Low-dose Intrathecal Morphine for Postoperative Pain Control in Patients Undergoing Transurethral Resection of the Prostate

BACKGROUND: Several studies addressing intrathecal morphine (ITM) use following spine surgery have been published either involving the pediatric population, using mid- to high-dose ITM, or not in conjunction with morphine patient-controlled analgesia (PCA).OBJECTIVES: To determine whether low-dose ITM is a useful adjunct to PCA for postoperative pain control following elective lumbar spine surgery in adults.METHODS: Thirty-two patients were enrolled in a double-blinded randomized controlled trial, and received either ITM or intrathecal placebo. Postoperatively, all patients were given a PCA pump and observed for the first 24 h in a step-down unit. Measurements of: total PCA morphine consumed in the first 24 h; intensity of pain; pruritus; nausea at 4 h, 8 h and 24 h; time to first ambulation; length of hospital stay; and occurrences of respiratory depression were recorded.RESULTS: The total PCA use was significantly lower in the ITM group. There were lower average pain scores in the ITM group, which increased to that of the intrathecal placebo group over 24 h; however, this failed to attain statistical significance. There were no differences in nausea, pruritus, time to first ambulation or hospital length stay. There were no cases of respiratory depression in either group.CONCLUSIONS: ITM may be a useful adjunct to PCA, but did not decrease time to ambulation or length of stay.

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Continuous Epidural Anesthesia for Transurethral Resection and Postoperative Pain Control

Korean Journal of Anesthesiology ◽

10.4097/kjae.1979.12.4.414 ◽

1979 ◽

Vol 12 (4) ◽

pp. 414

Author(s):

Won Ok Kim ◽

Yeh Chul Lee ◽

Wha Sung Chung ◽

Hung Kun Oh

Keyword(s):

Postoperative Pain ◽

Epidural Anesthesia ◽

Transurethral Resection ◽

Pain Control ◽

Postoperative Pain Control

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Intrathecal Morphine during Lumbar Spine Operation for Postoperative Pain Control

Neurosurgery ◽

10.1227/00006123-198603000-00015 ◽

1986 ◽

Vol 18 (3) ◽

pp. 341-344 ◽

Cited By ~ 18

Author(s):

J. Bob Blacklock ◽

Gary L. Rea ◽

Robert E. Maxwell

Keyword(s):

Lumbar Spine ◽

Treatment Group ◽

Postoperative Pain ◽

Urinary Retention ◽

Pain Control ◽

Intrathecal Morphine ◽

Test Group ◽

Bladder Function ◽

Postoperative Pain Control

Abstract The analgesic requirements and bladder function of 5 patients who received 1 mg of intrathecal morphine during lumbar spine operation are compared to those of 10 control patients. No analgesics were used by the treatment group for the first 24 hours postoperatively. The test group subsequently required twice the amount of analgesics during the 2nd through 5th days after operation compared to controls. All 5 patients who received intrathecal morphine developed urinary retention for 24 to 36 hours. The brief duration of analgesia, the increased narcotic use after the effects of the morphine dissipated, and urinary retention after a single intraoperative dose of intrathecal morphine suggest caution in using this technique.

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Small Doses of Intrathecal Morphine Combined with Systemic Diclofenac for Postoperative Pain Control After Cesarean Delivery

Anesthesia & Analgesia ◽

10.1213/00000539-199803000-00017 ◽

1998 ◽

Vol 86 (3) ◽

pp. 538-541 ◽

Cited By ~ 80

Author(s):

Monica M. S. C. Cardoso ◽

Jose C. A. Carvalho ◽

Antonio R. Amaro ◽

Ademar A. Prado ◽

Elizabeth L. Cappelli

Keyword(s):

Postoperative Pain ◽

Cesarean Delivery ◽

Pain Control ◽

Intrathecal Morphine ◽

Postoperative Pain Control ◽

Small Doses

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The Effect of Preoperative Opioid Dosage on Postoperative Outcomes in Patients Undergoing Knee Surgery

January 2018 - Pain Physician ◽

10.36076/ppj.2020/23/73 ◽

2020 ◽

Vol 1;23 (1;1) ◽

pp. 73-85

Author(s):

Bohan Xing

Keyword(s):

Postoperative Pain ◽

Postoperative Complications ◽

Pain Control ◽

Dose Group ◽

Low Dose ◽

Knee Surgery ◽

High Dose ◽

Postoperative Pain Control ◽

Opioid Dose ◽

Ed Visits

Background: Opioid prescription before knee replacement surgery is associated with longer hospital stays, more postsurgical pain, and a higher rate of complications. Despite the growing evidence against opioids, they remain popular preoperative pain management prescriptions. Objectives: The purpose of this study was to examine the effects of dosage of preoperative opioid use on orthopedic knee surgery pain control and postoperative outcomes and complications. Study Design: Observational, retrospective evaluation. Setting: University of Wisconsin Madison hospitals. Methods: The patients underwent orthopedic knee surgery between May 1, 2014 and April 30, 2015. We randomly selected 197 patients and divided them into 2 groups that had preoperative opioid dosages of either low dose ≤ 120 mEq morphine (MME) or high dose >120 MME. Of 197 patients, 100 were in the low dose morphine group, whereas 97 were high dose. The cutoff at 120 MME was calculated to be the median dosage across all patients. The primary outcomes were compared, differences in postoperative pain control, and range of motion (ROM). Secondary outcomes included anesthetic complications, length of hospital stay, postoperative opioid dose, and postoperative complications. Results: There were no statistically significant differences between the groups with regard to postoperative pain control, ROM, and immediate postoperative complications. Both groups showed similar length of hospitalization (2.199 to 2.304 days; P = 0.374), rate of postoperative infection, and joint intervention. The high dose group was more likely to have postoperative hemarthrosis and emergency department (ED) visits. However, the low dose group was more likely to have hypertension concurrently. Limitations: Because the study length was restricted to one year, the lack of data on longer term prognosis may limit extrapolation of data. Subjectivity of pain is difficult to measure and compare objectively. This study was not randomized prospectively, which may bias certain results due to unobserved differences. Conclusions: Preoperative opioid dose did not affect postoperative pain control or ROM in patients who received knee surgeries. Higher preoperative opioid doses were associated with more hemarthrosis and ED visits. Further exploration into quality of life indices and surgical complications such as need for revision may be a fruitful avenue. Key words: Opioids, analgesic, knee pain, total knee replacement, knee surgery, preoperative opioids, knee outcomes

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Side-Effect Profiles And Efficacy Of Low Dose Intrathecal Morphine Combine With Periarticular Injection In Elective Primary Unilateral Total Knee Arthroplasty

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00099 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0009

Author(s):

Chompunoot Pathonsamit ◽

Pruk Chaiyakit ◽

Ittiwat Onklin

Keyword(s):

Total Knee Arthroplasty ◽

Side Effects ◽

Postoperative Pain ◽

Knee Arthroplasty ◽

Side Effect ◽

Pain Control ◽

Intrathecal Morphine ◽

Postoperative Pain Control ◽

Periarticular Injection ◽

Total Knee

Background: Total knee arthroplasty (TKA) is concerned as a severe postoperative pain procedure. Intrathecal morphine provides good analgesia but has many side effects such as nausea, vomiting, pruritus and respiratory depression. Appropriate postoperative pain control strategy with lower side effect is still challenging. We combined periarticular injection(PI) as a multimodal analgesia with intrathecal morphine in order to decrease intrathecal morphine dosage and lower side effects. Objective: To determine side-effect profiles and efficacy of 0.1 mg and 0.2 mg intrathecal morphine combine with PI in primary unilateral TKA. Material and method: In this prospective, double-blinded, randomized controlled trial. Patients undergoing TKA were recruited from April 2018 to April 2019. All patients were randomized into 3 groups. M 0 (n=32), M 1 (n=36)and M 2 (n=34) represent no intrathecal morphine, 0.1 mg and 0.2 mg intrathecal morphine respectively. All Group received same regimen of PI as a multimodal analgesia and same postoperative pain control protocol. Results: Patients in group M 2 had more nausea or vomiting side effects compared to group M 1 in early postoperative 4 hours(77.1% and 51.4%) with statistical significant(p<0.05) and also required 2 antiemetic drug to relieve symptoms (4.7% and 2.3%) with statistical significant ( p<0.05). No difference in postoperative pain score, rescue analgesic drug consumption ,pruritic score, sedation score, respiratory depression and orthopedic outcomes such as straight leg rising time and maximum active knee flexion between M 1 and M 2 groups. Conclusion: Lower intrathecal morphine dosage (0.1 mg) combine with periarticular injection in primary unilateral total knee arthroplasty provide similar postoperative pain control as standard intrathecal morphine dosage(0.2 mg) combine with periarticular injection with lower rates and severities of nausea and vomiting in first postoperative 4 hours.

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