Early treatment of postoperative pain after tonsillectomy with patient controlled intravenous morphine – overdue or exaggerated?
18 April 2018 (online)
Tonsillectomy (TE) leads to disproportional high pain intensities with no uniform current treatment standard. The objective of the present study (DRKS00011092) was to assess the value of patient controlled intravenous analgesia (PCIA) with morphine in the pain treatment after TE.
Following TE, 30 consecutive adult patients were treated with oral analgesics (group 1) and so far 11 consecutive patients with PCIA (morphine 1 mg/ml, 1 mg bolus dose, maximum 30 mg in 4 hrs.) (group 2) for the first 3 postoperative days (POD). The primary efficacy endpoint was defined as the pain severity (numeric rating scale (NRS): 0 = no – 10 = worst possible pain) on PODs 1 – 3. Secondary endpoints included the amount of analgesics taken (morphin equivalent (meq) per os), quality of life (SF 36), patient satisfaction (QUIPS;NRS) and treatment-related side effects.
Pain severities of group 1 (Ø 25yrs.; 63% ♀) and group 2 (Ø 24yrs.; 80% ♀) on PODs 1 – 3 were Ø 4.48 vs. 4.11 (p = 0.68), 4.75 vs. 4.0 (p = 0.26) und 4.44 vs. 3.85 (p = 0.46), respectively. 75.9% of patients without PCIA took Ø 80.7 mg meq compared to 93.8 mg meq (p = 0,6) via the PCIA. The physical (Ø 36.2 vs. 33.9 (p = 0.54) and mental (49.2 vs. 51.9 (p = 0.42) functioning scores of groups 1 and 2 were comparably high as well as patient satisfaction (Ø 7.4 vs. 8.4; p = 0.12). Typical side effects of opioid analgesics like nausea (66.7% vs. 55.7; p = 0.54) and fatigue (96.6% vs. 100%; p = 0.57) were not significantly increased in the PCIA group.
The PCIA can be advocated as a secure alternative for postoperative pain control after TE with a high degree of patient satisfaction, autonomy and responsibility alongside with no increased morphine consumption and significant increase of adverse therapeutic effects.