CAN IMMEDIATE OPIOID REQUIREMENTS IN THE POSTANESTHESIA CARE UNIT BE USED TO DETERMINE ANALGESIC REQUIREMENTS ON THE WARD

The aim of this prospective study was to evaluate the efficacy of two dosage regimens of (im) morphine calculated from an initial (iv) titra ted dose in the early postoperative period. Seventy ASA I-III patients who underwent general anaesthesia (GA) (n = 58), regional anaesthesia (RA) (n = 10) or GA + RA (n = 2) for orthopaedic (n = 54), urological (n = II) or abdominal surgery (n = 5) received iv titrated morphine i n the post-anaesthesia care unit (PACU). Titration consisted of 3 mg m orphine iv every ten minuter until patients had a visual analogue pain scale (VAS) <3, without marked sedation. Seventeen patients did not c omplain at all or had good analgesia with an initial iv dose less than or equal to 6 mg of morphine followed by paracetamol only Patients wh o needed more than 6 mg iv morphine were randomly assigned to a ''high -close'' or a ''low-dose'' group and received a systematic int morphin e regimen calculated from the initial titrated dose. Pain was assessed by VAS before Each im injection and the next morning. One patient had respiratory depression and one marked sedation in the PACU. These pat ients were excluded from the rest of the study Only 16 patients had a VRS >3 at least once during the study period and only three needed res cue analgesia which was available on request. We conclude that a syste matic im morphine regimen adapted from an initial iv titration in the PACU provides efficacious and relatively inexpensive postoperative ana lgesia, applicable to a great majority of patients.