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Morphine metabolism after major liver surgery.

Rudin, Åsa LU ; Lundberg, Johan LU ; Hammarlund-Udenaes, Margareta; Flisberg, Per LU and Werner, Mads LU (2007) In Anesthesia and Analgesia 104(6). p.1409-1414
Abstract
BACKGROUND: Impaired metabolism of morphine may lead to an increase in sedation and respiratory depression. METHODS: In the present study we investigated morphine pharmacokinetics in patients who had undergone liver resection (n = 15) compared to a control group undergoing colon resection (n = 15). Morphine was administered IV by patient-controlled analgesia. Plasma concentrations of morphine, morphine-6-glucuronide, and morphine-3-glucuronide were measured 2-3 times daily for the first two postoperative days. Pain intensity scores were assessed three times daily and respiratory rate and sedation scores every third hour. RESULTS: There were no differences in morphine requirements 1.1 (0.8-2.5 [median, interquartile range]) mg/h (liver... (More)
BACKGROUND: Impaired metabolism of morphine may lead to an increase in sedation and respiratory depression. METHODS: In the present study we investigated morphine pharmacokinetics in patients who had undergone liver resection (n = 15) compared to a control group undergoing colon resection (n = 15). Morphine was administered IV by patient-controlled analgesia. Plasma concentrations of morphine, morphine-6-glucuronide, and morphine-3-glucuronide were measured 2-3 times daily for the first two postoperative days. Pain intensity scores were assessed three times daily and respiratory rate and sedation scores every third hour. RESULTS: There were no differences in morphine requirements 1.1 (0.8-2.5 [median, interquartile range]) mg/h (liver resection) and 1.5 (1.1-1.7) mg/h (colon resection) [P = 0.84]) or in pain intensity scores (P > 0.3) between the groups. Plasma morphine concentrations were higher in patients undergoing liver resection than in the control group (P < 0.01) reflecting a lower rate of morphine metabolism. Plasma morphine concentrations were correlated with the volume of liver resection (P < 0.02). However, plasma concentrations of morphine-6-glucuronide and morphine-3-glucuronide did not differ between the groups (P = 0.62 and P = 0.48, respectively). There was a higher incidence of sedation (P = 0.02), but not respiratory depression (P = 0.48), after liver resection. CONCLUSION: The study demonstrates that plasma concentrations of morphine are higher in patients undergoing liver resection compared with patients undergoing colon resection. Sedation scores were higher in patients undergoing liver resection. Caution is therefore recommended when administering morphine to this patient group. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Anesthesia and Analgesia
volume
104
issue
6
pages
1409 - 1414
publisher
Lippincott Williams & Wilkins
external identifiers
  • wos:000246791000016
  • scopus:34249010805
ISSN
1526-7598
DOI
10.1213/01.ane.0000261847.26044.1d
language
English
LU publication?
yes
id
c0eec71c-e3ed-4d48-abd1-48e8a25aef67 (old id 168197)
date added to LUP
2007-07-10 13:04:06
date last changed
2017-01-01 06:38:09
@article{c0eec71c-e3ed-4d48-abd1-48e8a25aef67,
  abstract     = {BACKGROUND: Impaired metabolism of morphine may lead to an increase in sedation and respiratory depression. METHODS: In the present study we investigated morphine pharmacokinetics in patients who had undergone liver resection (n = 15) compared to a control group undergoing colon resection (n = 15). Morphine was administered IV by patient-controlled analgesia. Plasma concentrations of morphine, morphine-6-glucuronide, and morphine-3-glucuronide were measured 2-3 times daily for the first two postoperative days. Pain intensity scores were assessed three times daily and respiratory rate and sedation scores every third hour. RESULTS: There were no differences in morphine requirements 1.1 (0.8-2.5 [median, interquartile range]) mg/h (liver resection) and 1.5 (1.1-1.7) mg/h (colon resection) [P = 0.84]) or in pain intensity scores (P &gt; 0.3) between the groups. Plasma morphine concentrations were higher in patients undergoing liver resection than in the control group (P &lt; 0.01) reflecting a lower rate of morphine metabolism. Plasma morphine concentrations were correlated with the volume of liver resection (P &lt; 0.02). However, plasma concentrations of morphine-6-glucuronide and morphine-3-glucuronide did not differ between the groups (P = 0.62 and P = 0.48, respectively). There was a higher incidence of sedation (P = 0.02), but not respiratory depression (P = 0.48), after liver resection. CONCLUSION: The study demonstrates that plasma concentrations of morphine are higher in patients undergoing liver resection compared with patients undergoing colon resection. Sedation scores were higher in patients undergoing liver resection. Caution is therefore recommended when administering morphine to this patient group.},
  author       = {Rudin, Åsa and Lundberg, Johan and Hammarlund-Udenaes, Margareta and Flisberg, Per and Werner, Mads},
  issn         = {1526-7598},
  language     = {eng},
  number       = {6},
  pages        = {1409--1414},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Anesthesia and Analgesia},
  title        = {Morphine metabolism after major liver surgery.},
  url          = {http://dx.doi.org/10.1213/01.ane.0000261847.26044.1d},
  volume       = {104},
  year         = {2007},
}