Korean J Anesthesiol.  2012 Sep;63(3):233-237. 10.4097/kjae.2012.63.3.233.

Effect of timing of morphine administration during propofol - remifentanil anesthesia on the requirements of post-operative analgesia

• Zand F
• Amini A
• Hamidi SA

• KMID: 2236273
• DOI: http://doi.org/10.4097/kjae.2012.63.3.233

Abstract

BACKGROUND
An important concern of intra-operative infusion of remifentanil is the possible development of acute opioid tolerance, which manifests as an increased postoperative analgesia requirement. We have examined the effect of the timing of intra operative morphine administration on the need for morphine consumption for pain control during the first 24 hours after operation.
METHODS
Sixty adult patients scheduled for elective open unilateral nephrolithotomy surgery were recruited for this prospective randomized double-blind study. Anesthesia was induced with 0.03 mg/kg midazolam, 1 microg/kg remifentanil, and 1.5-2 mg/kg propofol. Anesthesia was maintained with 100 microg/kg/min propofol, and 0.25 microg/kg/min remifentanil. Both groups received 0.1 mg/kg morphine intravenously at 2 different times; in the first group (group E) immediately after intubation and in the second group (group L) 20-30 min before the anticipated end of operation.
RESULTS
There was no difference in pain scores at awakening, the amount of morphine given to the 2 groups for pain control, or the time to discharge from PACU between the 2 groups. The pain scores at admission to ward and at every 4 hours thereafter, until 24 hours, were not significantly different between the 2 groups. The cumulative amount of the first 24 hours morphine consumption in the ward in E group was 28.2 +/- 20.1 mg and 26.5 +/- 15 mg in L group, respectively (P = 0.71).
CONCLUSIONS
Early intra-operative administration of morphine compared to that of morphine in the end of surgery did not affect postoperative morphine consumption and pain scores during the first 24 hours after surgery for open nephrolithotomy. Newer pharmacologic interventions for prevention of acute tolerance of opioids seems rational (Clinical trial registration No. ACTRN: 12609000570280).

Keyword

Morphine; Postoperative pain; Propofol; Remifentanil

MeSH Terms

Adult
Analgesia
Analgesics, Opioid
Anesthesia
Double-Blind Method
Humans
Intubation
Midazolam
Morphine
Pain, Postoperative
Piperidines
Propofol
Prospective Studies
Analgesics, Opioid
Midazolam
Morphine
Piperidines
Propofol