Epidural morphine improves postoperative analgesia in patients after total knee arthroplasty: A randomized controlled trial

Abstract

Background Patients after total knee arthroplasty (TKA) often develop moderate to severe pain. This study compared the analgesic effect of low-dose epidural morphine vs. a comparable saline injection in patients following TKA surgery. Methods This randomized, double-blinded, and placebo-controlled trial was conducted in a tertiary hospital in Beijing between July 1, 2017 and May 30, 2018. One hundred and ten patients following TKA under combined spinal-epidural anesthesia were randomized to receive either epidural morphine (2 mg diluted to 5 ml normal saline, the epidural morphine group) or placebo (5 ml normal saline, the placebo group). For all patients, single-injection femoral nerve block was performed, and a supplementary patient-controlled intravenous analgesia pump was provided. The severity of pain was assessed with the numerical rating scale (NRS, an 11-point scale where 0 = no pain and 10 = the worst pain) at 6, 12, 24, 36, and 48 hours after surgery. The primary endpoint was moderate to severe pain (NRS pain score ≥4) within 48 hours after surgery. Results The percentage with moderate to severe pain within 48 hours was lower in the epidural morphine group than in the placebo group (58.2% [32/55] with epidural morphine vs. 76.4% [42/55] with placebo; OR 0.43, 95% CI 0.19–0.98; p = 0.042). Furthermore, the cumulative morphine consumption within 48 hours was lower (18.4±6.1 mg vs. 22.4±7.3 mg; p = 0.002) whereas the mental component summary score of 30-day quality of life was higher (63.8±2.9 vs. 61.9±4.2; p = 0.008) in the epidural morphine group than in the placebo group. Conclusions For patients following TKA, the addition of epidural morphine to single-injection femoral nerve block improves the quality of analgesia within 48 hours, without increasing adverse events. Trial registration ClinicalTrials.gov NCT03203967 .

Bilateral quadratus lumborum block versus epidural morphine in aortobifemoral bypass graft surgery under general anaesthesia: A prospective randomized controlled study

“…All previous studies and case reports demonstrated the superiority of QL block for post-operative analgesia and lower opioid usage with all its side effects, on contrary; Irwin R. et al [29] in there 2020 published study concluded that parturient receiving bilateral QL block after caesarean section did not show any reduction in 24 hour morphine consumption by PCA versus those who received sham block. Although epidural morphine shows marvellous results for post-operative analgesia in plenty of published studies and an effect lasting 24 to 48 hours in some literature like Duale C et al [30] and Meng ZT et al [31], this was not the condition in our study in which the analgesic effect lasted only for 6 hours postoperatively. This can be explained by the nature of the surgery which includes three incisions; one midline and two groin incisions, also the ischaemic component of pain which is frequently encountered in patients with peripheral vascular disease.…”

Efficacy of dexmedetomidine in combination with morphine for pain management in patients with cesarean section

“…Single epidural morphine administration is common and widely used for postoperative analgesia. [14][15][16][17] Epidural administration of sufentanil-morphine combinations improves the mother's ability to mobilize and interact with her newborn infant. 18 Epidural administration of morphine at a single dose of 3 mg /24 hours causes no respiratory depression and potential for catheter-related complications in patients undergoing cesarean sections.…”

The Ramifications of Opioid Utilization and Outcomes of Alternative Pain Control Strategies for Total Knee Arthroplasties

“…111,112 One randomized controlled trial found that of 110 patients undergoing TKA, those who received epidural morphine had less severe pain scores and consumed significantly less opioids at the 48-hour mark compared with patients who received placebo (p < 0.002). 113 Intrathecal analgesia is an alternative to epidural analgesia in which medications are injected directly into the cerebrospinal fluid (CSF). 114 Intrathecal morphine (ITM) is commonly used, and when compared to control patients receiving bupivacaine spinal anesthesia alone, ITM administration has been found to improve pain scores at postoperative day zero and reduce initial postoperative opioid consumption following TKA.…”