Postoperative Analgesia After Co-administration of Clonidine and Morphine by the Intrathecal Route in Patients Undergoing Hip Replacement

Abstract

Postoperative analgesia after intrathecal co-administration of clonidine hydrochloride (75 micrograms) and morphine sulfate (0.5 mg) was compared with analgesia produced after either intrathecal morphine (0.5 mg) or 0.9% sodium chloride in 90 patients undergoing total hip replacement under bupivacaine spinal anesthesia. Patient-controlled morphine requirements were significantly reduced (P < 0.001) postoperation by both clonidine/morphine (median 5 mg/24 h) and morphine (median 7 mg/24 h) compared with control (saline) (median 28 mg/24 h). However, no significant additional reduction in postoperative analgesic requirements was shown with the clonidine/morphine combination compared with morphine alone. Visual analog pain scores, although good in all groups at all times, were significantly poorer in the control group at 2 h (P < 0.04) and 4 h (P < 0.001) after operation compared with both treatment groups, and significantly poorer than the clonidine/morphine group at 6 h (P < 0.002) and 24 h (P < 0.009) postoperation. Mean arterial blood pressure was significantly lower in the clonidine/morphine group than in the two other groups (P < 0.001) between 2 and 5 h after operation. The incidence of emesis was similar in the clonidine/morphine and morphine groups and was significantly more than in the control group.

Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-analysis of randomized trials

“…Thirteen trials (16 comparisons) tested morphine 0.05 to 2 mg added to bupivacaine compared with bupivacaine alone and reported on the duration of postoperative analgesia [3,4,21,30,34,37,38,43,46,61,63,69,75] (Fig. 2).…”

“…Fourteen trials (19 comparisons) tested morphine 0.05 to 0.5 mg added to bupivacaine and reported on presence or absence of postoperative respiratory depression [4,6,34,35,37,38,[41][42][43]46,56,61,75,79]. Respiratory depression was defined as respiratory rates <8, <9, <10, or <12 min À1 , or as PaCO 2 >6 kPa or different ranges of SpO 2 , or as the need for naloxone treatment.…”

“…Seventeen trials (21 comparisons) tested morphine 0.05 to 1 mg added to bupivacaine and reported on the incidence of postoperative pruritus [4,21,30,34,[37][38][39][41][42][43]46,56,61,69,74,75,79] (Table 2; Supplemental Data 6). The average incidence of pruritus with bupivacaine alone was 4.4%.…”

Intrathecal clonidine added to small-dose bupivacaine prolongs

“…Marked decrease in arterial blood pressure was observed with 75 µg of intrathecal clonidine (in combination with intrathecal morphine), 10 whereas relative hemodynamic stability was maintained with doses ≥150 µg, as demonstrated by using clonidine as the sole analgesic. 11 The aim of this prospective, randomized, double-blinded study was to evaluate the effects of clonidine in co-administration with bupivacaine during spinal anesthesia, regarding the onset and regression of motor block, sensory block, postoperative analgesia and possible side effects.…”

Définitions de la “dépression respiratoire” de l’analgésie postopératoire réalisée avec de la morphine intrathécale : une revue documentaire

“…20 Quite commonly, there was no definition whatsoever, despite the use of this term. 21,22 Definitions of RD in postoperative ITM analgesia literature included: a low respiratory rate (RR), 23 high arterial PCO 2 values, 24 low oxyhemoglobin saturation with pulse oximetry (SpO 2 ), 25 increased level of sedation (LOS), 26 depressed ventilatory response to hypoxia and hypercarbia, 27 the need for naloxone treatment, 7 or a combination of these. However, the lack of a more specific or uniform definition of RD makes it difficult to ascertain its true incidence.…”