Sex- and age-related differences in morphine requirements for postoperative pain relief
Sex- and age-related differences in morphine requirements for postoperative pain relief
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DOI：
10.1097/00000542-200507000-00023
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发表时间：
2005-07-01
期刊：
影响因子：
8.8
通讯作者：
Riou, B
中科院分区：
文献类型：
--
作者：
Aubrun, F;Salvi, N;Riou, B
背景：与性别相关的疼痛感知差异和对阿片类药物的易感性仍然是一个有争议的问题。术后即刻静脉滴注吗啡缓解疼痛是一种独特的临床模式，用于评估性别对报告疼痛的影响。由于疼痛治疗的剂量要求差异很大，作者在大量人群中进行了一项前瞻性研究，并评估了衰老的影响。方法：术后即刻静脉滴注吗啡2 mg（体重5 ~ 60 kg）或3 mg（体重5 ~ 60 kg）。每次给药间隔5分钟。给予吗啡所需的视觉模拟疼痛量表（VAS）阈值为30，疼痛缓解定义为VAS评分为30或更低。数据以平均值+/- SD表示。结果：分析了4317例患者的数据；男性占54%，女性占46%。获得疼痛缓解所需的吗啡平均剂量为11.9 +/- 6.8 mg或0.173 +/- 0.103 mg/kg。女性的初始VAS评分较高（74 +/- 19比71 +/- 19，P < 0.001），需要更大剂量的吗啡（0.183 +/- 0.111比0.165 +/- 0.095 mg/kg, P < 0.001）。相比之下，老年患者（年龄在0 ~ 75岁）无显著差异（0.163 +/- 0.083 vs. 0.157 +/- 0.085 mg/kg）。结论：与男性相比，女性术后疼痛更严重，需要更大剂量的吗啡（+11%）。这种与性别相关的差异在老年患者中消失。
Background: Sex-related differences in the perception of pain and susceptibility to opioids remain a matter of debate. intravenous morphine titration used to obtain pain relief in the immediate postoperative period is a unique clinical model for assessing the effect of sex on reported pain. Because of the wide variation in dose requirements for pain management, the authors conducted a prospective study in a large population and also assessed the effect of aging.Methods: Intravenous morphine titration was administered as a bolus of 2 (body weight :5 60 kg) or 3 mg (body weight > 60 kg) during the immediate postoperative period. The interval between each bolus was 5 min. The visual analog pain scale (VAS) threshold required to administer morphine was 30, and pain relief was defined as a VAS score of 30 or less. Data are expressed as mean +/- SD.Results: Data from 4,317 patients were analyzed; 54% of the patients were male, and 46% were female. The mean morphine dose required to obtain pain relief was 11.9 +/- 6.8 mg or 0.173 +/- 0.103 mg/kg. Women had a higher initial VAS score (74 +/- 19 vs. 71 +/- 19; P < 0.001) and required a greater dose of morphine (0.183 +/- 0.111 vs. 0.165 +/- 0.095 mg/kg; P < 0.001). In contrast, no significant difference was noted in elderly (aged > 75 yr) patients (0.163 +/- 0.083 vs. 0.157 +/- 0.085 mg/kg).Conclusion: Women experienced more severe postoperative pain and required a greater dose (+11%) of morphine than men in the immediate postoperative period. This sex-related difference disappeared in elderly patients.