Low-Dose Spinal Morphine for Post-Thoracotomy Pain: A Prospective Randomized Study

Suksompong, Sirilak; Pongpayuha, Ploynaree; Lertpaitoonpan, Warunya; Bormann, Benno von; Phanchaipetch, Teeravit; Sanansilp, Vimolluck

doi:10.1053/j.jvca.2012.12.003

Cited by 8 publications

(4 citation statements)

References 17 publications

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“…Bowrey et al compared 0.2 and 0.5 mg of intrathecal morphine for postoperative analgesia after total knee replacement and concluded that the higher dose of intrathecal morphine provided better analgesia than the lower dose, without any increase in side effects. 12 Although the incidence of side effects was similar in the two groups in their study, the rates were higher when compared with those in the present study where 0.1 mg of intrathecal morphine, combined with different doses of heavy bupivacaine, was administered. Among 33 patients of this study reported nausea (n = 12), vomiting (n = 8), pruritus (n = 13), and respiratory depression (n = 1) in the 0.2 mg morphine group.…”

Section: Discussioncontrasting

confidence: 65%

Comparison of two low dose local anesthetics in combination with morphine for spinal anesthesia for total knee arthroplasty

Güleç

Ozayar

Alkan

et al. 2020

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Section: Discussioncontrasting

confidence: 65%

Comparison of two low dose local anesthetics in combination with morphine for spinal anesthesia for total knee arthroplasty

Güleç

Ozayar

Alkan

et al. 2020

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“…However, although scores were significantly lower in the ITM group than in the control group, pain scores remained high during the first hour following the operation. In the present study, we used 0.2 mg of ITM for post-VATS pain control, based on the study of Suksompong et al, which demonstrated that 0.2 mg of ITM was effective as same as 0.3 mg of ITM for postoperative pain control for standard thoracotomy with a similar degree of side effects [ 39 ]. This may be because ITM had not reached its full effect or a single dose of 0.2 mg ITM without supplementing with other analgesics was insufficient to control pain during the period immediately following the operation.…”

Section: Discussionmentioning

confidence: 99%

Comparison between intrathecal morphine and intravenous patient control analgesia for pain control after video-assisted thoracoscopic surgery: A pilot randomized controlled study

2022

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Background Video-assisted thoracoscopic surgery (VATS) is a minimally invasive procedure, but patients may still experience intense pain, especially during the early postoperative period. Intrathecal morphine (ITM) is an effective pain control method that involves a simple maneuver and has a low risk of complications. This study aimed to study the effectiveness of ITM for pain control in patients who undergo VATS. Materials and methods A randomized controlled study was conducted who were in ASA classes 1–3, aged over 18 years, and scheduled for elective VATS. Patients were randomized into two groups: the ITM group (n = 19) received a single shot of 0.2 mg ITM before general anesthesia; and the control group (n = 19) received general anesthesia only. For 48 hours after surgery, other than intravenous patient-controlled analgesia (IVPCA) morphine, patients received no sedatives or opioid medications except for 500 mg acetaminophen four times daily orally. Postoperative pain scores and IVPCA morphine used, side effects, sedation at specific time-points, i.e., 1, 6, 12, 24, and 48-hours and overall treatment satisfaction scores were assessed. Results Postoperative pain scores (median [IQR]) in ITM group were significantly lower than control group (repeated-measure ANOVA, p = 0.006) and differed at the first (7 [2, 7] vs 8 [6, 9], p = 0.007) and sixth hours (3 [2, 5] vs 5 [5, 7], p = 0.002). The cumulative dose of post-operative morphine (median [IQR]) in ITM group was also lower (6 [3, 20] vs 19 [14, 28], p = 0.006). The incidence of pruritus was significantly higher in ITM group (68.42% vs. 26.32%, p = 0.009). No significant differences in nausea and vomiting, sedation scores, and satisfaction scores were observed between the two groups. Conclusion ITM could reduce pain scores and opioid consumption after VATS compared to IVPCA-opioids. However, pain scores and opioid consumption still remained high. No difference in patient satisfaction was detected.

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“…However, the use of intrathecal morphine may be associated with distressing side effects, such as itching, urinary retention, nausea and vomiting (PONV), and respiratory depression [ 20 ]. In an attempt to limit opioid side effects, the use of low-dose spinal opioids has been advocated [ 21 ]. Even mini-dose morphine (<0.1 mg) was frequently reported to be effective for managing acute postoperative pain after variety of surgeries without any evidence of respiratory depression [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of continuous femoral nerve block (CFNB/SA) and continuous femoral nerve block with mini-dose spinal morphine (CFNB/SAMO) for postoperative analgesia after total knee arthroplasty (TKA): a randomized controlled study

et al. 2015

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BackgroundUnsatisfactory analgesia for major knee surgery with femoral nerve block (FNB) alone was reported and the additional benefit of sciatic block to continuous femoral nerve block (CFNB) was not conclusive. The aim of the present study was to find the benefit of the additional mini-dose spinal morphine (0.035 mg) to CFNB for postoperative pain control and to compare their associated side effects after total knee arthroplasty (TKA).MethodsAfter written informed consent and with Institutional Ethics Committee approval, 68 American Society of Anesthesiologists (ASA) Physical Status I-III patients scheduled for elective unilateral TKA under spinal anesthesia (SA) were included in the present prospective, randomized controlled study. The patients were allocated into two groups. CFNB was placed in all patients by the inguinal paravascular approach with 20 ml of 0.25 % levobupivacaine. Group I (named CFNB/SA group), SA was administered with 2.8 ml levobupivacaine and Group II (named CFNB/SAMO group), SA with 2.8 ml levobupivacaine plus morphine 0.035 mg. At Post Anesthesia Care Unit (PACU), pain and other adverse effects were recorded. Pain was assessed by visual analog scale (VAS) 0-10. Tramadol 50 mg intravenous (IV) was given if the VAS > 4. In the ward, all patients were maintained by continuous femoral infusion of 0.125 % levobupivacaine rate 7 ml/hr and then reduced to 5 ml/hr if VAS ≤3.ResultsPatient’s demographics data in each group were not different. At post-operative (PO) 12-24 h, the VAS scores were significantly lesser in the CFNB/SAMO group. Cumulative tramadol IV requirement for PO48h were also significantly lesser in the CFNB/SAMO group. Nausea, vomiting and numbness were significantly greater in the CFNB/SAMO group during early postoperative period (PO1-6 h).ConclusionThough in some patients CFNB was inadequate, a mini-dose of intrathecal morphine (0.035 mg) in addition to CFNB was found to be effective with minimal side effects.Trial registrationThai Clinical Trial Registry (identifier: TCTR20150609003, date of registration: 6 June 2015).

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Low-Dose Spinal Morphine for Post-Thoracotomy Pain: A Prospective Randomized Study

Cited by 8 publications

References 17 publications

Comparison of two low dose local anesthetics in combination with morphine for spinal anesthesia for total knee arthroplasty

Comparison of two low dose local anesthetics in combination with morphine for spinal anesthesia for total knee arthroplasty

Comparison between intrathecal morphine and intravenous patient control analgesia for pain control after video-assisted thoracoscopic surgery: A pilot randomized controlled study

Comparison of continuous femoral nerve block (CFNB/SA) and continuous femoral nerve block with mini-dose spinal morphine (CFNB/SAMO) for postoperative analgesia after total knee arthroplasty (TKA): a randomized controlled study

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