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REGIONAL ANESTHESIA AND PAIN MANAGEMENT

The Effects of Residual Pain on Oxygenation and Breathing Pattern During Morphine Analgesia

Department of Anesthesia, Hôpital Henri Mondor, Créteil, France

Address correspondence and reprint requests to Dr. Gilles Dhonneur, Department of Anesthesia, Hôpital Henri Mondor, 51 av. du Mal de Lattre-de-Tassigny, 94010 Créteil cedex, France. Address e-mail to gilles.dhonneur{at}hmn.ap-hop-paris.fr

To determine the influence of pain on opioid-induced respiratory depression, we studied oxygenation and breathing patterns in 40 patients scheduled for knee surgery during postoperative patient-controlled analgesia (PCA). After 1 h of morphine PCA, patients were randomized to receive either 20 mL of placebo or bupivacaine 0.25% through a crural nerve catheter and allowed to use PCA for one more hour. Abnormal breathing events were identified and characterized by using the Edentrace II device (Nellcor, Jouy-en-Josas, France). The SpO₂ below which the patient spent 25% and 50% of a studied period was calculated (SpO₂₂₅, SpO₂₅₀). Pain relief with regional analgesia increased the incidence of abnormal respiratory events associated with oxygen desaturation: during the second period, the pain score was lower in the bupivacaine group (0.7 ± 1 vs 4.1 ± 1.2), morphine consumption was larger in the placebo group (4.2 ± 1.3 vs 0.7 ± 1.4 mg), and there were more abnormal obstructive breathing events in the bupivacaine group (11 ± 16 vs 3.7 ± 4.3). SpO₂₂₅ and SpO₂₅₀ were lower in the bupivacaine than in placebo group (91.5% ± 2.8% vs 93.1% ± 2.1%, 92.9% ± 2.4% vs 94.2% ± 1.8%).

Implications: Pain relief with regional analgesia in patients previously treated with opioids increases the incidence of abnormal respiratory events associated with oxygen desaturation.

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