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Age-adapted morphine titration produces equivalent analgesia and adverse effects in younger and older patients

Keïta, H.*; Tubach, F.; Maalouli, J.; Desmonts, J.-M.; Mantz, J.*

European Journal of Anaesthesiology (EJA): May 2008 - Volume 25 - Issue 5 - p 352–356
doi: 10.1017/S0265021507003080
Original Article

Background To determine the efficacy and safety of intravenous postoperative morphine titration in the elderly compared with younger patients.

Methods In the post-anaesthesia care unit, patients complaining of pain received morphine until adequate pain relief. Intravenous morphine was titrated as 3 mg boluses in young (age ≤65 yr) and 2 mg in elderly patients (>65 yr) every 5 min.

Results We studied 350 young and 68 elderly patients. There were no significant differences between the two age groups for pain intensity at the onset of titration (numerical rating scale, 7.4 ± 1.7 in young vs. 7.5 ± 1.7 in elderly patients), area under the curve of numerical rating scale vs. morphine boluses (97.7 ± 59.6 vs. 98.2 ± 62), number of boluses required to obtain pain relief (3 ± 1.3 vs. 3 ± 1.3), percentage of titration failures (10% vs. 9%) and incidence of excessive sedation (18% vs. 21%). Renal clearance was significantly reduced in elderly compared with young patients (55 ± 21 vs. 85 ± 15 mL min−1; P < 0.0001).

Conclusion Using lower bolus doses, pain relief in the immediate postoperative period with morphine was as efficacious and safe in elderly patients as in younger patients. The decrease in renal clearance of morphine in the elderly justifies the reduction of intravenous morphine boluses for the treatment of postoperative pain.

* Assistance Publique Hôpitaux de Paris, Hospital Louis Mourier, Department of Anaesthesia, Colombes; Hospital Bichat, Paris, France

Assistance Publique Hôpitaux de Paris, Department of Epidemiology and Biostatistic, Paris, France

Assistance Publique Hôpitaux de Paris, Department of Anaesthesia, Paris, France

Correspondence to: Hawa Keita, Department of Anaesthesia, 178 rue des Renouillers, 92701 Colombes, France. E-mail:; Tel:+33 1 47 60 61 62; Fax: +33 1 47 60 60 59

Accepted for publication 10 November 2007

First published online 9 January 2008

© 2008 European Society of Anaesthesiology