by coffeeluvinRN

I'm currently doing a research project on the standard post-op order at my hospital which is the use of 1-2mg of Morphine every one hour post-op for CABG patients for the first 24 hours. and I'm looking at the relation of the need of the pain med to gender. Many studies have found that men tend to need more morphine (30-40% more) and females require significantly less. One of the reasons hypothesized is the fact that morphine is lipophilic and since females have more body fat composition compared to males, the morphine stays in the female's fat longer.

Has anyone else found any differences between pain meds and gender?

What do other hospitals use for post-op CABG pain management? Does any one titrate the pain meds accordings to weight or gender or age????

Any input would be greatly appreciated for my research!

Re: Gender and Pain Management

We don't titrate according to anything other than the pt's pain level, but it will be interesting to hear what you find out regarding age, weight and sex.

Our standard orders are Morphine 2,4, and 6mg every 1-2 hours for pain (pretty big range for use of nursing judgement) and Vicodin or Percocet 1-2 tabs every 4 hours for pain. Seems to be pretty effective for us.

I'm still very new so I can't really say if I've noticed men needing more morphine than women, but there are definitely differences in how often some people ask or think they need pain medicine. Education is huge in this specialty!

Re: Gender and Pain Management

Just wondering if anyone else had any comments regarding their practices for CABG patients? Looking if any hospital takes into consideration gender (regardless of the drug of choice)????

Re: Gender and Pain Management

Originally Posted by coffeeluvinRN

Just wondering if anyone else had any comments regarding their practices for CABG patients? Looking if any hospital takes into consideration gender (regardless of the drug of choice)????

No. That is a silly notion...at first glance.

However...in my experience (which is unequivocally non-scientific)...having observed innumerable patients....
Little frail old-ladies seem to handle post-op CABG pain MUCH BETTER than younger men...in general...for whatever reasons...

And...although the studies/theories you mention are surely well done and fancy, i think it's less to do with how they metabolize morphine...and more to do with other less scientific things...probably suited more to psycho-social-babble than to physiology... But, thats my opinion.

A quick last 3 point from me...

1) I dont think you'll ever see anyone/institution take the idea of different pain-control policies for different genders seriously. Ever. Silly i think. Pain is pain...and pain control is individualized...regardlessof sex, race, etc. (why not look into pain control between races? Eye colors?, etc... obvious slippery-slope you're exploring...)

2) It IS a GREAT idea for a research-type project for nursing-school...full of stuff to talk about and hypothesize about and ponder...till you're blue in the face.

3) Did i mention old-ladies oddly seem to handle pain better than younger men?

Re: Gender and Pain Management

In my experience (and my coworkers agree) boys/men (in general) aged 13-55, have very low pain tolerance. And yes a frail 75 year old woman with skull fx, multi bil rib fx, and broken pelvis, and a tib-fib c/o much less pain than a 20 year old 300 pound man with a broken clavicle-doesn't seem right. No matter what I do they still want more pain meds (and their mom)

Re: Gender and Pain Management

Hmmm...

I see the same thing in practice.

Re: Gender and Pain Management

We use MS, fentanyl, and hydromorphone. Ketorolac in select cases (works great but has bigger adverse effect/contraindication profile).

A good rule of thumb is to go by weight over gender.

Younger men have greater thoracic was mass and musculature. Adding in the effects of age and diabetes contributes to neuropathy which impacts pain sensation.

All our sternotomies get bupivicaine infusion pumps which infuse by catheter running along the sternal incision.

Re: Gender and Pain Management

taking into account chronic pain? Gender differences in drug seeking behavior? Interesting topic!

Re: Gender and Pain Management

Originally Posted by TakeBack

All our sternotomies get bupivicaine infusion pumps which infuse by catheter running along the sternal incision.

How well does this work? It seems like a great idea in theory.

Re: Gender and Pain Management

This is about peri nerve blocks. There's similar evidence for periosteal infusion but I don't have the link.....Small sample size but here ya go:

Parasternal block and local anesthetic infiltration with levobupivacaine after cardiac surgery with desflurane: the effect on postoperative pain, pulmonary function, and tracheal extubation times.

McDonald SB - Anesth Analg - 01-JAN-2005; 100(1): 25-32

Early tracheal extubation has become common after cardiac surgery. Anesthetic techniques designed to achieve this goal can make immediate postoperative analgesia challenging. We conducted this randomized, placebo-controlled, double-blind study to investigate the effect of a parasternal block on postoperative analgesia, respiratory function, and extubation times. We enrolled 20 patients having cardiac surgery via median sternotomy; 17 patients completed the study. A de-sflurane-based, small-dose opioid anesthetic was used. Before sternal wire placement, the surgeons performed the parasternal block and local anesthetic infiltration of sternotomy and tube sites with either 54 mL of saline placebo or 54 mL of 0.25% levobupivacaine with 1:400,000 epinephrine. Effects on pain and respiratory function were studied over 24 h. Patients in the levobupivacaine group used significantly less morphine in the first 4 h after surgery (20.8 +/- 6.2 mg versus 33.2 +/- 10.9 mg in the placebo group; P=0.013); they also had better oxygenation at the time of extubation. Four of nine in the placebo group needed rescue pain medication, versus none of eight in the levobupivacaine group (P=0.08). Peak serum levobupivacaine concentrations were below potentially toxic levels in all patients (0.64 +/- 0.43 microg/mL; range, 0.24-1.64 microg/mL). Parasternal block and local anesthetic infiltration of the sternotomy wound and mediastinal tube sites with levobupivacaine can be a useful analgesic adjunct for patients who are expected to undergo early tracheal extubation after cardiac surgery.