[Postoperative intravenous morphine titration in PACU after bariatric laparoscopic surgery]

OBJECTIVE

There is limited information available regarding intravenous (IV) morphine administration in obese patients in PACU. The aim of this study was to compare two IV morphine titration (IMT) regimen in two surgical centers.

STUDY DESIGN

Observational study.

PATIENTS

Laparoscopic bariatric surgery in one private (Saint-Grégoire Clinic) and one public (University Hospital of Amiens) surgical center.

METHODS

A strict and common protocol of IMT was implemented if PACU of both centers according to the recommendations of the French Society of Anaesthesia and Intensive Care. When pain score increased to>30, IMT was titrated every 5 min in 3mg increments until pain relief (VAS≤30 mm). Pain level, dose of morphine (per total and ideal body weight), effectiveness, and side events were recorded.

RESULTS

Data were recorded for 159 adult patients (129 women). Mean age and BMI were 42±12 yrs and 43.8±6.9 kg/m(2). Ninety-eight patients were eligible for IMT regimen but only 76 patients received IV morphine (47.8 %). Mean dose was 7.3 mg±3.5mg [1-19 mg], (60.4 μg/kg and 115.8 μg/kg). IMT was less frequent, mean dose was greater (8.6±4.2 vs 6.2±2.9 mg) and number of patients with pain relief was higher (73.7 vs 35.6 %) in the public hospital. No severe adverse events have been recorded and there was no difference in both centers regarding these events.

CONCLUSION

Implementation of a IMT regimen in PACU was not associated with effective pain relief after laparoscopic surgery in obese patients.