation (modified Ramsay Sedation Scale) · first 24 hMorphine 4.5 vs Morphine 0, Morphine 1.5 and Morphine 3 · significant increase in sedation | 2.2 ± 0.5 | 2.1 ± 0.2 | 2.1 ± 0.2 | 2.5 ± 0.5 | P = 0.000 |
Postoperative nausea
- No relationship between postoperative nausea and epidural morphine dosage
Original publication
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