The Effect of Intrathecal Morphine Added to Continuous Femoral 3-in-1 Nerve Block for Analgesia after Total Knee Replacement

Park, Chang Kil; Cho, Choon Kyu; Shin, Hyun Ho; Cho, Jung Ha

doi:10.4097/kjae.2008.54.5.544

Cited by 3 publications

(4 citation statements)

References 33 publications

(47 reference statements)

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“…Only nine of the patients were less than 60 years of age. Likewise, the patients in previous studies had a mean age of 65−67 year in major knee surgery [2,10,11]. Accordingly, we recommend that lower doses of opiates be used in patients undergoing TKR.…”

Section: Abolition Of Quadriceps Muscle Spasm By Femoral Nerve Block ...mentioning

confidence: 88%

“…Recently, the authors [10] determined that the addition of a smaller dose, 0.1 mg, of IT morphine to continuous 3-in-1 block improves postoperative analgesia compared with 3-in-1 block alone after TKR. We assumed that if combined with 3-in-1 block, the effective dose of IT morphine could be reduced to a smaller one than those speculated by Tarkkila et al (0.3 mg) [11] and Rathmell et al (0.2 mg) [2].…”

Section: Introductionmentioning

confidence: 99%

“…The patients in previous studies had a mean age of 65 [2], 66 [11], and 67 year [10] in major knee surgery. Therefore, a minimum effective dose of IT morphine for TKR while avoiding respiratory depression is needed.…”

Section: Introductionmentioning

confidence: 99%

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Optimizing the dose of intrathecal morphine when combined with continuous 3-in-1 nerve block after total knee replacement

Park

Cho

Lee

et al. 2009

Korean J Anesthesiol

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Background: Continuous femoral 3-in-1 block alone is insufficient for the treatment of severe pain after total knee replacement (TKR). Intrathecal (IT) morphine provides effective postoperative analgesia but may result in many side effects. The optimal dose of spinal morphine when combined with continuous 3-in-1 block after TKR is not known.Methods: Patients were randomized to receive IT morphine in five groups (n = 20 per group): 1) 0.0 mg, 2) 0.05 mg, 3) 0.1 mg, 4) 0.15 mg, and 5) 0.2 mg. All patients received continuous 3-in-1 block performed with 20 ml of 0.25% bupivacaine, followed by a continuous infusion of 0.125% bupivacaine at the rate of 2 ml/h plus PCA boluses of 1 ml with a lockout of 10 minutes. The intensity of pain at rest and on movement of the knee was assessed by using a visual analog scale for the first two postoperative days.Results: All treatment groups produced effective pain relief and decreased cumulative femoral PCA bolus use of 0.125% bupivacaine compared with control, respectively (P ＜ 0.05); however, there were no significant differences among the treatment groups. The incidence of vomiting was significantly more frequent with 0.1−0.2 mg IT morphine groups compared with control, respectively (P ＜ 0.05). The rate of administration of antipruritic medication was increased as IT morphine dose increased (P ＜ 0.05).Conclusions: Use of 0.05 mg IT morphine would appear to provide the optimal balance between pain relief and adverse effects following TKR.

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Section: Abolition Of Quadriceps Muscle Spasm By Femoral Nerve Block ...mentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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Optimizing the dose of intrathecal morphine when combined with continuous 3-in-1 nerve block after total knee replacement

Park

Cho

Lee

et al. 2009

Korean J Anesthesiol

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“…As expected, a sensory block to a pinprick from SFNB had mostly dissipated by 9 AM on POD 1. However, severe postoperative pain after TKR persisted for more than 2 days [ 17 ], and SFNB is inadequate for pain relief after TKR. This is consistent with the findings of Fournier et al [ 18 ] in which for a longer term pain relief, a single shot technique FNB appeared to be inadequate.…”

Section: Discussionmentioning

confidence: 99%

Optimizing dose infusion of 0.125% bupivacaine for continuous femoral nerve block after total knee replacement

Park

Cho

Lee

et al. 2010

Korean J Anesthesiol

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BackgroundThe optimal dose infusion of 0.125% bupivacaine via a femoral catheter after total knee replacement (TKR) has not been defined. This study examined various dose infusions of bupivacaine to determine the analgesic quality in patients receiving a continuous femoral nerve block (CFNB).MethodsPatients were randomized to receive a single-injection femoral nerve block (SFNB) or CFNB performed with 20 ml of 0.125% bupivacaine, followed by a continuous infusion of 0.125% bupivacaine in four groups (n = 20 per group): 1) 0 ml/h (SFNB), 2) 2 ml/h, 3) 4 ml/h, and 4) 6 ml/h. The pain intensity at rest and on knee movement was assessed using a visual analog scale (VAS) for the first 2 postoperative days. The cumulative bolus use of IV patientcontrolled analgesia (PCA) with a morphine-ketorolac combination was evaluated.ResultsA lower cumulative bolus of IV PCA was noted in all CFNB groups compared to SFNB on postoperative days (PODs) 1 and 2, respectively (P < 0.05). Lower VAS scores at rest were observed in the 4 ml/h and 6 ml/h groups than in the SFNB group on PODs 1 and 2, respectively, but only on POD 2 in the 2 ml/h group (P < 0.05). Lower VAS scores on movement were noted in the 4 ml/h than the SFNB group on PODs 1 and 2, but only on POD 1 in 6 ml/h (P < 0.05).ConclusionsThe minimum effective infusion rate of 0.125% bupivacaine for CFNB after TKR appears to be 4 ml/h according to the VAS pain scores.

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Intrathecal morphine versus femoral nerve block for pain control after total knee arthroplasty: a meta-analysis

Tang¹,

Tang²,

Wang³

et al. 2017

J Orthop Surg Res

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BackgroundThis meta-analysis aims to illustrate the efficacy and safety of intrathecal morphine (ITM) versus femoral nerve block (FNB) for pain control after total knee arthroplasty (TKA).MethodsIn April 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, Cami Info. Inc., Casalini databases, EBSCO databases, Verlag database and Google database. Data on patients prepared for TKA surgery in studies that compared ITM versus FNB for pain control after TKA were collected. The main outcomes were the visual analogue scale (VAS) at 6, 12, 24, 48 and 72 and total morphine consumption at 12, 24 and 48 h. The secondary outcomes were complications that included postoperative nausea and vomiting (PONV) and itching. Stata 12.0 was used for pooling the data.ResultsFive clinical studies with a total of 225 patients (ITM group = 114, FNB group = 111) were ultimately included in the meta-analysis. The results revealed that the ITM group was associated with a reduction of VAS at 6, 12, 24, 48 and 72 h and total morphine consumption at 12, 24 and 48 h. There was no significant difference between the occurrences of PONV. However, the ITM group was associated with an increased occurrence of itching after TKA.ConclusionsSome immediate analgesic efficacy and opioid-sparing effects were obtained with the administration of ITM when compared with FNB. The complications of itching in the ITM group were greater than in the FNB group. The sample size and the quality of the included studies were limited. A multi-centre RCT is needed to identify the optimal method for reaching maximum pain control after TKA.Electronic supplementary materialThe online version of this article (doi:10.1186/s13018-017-0621-0) contains supplementary material, which is available to authorized users.

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The Effect of Intrathecal Morphine Added to Continuous Femoral 3-in-1 Nerve Block for Analgesia after Total Knee Replacement

Cited by 3 publications

References 33 publications

Optimizing the dose of intrathecal morphine when combined with continuous 3-in-1 nerve block after total knee replacement

Optimizing the dose of intrathecal morphine when combined with continuous 3-in-1 nerve block after total knee replacement

Optimizing dose infusion of 0.125% bupivacaine for continuous femoral nerve block after total knee replacement

Intrathecal morphine versus femoral nerve block for pain control after total knee arthroplasty: a meta-analysis

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