Sex differences in the daily rhythmicity of morphine consumption after major abdominal surgery

Authors

  • Stefano Cattaneo, MD
  • Pablo Ingelmo, MD
  • Luigia Scudeller, MD, PhD
  • Manuela De Gregori, PhD
  • Dario Bugada, MD
  • Marco Baciarello, MD
  • Maurizio Marchesini, MD
  • Giovanni Alberio, MD
  • Marco Normanno, MD
  • Gloria Saccani Jotti, MD
  • Tiziana Meschi, MD
  • Guido Fanelli, MD
  • Massimo Allegri, MD

DOI:

https://doi.org/10.5055/jom.2017.0372

Keywords:

daily rhythm, postoperative pain, patient-controlled analgesia

Abstract

Objective: The sex of the patients has been shown to affect postoperative pain and morphine consumption; still a clear understanding able to explain the reasons behind this difference struggles to emerge. Our research aimed to investigate one specific aspect of the variability in morphine consumption between sexes. Previous studies have shown that circadian rhythm can influence opioid consumption. Furthermore, circadian rhythm is different between female and male. Our analysis investigated the presence of differences in daily rhythmicity of morphine consumption between males and females.

Design: This is a secondary analysis of data collected during 2 years long multicenter clinical trial (NCT01233752).

Settings: Clinical data were collected in two Italian hospitals: IRCCS Foundation Policlinico S. Matteo (Pavia) and San Gerardo Hospital (Monza).

Patients: The authors recorded data about morphine consumption in 157 patients who underwent major abdominal surgery, who received morphine intravenous patient-controlled analgesia (IV-PCA) as postoperative analgesia.

Interventions: The authors analyzed the daily periodicity of effective boluses delivered by morphine IV-PCA with Poisson multilevel models, adjusted by the time of start for each pump. An effective bolus was defined as a correctly delivered bolus of 1 mg of morphine. The authors also evaluated the interactions among the time of the day and sex, age (</ ≥ 55 y), and body mass index (BMI; < /≥30 kg/m2).

Main Outcome Measure(s): Differences in sex of morphine consumption rhythms over the 24 hours of the day.

Results: Morphine consumption showed a statistically significant daily periodicity (p < 0.001) in our study population. Consumption was higher around 2 am (rate 0.4 mg/min·patient) and lower around 12 pm (rate 0.05 mg/min·patient). Global consumption was not associated with the pump start time, age, or sex. The daily periodicity of morphine consumption was different between males and females (p = 0.004), with males consuming more morphine during the night.

Conclusions: Our analysis confirmed the presence of daily rhythm for morphine consumption in patients treated with IV-PCA morphine after major abdominal surgery. A difference in the daily periodicity was observed between sexes. No difference emerged in daily periodicity for the categories of age and BMI.

Author Biographies

Stefano Cattaneo, MD

Department of Anesthesia, McGill University, Montreal, Québec, Canada.

Pablo Ingelmo, MD

Allan Edwards Research Center for Pain, Department of Anesthesia, Montreal Children's Hospital, McGill University, Montreal, Québec, Canada

Luigia Scudeller, MD, PhD

Clinical Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Policlinic San Matteo Foundation, Pavia, Italy

Manuela De Gregori, PhD

Pain Therapy Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

Dario Bugada, MD

Department of Surgical Science, University of Parma, Parma, Italy

Marco Baciarello, MD

Department of Surgical Science, University of Parma, Parma, Italy; Anesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliera Universitaria Parma, Parma, Italy

Maurizio Marchesini, MD

Anesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliera Universitaria Parma, Parma, Italy

Giovanni Alberio, MD

Anesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliera San Gerardo, Monza, Italy

Marco Normanno, MD

Anesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliera San Gerardo, Monza, Italy

Gloria Saccani Jotti, MD

Faculty of Medicine, Department of Biomedical, Biotechnological and Translational Sciences (S.Bi.Bi.T), University of Parma, Parma, Italy

Tiziana Meschi, MD

Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy

Guido Fanelli, MD

Department of Surgical Science, University of Parma, Parma, Italy; Anesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliera Universitaria Parma, Parma, Italy.

Massimo Allegri, MD

Department of Surgical Science, University of Parma, Parma, Italy; Anesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliera Universitaria Parma, Parma, Italy

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Published

03/01/2017

How to Cite

Cattaneo, MD, S., P. Ingelmo, MD, L. Scudeller, MD, PhD, M. De Gregori, PhD, D. Bugada, MD, M. Baciarello, MD, M. Marchesini, MD, G. Alberio, MD, M. Normanno, MD, G. S. Jotti, MD, T. Meschi, MD, G. Fanelli, MD, and M. Allegri, MD. “Sex Differences in the Daily Rhythmicity of Morphine Consumption After Major Abdominal Surgery”. Journal of Opioid Management, vol. 13, no. 2, Mar. 2017, pp. 85-94, doi:10.5055/jom.2017.0372.

Issue

Vol. 13 No. 2 (2017): March/April

Section

Articles

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