Comparison of Intrathecal Fentanyl Infusion with Intrathecal Morphine Infusion or Bolus for Postoperative Pain Relief After Hip Arthroplasty

Abstract

The purpose of this study was to compare an intrathecal fentanyl infusion with intrathecal morphine infusion or bolus for postoperative pain relief after hip arthroplasty. Sixty patients scheduled to undergo hip joint replacement were studied. A 28-gauge (n = 12) or a 22-gauge (n = 48) spinal catheter was introduced through the L3-4 interspace, 3-4 cm into the subarachnoid space. Spinal anesthesia was induced with 2 mL of plain 0.5% bupivacaine; additional bupivacaine was given in 0.5-mL increments, as required. Patients were given in a random and double-blind fashion either 0.5 mL of saline as a single bolus, followed by an infusion of 120 micrograms of fentanyl in 24 h (Group I, n = 20), 0.5 mL of saline, followed by an infusion of 200 micrograms of morphine in 24 h (Group II, n = 20), or 200 micrograms of morphine as a single bolus, followed by an infusion of 3 mL of saline in 24 h (Group III, n = 20) through the intrathecal catheter. In Group I, supplementary intramuscular (IM) opioid was required more often (46 doses) than in Group II (18 doses) in 24 h (P < 0.01). The number of patients given IM administered opioid was larger in Group I (18 patients) than in Group II (8 patients) (P < 0.01). The IM opioid was requested sooner in Group I (18 patients, mean 480 min) after the intrathecal injection than in Group III (13 patients, mean 786 min) (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Technical aspects and postoperative sequelae of spinal and epidural anesthesia: A prospective study of 3,230 orthopedic patients

“…41 Urinary retention, as well as nausea and vomiting, have been shown to be side effects of opioids, particularly after intrathecal or epidural administration. 42,43 As noted in the present study, urinary retention and micturition problems may continue for several days in the hip and knee arthroplasty patients after the removal of the 24hour perioperative urinary bladder catheter.…”

Intrathekal verabreichtes Morphin bei orthopädischen Eingriffen

“…Originalien Intrathekal verabreichtes Morphin kann in Kombination mit Spinalanäs thesien eine gut wirksame und lang anhaltende, postoperative Analgesie bei orthopädischen Eingriffen erzie len [9,11,15,21,25]. Hierbei ist die Vermeidung von Atemdepressionen eine Voraussetzung für die breite An wendung von intrathekalem Mor phin im klinischen Alltag.…”

Verbessert der Zusatz von Clonidin zur Spinalan�sthesie die analgetische Wirkung niedrig dosierten intrathekalen Morphins?

“…nation mit Lokalanästhetika bei Spinalanästhesien eine gut wirksame und lang anhaltende postoperative Analgesie bei orthopädischen Eingriffen erzielen [3,5,8,12,16]. In ersten randomisierten Studien wurden sehr unterschiedliche Dosierungen von 0,2-1,0 mg Morphin intrathekal angewendet [4,12].…”

“…Danach führte die Dosierung von 0,2 mg Morphin intrathekal bereits zu einer signifikanten analgetischen Wirkung bei orthopädischen Eingriffen [16].…”