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REGIONAL ANESTHESIA AND PAIN MANAGEMENT

The Intensity of Preoperative Pain Is Directly Correlated with the Amount of Morphine Needed for Postoperative Analgesia

Robert Slappendel, MD^*, Eric W. G. Weber, MD^*, Marian L. T. Bugter, MD^*, and Ris Dirksen, PhD, MD

*Department of Anesthesiology, Sint Maartenskliniek; and Department of Anesthesiology, University Hospital Nijmegen, Nijmegen, The Netherlands

Address correspondence and reprint requests to Robert Slappendel, MD, Department of Anesthesiology, Sint Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands.

The aim of this study was to examine whether severity of preoperative 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 24 h, 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 preoperative pain levels correlated with significantly greater postoperative morphine intake. The mean morphine intake during the first 24 h 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 preoperative 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 preoperative 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 24 h.

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