British Journal of Anaesthesia, 2000, Vol. 85, No. 2 233-237
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia
Efficacy and respiratory effects of low-dose spinal morphine for postoperative analgesia following knee arthroplasty
The Acute Pain Management Unit, York District Hospital, Wigginton Road, York YO3 7HE, UK*Corresponding author
A randomized, double-blind study of 38 patients undergoing total knee replacement was undertaken to compare the efficacy and respiratory effects of low-dose spinal morphine and patient-controlled i.v. morphine against patient-controlled i.v. morphine alone. Patients received either morphine 0.3 mg or saline 0.3 ml with 0.5% heavy spinal bupivacaine 2–2.5 ml. Respiratory effects were measured continuously for 14 h postoperatively with an Edentec 3711 respiratory monitor. There was an improvement in pain relief in the intrathecal morphine group, with significantly lower median VAS pain scores on movement at 4 h (0 (median 0–1.5) vs 5 (1.25–7.75) P<0.01), 12 h (2 (1–5) vs 6 (3–8) P<0.01) and 24 h (3 (1–5) vs 5 (3–7) P<0.05) postoperatively, despite using significantly less patient-controlled morphine (20 mg (10.25–26.25) vs 38.5 mg (27–51) P<0.01) in the first 24 h. There was a small but statistically significant reduction in the median oxygen saturation (SpO2) in the intrathecal morphine group 97 (95–99)% compared with the placebo group 99 (97–99)% (P<0.05). Although marked disturbances in respiratory pattern were observed in both groups, none of the patients in the study had severe hypoxaemia (SpO2 <85% >6 min h–1) and there was no significant difference in the incidence of mild (SpO2 <94% >12 min h–1) or moderate (SpO2 <90% >12 min h–1) hypoxaemia or in the incidence of episodes of apnoea or hypopnoea in the two groups.
Br J Anaesth 2000; 85: 233–7
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