Needed for Postoperative Analgesia
The aim of this study was to examine whether severity of postoperative pain intensity is related to postoperative pain and morphine consumption. Sixty consecutive patients scheduled for total hip surgery during intrathecal anesthesia were studied. Preoperative visual analog scale (VAS) scores and analgesic intake was assessed 1 day before surgery. Three groups of patients were identified: those with mild pain (n-12, VAS score 0.4), moderate pain (n=18, VAS score 4-7), and severe pain (n-28, VAS score 7-10). Postoperative pain scores were recorded in the first 24h, as was the amount of morphine delivered by the patient-controlled analgesia pump. There were no differences among the groups in VAS scores at any time. Severe postoperative pain levels correlated with significantly greater postoperative morphine intake. The mean morphine intake during the first 24h postoperatively was 19.2 mg in the mild pain group, 21.2 mg in the moderate pain group, and 29.5 mg in the severe pain group (p <0.05 compared with both other groups).
We conclude that patients with severe postoperative pain self-medicate to achieve postoperative pain scores equivalent to those of patients with mild and moderate pain and require a greater postoperative morphine intake for adequate analgesia than patients with mild or moderate postoperative pain.
Implications: In this study, we showed that severity of preoperative pain intensity relates to postoperative pain levels and morphine consumption. Patients scheduled for total hip surgery with severe preoperative pain require more postoperative morphine in the first 24h.
In this study, we showed that patients with severe preoperative pain require an approximately 50% greater morphine intake by PCA pump to attain the same level of postoperative analgesia in the first 24h after total hip surgery than patients with mild or moderate preoperative pain. In addition, patients want to lower their pain scores to the same range regardless of the original score.
Robert Slappendel MD, Eric W.G. Weber MD, Marian L.T. Bugter MD, and Ris Dirksen PhD, MD. The Intensity of Preoperative Pain Is Directly Correlated with the Amount of Morphine Needed for Postoperative Analgesia. Anesthesia & Analgesia 1999;88(1):146-148.