Review article

Low dose spinal morphine and intravenous diclofenac for postoperative analgesia after total hip and knee arthroplasty

DAGMAR OBERHOFER ; Department of Anaesthesiology and Intensive Care, University Hospital Sveti Duh, Sveti Duh 64, 10000 Zagreb
KATARINA ŠAKIĆ ; Department of Anaesthesiology and Intensive Care, University Hospital Sveti Duh, Sveti Duh 64, 10000 Zagreb
VIŠNJA NESEK-ADAM ; Department of Anaesthesiology and Intensive Care, University Hospital Sveti Duh, Sveti Duh 64, 10000 Zagreb
ALEKSANDRA SMILJANIĆ ; Department of Anaesthesiology and Intensive Care, University Hospital Sveti Duh, Sveti Duh 64, 10000 Zagreb
ELVIRA GRIZELJ-STOJČIĆ ; Department of Anaesthesiology and Intensive Care, University Hospital Sveti Duh, Sveti Duh 64, 10000 Zagreb
MILKA VUKELIĆ ; Department of Anaesthesiology and Intensive Care, University Hospital Sveti Duh, Sveti Duh 64, 10000 Zagreb
VIVIANA MRŠIĆ ; Department of Anaesthesiology and Intensive Care, University Hospital Sveti Duh, Sveti Duh 64, 10000 Zagreb

Abstract

Background and Aims: Intrathecal (IT) morphine added to a spinal
anaesthesia provides effective postoperative analgesia after hip and knee arthroplasty reducing the need for systemic opioids. To reduce the risk of side effects like pruritus, nausea/vomiting, and a more serious effect of respiratory depression, low dose IT morphine (0,1–0,3 mg) has been used. The aim of this prospective, randomized, double-blind study was to assess the analgesic efficacy of 0,2 mg IT morphine combined with postoperative i.v. diclofenac in the first 24 hours after hip and knee arthroplasty, the primary outcome measure being the number of patients without any additional opioid
request. Side effects and possible complications of therapy and patient satisfaction with pain management were also recorded.

Patients and Methods: 40 patients were randomized to receive spinal
anaesthesia with levobupivacaine and 0,2 mL normal saline (control group) or 0,2 mg IT morphine. All patients received diclofenac 75 mg i.v. one and 10 hours postoperatively. Pain was assessed by numeric rating scale at 3,6,12 and 24 hours postoperatively and morphine 2 mg i.v. was given for inadequate analgesia. The third dose of diclofenac could be given 10–12 hours after the second dose for a pain score 3–4.

Results: IT morphine group had significantly lower postoperative pain
scores at all measured time intervals and used significantly less i.v. morphine. 76,2% of patients in the IT morphine group did not require any additional i.v. morphine compared to 11,1% of the control group. This resulted in significantly higher patient satisfaction despite common occurence of mild pruritus. Postoperative nausea/vomiting were frequent in both groups with no cases of respiratory depression.

Conclusions: Low dose IT morphine added to regular postoperative i.v. diclofenac provides excellent analgesia after hip and knee arthroplasty and allows for a protocol without additional systemic opioids.

Keywords

Hrčak ID:

68927

URI

https://hrcak.srce.hr/68927

Publication date:

1.6.2011.

Visits: 1.910 *