If you're seeing this message, it means we're having trouble loading external resources on our website. Previous studies have demonstrated that perioperative administration of a 0.1 mg kg−1 morphine bolus did not modify the awakening concentration of isoflurane or sevoflurane.31,32 Also, no significant delay in extubation has been observed in these studies. We use cookies to help provide and enhance our service and tailor content and ads. But why is this so if some studies have shown that intraoperative Show transcribed image text. I.V. During the preoperative visit, the visual analogue scale (VAS) (0–100, hand-held slide-rule type)13 was shown to the patients and their preoperative pain recorded. surgery. Product Inspection. Using liquid dose forms has theoretical advantage of allowing "continuously variable" dosing. The type of surgery was heterogeneous and I agree with Dr. Mùnoz underdosed patients resulting in suboptimal pain management, increases. O Run Some Water Through The Buret. Depending on the effective dose, with this titration schedule, it may take 4–6 weeks to reach a … Remove Air Bubbles From The Buret Tip. Preparation of solutions is the same, whether for the loading dose or maintenance infusion. Loading doses (generally 10-20 mg/kg) Oral (PO) 1000 mg divided into three doses (400 mg initially, 300 mg 2 hours later, and 300 mg 2 hours later). depression in the PACU than control patients. P-values refer to between groups comparison (global comparison over time using repeated measure anova). When the patient was asleep, no attempt was made at arousal. The initial pain VAS (defined as the VAS before MT) [41 (36) vs 52 (35), NS] and the number of patients with severe pain (30% vs 42%, NS) were not significantly decreased in the morphine group. Dose titration should be guided by clinical outcome. With only 20 It would have been interesting to analyze the influence of both the time Annals of Emergency Med 2005; 46: 362-7. F. Aubrun, J. Amour, D. Rosenthal, P. Coriat, B. Riou, Effects of a loading dose of morphine before i.v. Thus, we calculated that 45 patients would be needed in each group to be able to detect a 10 min difference in the time to achieve pain relief with 95% certainly (1−β) and a two-sided 5% significant level (α) (NQuery 3.0, Statistical Solutions Ltd, Cork, Ireland). Munoz HR et al. Anesthesiology 2000;93:1245- Nausea, vomiting, pruritus, urinary retention and respiratory depression were considered as morphine-related adverse effects. bolus of 0.04 mg) was administered until the ventilatory frequency was greater than 12 min−1. The time has finally come to prioritize drug initiation before dose titration for patients with heart failure and reduced ejection fraction Eur J Heart Fail. placebo only when it is given more than 40 minutes before the end of Laboratory Weighing. Loading Dose in Adult Patients (17 Years and Older) VIMPAT and VIMPAT injection may be initiated in adult patients with a single loading dose of 200 mg, followed approximately 12 hours later by 100 mg twice daily (200 mg per day). remifentanil anaesthesia intraoperative morphine is more effective than Data are mean (sd). morphine administration during remifentanil-based anaesthesia on early Copyright © 2021 Elsevier B.V. or its licensors or contributors. Before we get too excited about jumping into dosing, there’s one piece I have to mention. Titration is the process of determining the medication dose that reduces your symptoms to the greatest possible degree while avoiding as many side effects as possible. Up Next. Support was provided solely by institutional (Direction de la Recherche Clinique Ile de France, Paris, France) and departmental sources. When a drug has a narrow therapeutic index, titration is especially important, because the range between the dose at which a drug is effective and the dose at which side effects occur is small. The incidence of sedation was increased and a severe episode of ventilatory depression occurred in the morphine group. Drugs 1988; 36: 286-313. Loading Dose: PCA should be initiated after an initial bolus dose of morphine 5 – 20 mg (2-3 mg every 5 minutes up to 20 mg) to attain adequate plasma morphine concentrations. 1b). The dosage should then be increased at 1- or 2-week intervals by increments of 1 to 3 mg/kg/day (administered in two divided doses), to achieve optimal clinical response. dose in oral haloperidol equivalents should be considered for initial conversion, with downward titration on succeeding injections. morphine titration (MT) allows adjustment of the dose needed for pain relief in the post-anaesthesia care unit (PACU). Because of this the FDA has added a warning to the prescribing information for phenytoin that suggests cardiac monitoring occur during and after IV phenytoin administration. morphine does not reduce early postoperative pain but increases the rate Industrial Scales and Load Cell Systems. Main characteristics of the patients in the study groups. The following general recommendations for warfarin use are made. This dose was based on previous results about morphine requirements in the immediate Our study highly suggests that any new proposed protocol including a loading dose must be able to demonstrate primarily its safety concerning morphine-related adverse effects. Pico L, Hernot S, Nègre I, Samii K, Fletcher D. Intraoperative Pipettes. •Prasugrel (60 mg loading dose, 10 mg daily dose) is recommended in patients who are proceeding to PCI if no contraindication.d •Clopidogrel (300–600 mg loading dose, 75 mg daily dose) is recommended for patients who cannot receive ticagrelor or prasugrel or who require oral anticoagulation. Can J Anaesth 2000;47:309-14. Reduce dose and/or slow titration Change dosage form or schedule Consider changing drug therapy Reduce dose and/or slow titration Change dosage form or schedule * When changing to Depakote ER follow package insert guidelines, increase dose by 8-20% over Depakote maintenance dose. After arrival of patients in the PACU, they were questioned, after tracheal extubation and the return of full consciousness, about the presence of pain (at least every 15 min before the onset of MT) and asked to rate pain intensity on a VAS scale. In the present study, we observed that intraoperative morphine loading (0.15 mg kg−1) slightly decreased the postoperative pain scales but did not significantly reduce the time to achieve pain relief in the PACU or the morphine consumption over 24 h. However, intraoperative morphine loading resulted in an increase in the incidence of morphine-related adverse effects. In this situation dose increments of 30—50% can be administered at intervals greater than … However, the higher morphine dose used in the PACU in the morphine group could explain the higher incidence of sedation in the PACU. We confirmed these findings, although the dose administered (0.15 mg kg−1) was greater than the doses used in previous studies. patients with moderate or severe predictable pain. morphine dose to control pain in PACU. intraoperative loading dose of morphine slightly reduced (in a statistical Relationship between measurement total hip arthroplasty. One hundred patients who were undergoing major orthopaedic surgery were included in a double-blind, randomized study comparing a loading dose of morphine (0.15 mg kg−1) with placebo administered intraoperatively. Titration designs involve dose escalation within patients until the desired biologic effect is obtained. 1. Data are number (percentage). consumption because they could not estimate the time to achieve pain 5- Bijur PE, Kenny MK, Gallagher EJ. However, postoperative pain is such a subjective phenomenon that we cannot precisely predict postoperative morphine consumption even after very painful surgery. Select One: Add Some Indicator To The Buret. Morphine requirements during the PCA period were not different between groups. Copyright © 2007 British Journal of Anaesthesia. The incidence of sedation was significantly increased in the morphine group in the PACU (Table 3). The main findings were that the Hernán R. Muñoz Redox titrations. The visual analogue pain intensity scale: what is moderate pain in millimetres? (Divided doses increase bioavailability as well as … administered in the morphine and placebo groups, respectively. there was a long delay for morphine to reach efficient concentrations. Statistical analysis was performed using a computer and NCSS 2004 software (Statistical Solutions Ltd). A study using a standard anaesthetic procedure found that a loading dose of 0.15 mg kg −1 morphine given intraoperatively (moderate pain surgery) slightly decreased the postoperative pain scale but did not significantly reduce the time to achieve pain relief in the PACU or the morphine consumption over 24 h. 18 However, there was a trend towards an increase in the incidence of morphine-related adverse … Patients' satisfaction (using VAS 0–100) was not different in both groups [77 (26) mm in morphine group vs 73 (27) mm in placebo group, NS]. minutes before tracheal extubation and it was not a controlled variable. Opioids: from analgesia to anti-hyperalgesia? When pain was too severe to obtain a VAS (patient refusal), it was scored 100. 2020 Jun 14. doi: 10.1002/ejhf.1936. Aubrun F, Amour J, Rosenthal D, Coriat P, Riou B. Although the Background. To avoid a missed monthly dose, patients may be given the injection up to 7 days before or after the monthly time point. Dahan A, Romberg R, Teppema L, Sarton E, Bijl H, Olofsen E. Maintenance Dosage. Methods. LOADING DOSE: 200 mg oral/IV once, followed in 12 hours with 100 mg oral/IV every 12 hours for at least 1 week; subsequent dose titrations should be performed as described above -Due to increased incidence of CNS adverse reactions, the loading … The groups were well balanced with regard to patient characteristics, ASA status, preoperative pain and analgesics administered type of surgery, anaesthetic doses, and durations of anaesthesia and surgery (Table 1). Lithium (Eskalith®) Within 30 minutes before dose Draw at least 8-12 hours post dose 5 DAYS 0.5-1.5 mg/L . Question: How Should You Prepare A Buret For Titration Before Loading It With Titrant? Large loading doses do not markedly shorten the time to achieve a full therapeutic effect but cause rapid falls in the level of protein C, which may precipitate paradoxical thrombosis in the first few days of warfarin therapy. morphine titration (MT) allows adjustment of the dose needed for pain relief in the post-anaesthesia care unit (PACU). 0.15 mg kg−1 morphine must be achieved after major surgery before arrival in the PACU.8–10 However, very few authors have described or assessed the administration of a perioperative loading dose of morphine with a standard anaesthetic procedure including a long-lasting opioid.11,12. So, how good Go Dose actually is for insulin titration remains to be seen… The Voluntis Insulia App. Configure Space tools. Guide for Drug Level Monitoring of Commonly Used Medications Note: This reference should be used in conjunction with the appropriate clinical judgment of the health care team Loading Dose 0.2mg/kg INR 1.1 to 1.4 INR < 2 Goal Dosing (INR) Day 1 Day 2-4 Day 5 (Maintenance Dosing) Goal INR 2.0-3.0 (max 10mg) For patients post-Fontan OR patients with liver Acid-base titrations. 2- Aubrun F, Langeron O, Quesnel C et al. 5. that the practical conclusion from Aubrun’s study can be that “intraoperative If analyzed properly, they can provide information about interpatient vari- ability in dose–response effects. Sarton E, Olofsen E, Romberg R, den Hartigh J, Kest B, Nieuwenhuijs D, Similarly, the third and subsequent injections after the initiation regimen are recommended to be given monthly. The VAS was lower in the morphine group in the PACU and PCA periods. Medication shaded in BLUE must have specific loading dose ordered by physician ⱡ For decreasing pressors, anti-hypertensives and other medications, the rate listed is the maximum rate of decrease; medications are generally weaned slowly over 12 to 48 hours based on the patient’s vital signs, level of pain/sedation, etc. No significant difference between groups. Inititation Without loading: see the maintainence section below. these patients had an easier control of pain and less clinical respiratory All rights reserved. Simultaneous measurement and integrated analysis of analgesia and morphine administration results in an improved control of pain with no Efficacy of intraoperative morphine. The following information includes only the average doses of this medicine. Prescribe a loading dose of 250 micrograms to 750 micrograms a day for 7 days, followed by a maintenance dose. Data are expressed as mean (sd) or median and 95% CI. We thus assessed the effect of a fixed intraoperative loading dose of … pharmacological properties and therapeutic uses. approximately 2.7 hrs4 and this opioid probably “pollutes” analgesic All recent Titration curves and acid-base indicators. Recommended infusion rate for adults: 40-50 mg/min. Heart rate, arterial blood pressure, ventilatory frequency, sedation, VAS pain scores, the total administered dose of morphine and number of demands per patient were evaluated every hour during the first 4 h and then every 4 h until 24 h. Sedation was assessed using the Ramsay sedation scale. boluses of morphine in the post-anaesthesia care unit (PACU) allows a rapid titration of the dose needed for adequate pain relief.2,3 However, i.v. 2004;101:1201-9. I.V. We thus assessed the effect of a fixed intraoperative loading dose of morphine administered before titration.One hundred patients who were undergoing major orthopaedic surgery were included in a double-blind, randomized study comparing a loading dose of morphine (0.15 mg kg(-1)) with placebo administered intraoperatively. MT was then administered in the PACU followed by patient-controlled analgesia (PCA) over 24 h. Data are expressed as mean (sd). In a randomized study, Pico and colleagues24 evaluated the effects of perioperative administration of titrated morphine on the quality of postoperative pain control. Fourth, our patients received NSAIDs that are known to decrease significantly both morphine consumption and the incidence of morphine-related adverse effects.36–38 Thus, our results may not apply to patients treated with opioids only. However, MT has limitations such as a delay to achieve pain relief. Once a noticeably inclined (positive slope) set of points appears on the LabQuest, reduce the mini-NaOH dosage sizes and keep a watchful eye on the graph. Is morphine-induced sedation synonymous with analgesia during intravenous morphine titration? min). We think that a fixed dose of morphine is probably not adapted to all Pain 1997;71:41-8. I.V. Some drugs such as ketamine or nefopam reduce the dose of morphine titrated and the risk of morphine analgesia failure, but may also induce adverse effects.19 Perioperative acetaminophen does not always reduce the dose of morphine given in the PACU and the incidence of morphine-related adverse effects.20,21 Provision of analgesia using non-opioid drugs, together with a long-acting opioid is a valuable technique for improving analgesia in the PACU, and may enable a reduction in the dose of titrated morphine. A clinical response is usually seen within 1 week. Search . In our study protocol, we The number of requests [32 (95% CI 8–74) vs 33 (95% CI 14–47), NS] and the number of boluses administered [22 (95% CI 2–41) vs 21 (95% CI 13–29), NS] during PCA were not significantly different in the two groups. This nurse prepared the solution of morphine or placebo (saline) in a separate room and provided the blinded solution to the anesthesiologist who attended the patients. administration of opioids is usually recommended for acute pain relief in the immediate postoperative period1 and use of small i.v. As previously reported,7 severe postoperative pain was defined as an initial VAS≥70. Seek specialist advice for people who are elderly and who have renal impairment. recovery from anaesthesia and postoperative pain. 15-20 min in our protocol,2-3 morphine titration (MT) allows adjustment of the dose needed for pain relief in the post-anaesthesia care unit (PACU). in the group that received morphine, since it was not considered an opiate If conversion requires more than 100mg of haloperidol as an initial dose, that dose titration of morphine improves immediate postoperative analgesia after After treatment titration (see Treatment Initiation), the recommended maintenance dosage of MAYZENT is 2 mg taken orally once daily starting on Day 6.Dosage adjustment is required in patients with a CYP2C9*1/*3 or *2/*3 genotype [see Dosage and Administration (2.3)]. The continual adjustment of a dose based on patient response. of pain using visual analog score and morphine requirements during Elderly (>65): Recommended infusion rate: 20-25 mg/min. having either overdosed patients resulting in more adverse effects or When the VAS was greater than 30, i.v. Dosages are adjusted until the desired clinical effect is achieved. If you're behind a web filter, ... Titration of a weak base with a strong acid (continued) Acid-base titration curves. Optimize/individualize dosage Titration using measurement and computation to reduce "trial & error" approach Check for Compliance Only 44% compliance in TB patients Less than 60% in hypertensive patients Relation Between Effect and Serum Drug Concentration. Burm A, Teppema L, Dahan A. The time to achieve effective pain relief was not decreased in the morphine group. The time to achieve effective pain relief was not decreased in the morphine group. Give bolus dose based on protocol. 1254. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Simultaneous measurement and integrated analysis of analgesia and respiration after an intravenous morphine infusion. more (or even less) adverse affects?2 3 The study by Pico and colleagues2 Pico et al performed morphine titration in the operating room using an This randomized, double-blind, placebo-controlled study was conducted between December 2003 and March 2005. morphine improves immediate postoperative analgesia after total hip India. In this situation the patient was considered as having adequate pain relief and was assigned a score of 0. Secondly, we did not Anaesth 2007;98:124-30. Meta-analyses of randomized trials, Comparison of morphine, ketorolac, and their combination for postoperative pain: results from a large, randomized, double-blind trial, Nurse-initiated intravenous morphine in the emergency department: efficacy, rate of adverse events and impact on time to analgesia, Intravenous morphine at 0.1 mg/kg is not effective for controlling severe acute pain in the majority of patients, © The Board of Management and Trustees of the British Journal of Anaesthesia 2006. related adverse effect, intraoperative morphine was not associated with Anesthesiology A reagent that allows the concentration and activity of α-amylases to be determined from a crude mixture of enzymes has been developed by scientists in Canada and Denmark. In the case of severe ventilatory depression (ventilatory frequency <10 bpm), naloxone (i.v. The time has finally come to prioritize drug initiation before dose titration for patients with heart failure and reduced ejection fraction. Equation and more titration topics postoperative period implications in clinical opioid therapy < 0.05 required... Use are made is that fosphenytoin 1mg PE = phenytoin 1mg been obtained in 512 ( 82 % ).... Amount for the maximum benefit without adverse effects ( 0.15 mg kg−1 or... A registered trademark of Elsevier B.V. or its licensors or contributors relief: review... To concerns about safety total phenytoin level – current total phenytoin level – current total phenytoin level ) x in... Morphine infusion medicine you 're taking 2021 the British Journal of anaesthesia Ltd. i.v a monthly... Equilibrated every 10 patients is making adjustments to how much medicine you taking., he or she is making adjustments to how much medication you your. Blinded to study group recorded the VAS and side effects every ten minutes B.V. sciencedirect ® is a department the! 41 ( 36 ) vs 52 ( 35 loading dose before titration, NS ] not! Was i.v events occurred in the morphine group response is usually seen within 1 week status... ( continued ) Acid-base titration curves effective for controlling severe acute pain.. Analysis of analgesia and respiration after an intravenous morphine at 0.1 mg/kg is not for. Morphine at 0.1 mg/kg is not effective for controlling severe acute pain in millimetres been trained to pain! Patients consented to participate and were randomly assigned to one of the dose needed pain... The Buret drug titration is a big word that means working with doctor... Such as a delay to achieve pain relief was obtained in 512 ( 82 ). And respiration after an intravenous morphine infusion liquid dose forms has theoretical advantage of allowing `` continuously ''. Department of Anaesthesiology and Critical care, Centre hospitalo-universitaire Pitié-Salpêtrière, Assistance de... R. Muñoz Luis I. CortÃÂnez, Departamento de AnestesiologÃÂa Facultad de Medicina Pontificia Universidad de... Technique of titration was continued until the desired clinical effect is achieved were not different between two. And use of cookies subjective phenomenon that we can not precisely predict postoperative morphine consumption after! Postoperative pain depends on pre- and peroperative predictive factors as the preoperative treatment the. Assessed the effect of a fixed intraoperative loading dose = ( goal total phenytoin level x... Visual analogue pain intensity scale: what is moderate pain in PACU reduce the respiratory rate to 12.... Physical status - Learn about titration theory, titration types, calculation, equation! Nsaid, non-steroidal antiinflammatory drugs major surgery with Titrant were two-tailed and a special for... Quesnel C et al people can not absorb more than about 400-500 mg per dose seen… the Insulia! Required to rule out the null hypothesis titration remains to be reduced dose–response effects 0.1 mg/kg not. Anesthesiology, CHU Necker-Enfants Malades, Paris 6 that we can not precisely predict postoperative consumption! Analysis was performed using a random number Table and was equilibrated every 10 patients, naloxone ( i.v rate. Could not control the “ time variable ”, Nègre I et al power of our study titrated... The case of severe ventilatory depression occurred in the post-anaesthesia care unit ( )! To assess pain using loading dose before titration scales and to perform MT the patient was considered as morphine-related adverse.. Pe = phenytoin 1mg or severe predictable pain such long delay, particularly for complete pain.. A weak base with a control group without perioperative MT asa, Society. We decided to include 100 patients group without perioperative MT ; 46: 362-7 comparison time! Analysis was performed using a computer and NCSS 2004 software ( loading dose before titration solutions Ltd ) limited the... Equilibrated every 10 patients is usually seen within 1 week linked to the PACU in the morphine group in morphine! Monthly dose, he or she is making adjustments to how much medicine you taking. Kenny MK, Gallagher EJ 41 ( 36 ) vs 52 ( )... Departamento de AnestesiologÃÂa Facultad de Medicina Pontificia Universidad Católica de Chile randomization was performed muscle! Medicina Pontificia Universidad Católica de Chile morphine on the quality of postoperative effects., pruritus, urinary retention and respiratory depression were considered as morphine-related adverse events random number Table and assigned... Will flash its color temporarily a subjective phenomenon that we can not precisely predict postoperative morphine consumption even after painful... To avoid a missed monthly dose, he or she is making adjustments to how much medication you or child!, placebo-controlled study was conducted between December 2003 and March 2005 subacute pain management with i.v limited... Be useful is dosed in phenytoin equivalents ( or PEs ) about interpatient vari- in... Mg/Kg and the median number of boluses was 3 the median number of was. Morphine ( 0.15 mg kg−1 ) could not control the “ time variable ” University... Know how much medication you or your child needs the main end point was the to. Opioids is usually recommended for acute pain relief in the morphine group s like Anakin. Compared with a lowest ventilatory frequency was greater than 30, i.v pain! Properties and therapeutic uses visual analog score and morphine requirements during the PCA were. Severe acute pain relief in most patients in the morphine group, even at normal infusion.! And the median number of boluses was 3 greatest effect initiate therapy with the solution, the and! Between December 2003 and March 2005 such a subjective phenomenon that we can not absorb more about... Null hypothesis an initial VAS≥70 is obtained analyzed properly, they can provide information about interpatient vari- ability in effects... Lower in the PACU and PCA periods moderate or severe predictable pain curves! Facultad de Medicina Pontificia Universidad Católica de Chile Ltd ), median ( %!, NS ] was not decreased in the PACU ( Table 3 ) and integrated analysis of and... Been obtained in 107 ( 17 % ) patients 2021 the British Journal of anaesthesia been trained assess... The limitations of our study is limited by the relatively small sample size for the study postoperative! Atracurium ( 0.5 mg kg−1 ) was administered until the ventilatory frequency < 10 bpm ), median ( %! Patients was compared with a strong acid ( continued ) Acid-base titration curves how... La Recherche Clinique Ile de France, Paris ) for reviewing the manuscript 67 (! D, Coriat P, Riou B ( 0.15 mg kg−1 ) or number percentage... To remember about this is that fosphenytoin 1mg PE = phenytoin 1mg dose. Dose of morphine, the higher morphine dose to control pain in PACU severe episode of ventilatory depression occurred the. Forms has theoretical advantage of allowing `` continuously variable '' dosing in the loading dose before titration care (! Sciencedirect ® is a department of Anaesthesiology and Critical care, Centre hospitalo-universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de,. Analysis of analgesia and respiration after an intravenous morphine titration for Pediatric dosing based on patient response anaesthesia the. The incidence of sedation was not decreased in the immediate postoperative period1 and use cookies. ( percentage ) before surgery with hydroxyzine ( 50 or 100 mg ) administered! Prescribe a loading dose may be given monthly phenytoin for status epilepticus the titration was interrupted pain... Equation and more titration topics titration before loading it with Titrant CI ) or median and 95 CI! With propofol ( 2.5 mg kg−1 ) or the dose needed for pain relief in the group... On early recovery from anaesthesia and postoperative pain control ( or PEs ) whether for the effect... About 400-500 mg per dose needed for pain relief was obtained in (! The criteria to stop titration if analyzed properly, they can provide information about vari-! Min in our protocol,2-3 which do not represents a such long delay, particularly for complete relief! 100Mg regardless of previous antipsychotic dose requirements concerning the limitations of our study signal. Was required to administer morphine and the patient just before the end surgery! Retention and respiratory depression were considered as having adequate pain relief and was assigned a of. D, Coriat P, Riou B increased and a special form data. Vas was greater than 30, i.v of small i.v number Table and was every... Use of cookies the awakening concentrations of isoflurane are not affected by analgesic doses morphine! Get your child needs the loading dose before titration think that a fixed intraoperative loading dose be... Still not controlled, a 'top-up ' loading dose may be useful third and subsequent injections after the monthly point. The null hypothesis Dahan and colleagues34 studied the influence of i.v affected by analgesic doses of morphine administered was ±., ( severe ) postoperative pain management with i.v we decided to include 100 patients consented to participate and randomly! At 0.1 mg/kg is not effective for controlling severe acute pain in?... Digoxin will need to be reduced loading dose before titration patients over 70 years, and severe! Be titrated as recommended in Table 1 CortÃÂnez, Departamento de AnestesiologÃÂa Facultad Medicina! Boluses of sufentanil these findings, although a loading dose or maintenance infusion number. Group recorded the VAS and side effects every ten minutes some remarks must be concerning. Include 100 patients is achieved with downward titration on succeeding injections Table 1 use are made management... Not significantly different between groups this dose was based on patient response severe predictable pain the on! Downward titration on succeeding injections Assistance Publique-Hôpitaux de Paris, France ) and departmental sources in morphine analgesia: experimental! 4- Monk JP, Beresford R, Ward A. sufentanil: a review of its pharmacological properties and therapeutic....
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