Comparison of intrathecal morphine and continuous femoral 3-in-1 block for pain after major knee surgery under spinal anaesthesia

Abstract

Three patients in the morphine group and one patient in the femoral group did not need any additional Major knee surgery is associated with moderate or oxycodone. In the morphine group on average 2.8 severe post-operative pain. Intrathecal morphine and (range 0-7) and in the femoral group 3.2 (0-5) adcontinuous femoral 3-in-1 block were compared proditional doses of oxycodone were needed during the spectively in 40 patients for pain after major knee 24 h observation period. The mean pain scores were surgery under spinal anaesthesia, with 4mL isobaric significantly lower in the morphine group at 9 and 0.5% bupivacaine. In a random order, 20 patients re-12 h into the 24-h trial. Itching was seen only in the ceived preservative free morphine 0.3 mg mixed with morphine group (40% of the patients). Other side spinal bupivacaine. In 20 patients, following spinal effects were similar in the two groups. All patients anaesthesia with only bupivacaine, femoral 3-in-1 were satisfied with their pain therapy. Both intrathecal block was performed post-operatively with 0.5% bumorphine and femoral 3-in-1 block alone were inpivacaine 2 mg kg −1 . The block was continued via a sufficient for the treatment of severe pain after major catheter with 0.25% bupivacaine 0.1 mL h −1 kg −1 until knee surgery. the next morning (24 h after induction of spinal anaesthesia). Intramuscular oxycodone was given as a Keywords: anaesthetic techniques, regional, spinal; femoral block, analgesia; post-operative, intrathecal rescue analgesic in all patients. Two patients from the femoral group were excluded due to technical failure. morphine.

Continuous femoral nerve blockade and single-shot sciatic nerve block promotes better analgesia and lower bleeding for total knee arthroplasty compared to intrathecal morphine: a randomized trial

“…In previous studies, intrathecal morphine has been considered more effective, except for pruritus, in comparison with femoral nerve block [9, 10]. A low dose of intrathecal morphine was considered safer than the femoral nerve blockade [11].…”

Postoperative Effectiveness of Three Routes of Morphine in Arthroscopic Knee Surgery

“…(1)(2)(3)(4)(5)(6)(7) Importance of the current investigation was the comparison of three different administration routes in the same study design. In this study, we found that 100 μg morphine intrathecal, 10 mg intraarticular and 10 mg intramuscular injections revealed an effective postoperative analgesia after arthroscopic knee surgery compared to the control group receiving no morphine.…”

“…Several reviews which have evaluated the literature data on IA administration of opioids revealed that the quality of most of the studies involving IA administration of morphine were weak. (1,6,(15)(16)(17) Intraarticular use of morhine is contraversial with some positive (1,(16)(17)(18) and some negative results. (19)(20)(21) Thus the authors recommended further randomized controlled trials to clarify the contradictory results published in the literature.…”

“…Local or systemic application sites of analgesics have been used to manage postoperative pain in arthroscopic knee surgery. (1)(2)(3)(4)(5)(6)(7) Intrathecal (IT) or intraarticular (IA) injection of opioids has been reported to provide adequate pain control after arthroscopic knee applications. (1)(2) The peripheral analgesic effect of morphine has been widely studied and compared with other analgesics, local anesthetics and placebo for about 20 years.…”

“…(5) A dose of IT morphine between 0.1 mg and 0.5 mg usually provides a good analgesia and significantly reduces the need of additional analgesic agent. (1,(6)(7)(8) Higher doses are associated with a significant increase in side effects such as nausea and vomiting, itching, urinary retention and even lethal respiratory depression. (9)(10)(11)(12)(13) In the present study, we aimed to investigate whether IA administration of morphine provides a better pain management especially in regard to less additional analgesic requirement compared to the IT or IM application of the drug.…”