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Evaluation of the pharmacokinetic profile and analgesic efficacy of oral morphine after total hip arthroplasty

Published online by Cambridge University Press:  24 May 2006

B. D. Manoir ,
P. Bourget ,
M. Langlois ,
B. Szekely ,
M. Fischler ,
M. Chauvin ,
A. Paci  and
D. Fletcher
B. D. Manoir
Affiliation:
Département d'Anesthésie Réanimation CHU Caen, Villejuif, France
P. Bourget
Affiliation:
Département de Pharmacie Clinique Institut Gustave Roussy, Villejuif, France
M. Langlois
Affiliation:
Département d'Anesthésie Réanimation CHU Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France
B. Szekely
Affiliation:
Département d'Anesthésie CMC Foch, Suresnes, France
M. Fischler
Affiliation:
Département d'Anesthésie CMC Foch, Suresnes, France
M. Chauvin
Affiliation:
Département d'Anesthésie Réanimation CHU Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France
A. Paci
Affiliation:
Département de Pharmacie Clinique Institut Gustave Roussy, Villejuif, France
D. Fletcher
Affiliation:
Département d'Anesthésie Réanimation CHU Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France
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Abstract

Summary

Background and objective: Oral morphine may be useful for postoperative pain relief, but few studies have tested its use after in-hospital surgery. Methods: We evaluated clinical efficacy and the pharmacokinetic parameters of oral morphine after total hip arthroplasty. We recruited 60 patients who had total hip arthroplasty under general anaesthesia. The patients were randomized to receive placebo, 10 mg morphine sulphate or 20 mg morphine sulphate orally every 4 h for 24 h. The oral administration was started 3 h after the morphine-loading dose in the Post Anaesthesia Care Unit and then patients used intravenous morphine patient-controlled analgesia for 24 h. Pain score at rest (scored by patients on a visual analogue scale), sedation, nausea, vomiting and urinary retention were monitored. In 11 additional total hip arthroplasty patients, we determined the pharmacokinetics of morphine and its metabolites after oral administration of 20 mg morphine sulphate every 4 h for 16 h. Results: The amount of morphine administered via patient-controlled analgesia over 24 h was reduced in the 20-mg group compared with that in the placebo group (19.0 ± 2.7 mg vs. 33.0 ± 5.5 mg; P = 0.03). No significant morphine-sparing effect was observed in the 10-mg group. Pain scores and side-effects were similar in all groups. The pharmacokinetic study revealed a limited and slow absorption of morphine. Conclusion: Despite a limited absorption of oral morphine postoperatively, high doses of oral morphine have a significant analgesic effect after total hip arthroplasty.

Keywords

ANALGESICS, OPIOID, morphineDRUG ADMINISTRATION ROUTES, oralPOSTOPERATIVE PERIODPAIN ACUTE AND POSTOPERATIVEANALGESIA, PATIENT CONTROLLEDBIO-AVAILABILITY
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 9 , September 2006 , pp. 748 - 754
Copyright
2006 European Society of Anaesthesiology

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