British Journal of Anaesthesia, Vol 78, Issue 6 666-670, Copyright © 1997 by The Board of Management and Trustees of the British Journal of Anaesthesia
M. Bachmann, E. Laakso, L. Niemi, P. H. Rosenberg and M. Pitkanen
Postoperative pain after major orthopaedic operations can be controlled by
continuous intrathecal administration of opioids or local anaesthetics.
Effective intrathecal analgesia can be achieved through synergism of low
doses of the two analgesic drugs and, possibly, less drug-related adverse
effects. Therefore, we have evaluated the usefulness of a combined low-dose
bupivacaine and morphine infusion in patients undergoing hip and knee
arthroplasty. Spinal anaesthesia was induced in 55 ASA I-III patients with
0.5% bupivacaine 2 ml via a 28- gauge spinal catheter (L3-4 interspace) and
0.5-ml increments were given if needed. Intrathecal 24-h infusions
consisted of bupivacaine 2 mg h-1 alone (n = 18), bupivacaine 1 mg h-1
alone (n = 18) or bupivacaine 1 mg h-1 combined with morphine 8 micrograms
h-1 (n = 19). The interview after 3, 6, 12 and 24 h included assessment of
pain at rest and on movement (VAS scale), occurrence of sensory and motor
block and nausea/vomiting. Bupivacaine 1 mg h-1 combined with an infusion
of morphine provided as good postoperative analgesia as bupivacaine 2 mg h-
1, but motor block disappeared earlier (P = 0.01). Patients in the
bupivacaine 1-mg h-1 group required more supplementary doses of oxycodone
i.m. than the other groups (P = 0.04). Time to first oxycodone dose from
the start of intrathecal infusion did not differ between groups. The
frequency of nausea and vomiting was similar in all groups. In spite of
this, antiemetic medication was required more often in the bupivacaine 1-mg
h-1 group (possible because of opioid rescue medication). On the ward, one
patient in the bupivacaine 2-mg h-1 group experienced a new increase in
sensory block with concomitant hypotension. One patient in the same group
had minor decubitus on the heel of the operated leg, probably because of
prolonged motor block. We conclude that intrathecal infusion of a
combination of bupivacaine 1 mg h-1 and morphine 8 micrograms h-1 produced
adequate postoperative analgesia. Unfortunately, postoperative nausea and
vomiting was a frequent disturbing adverse effect.
CLINICAL INVESTIGATIONS
Intrathecal infusion of bupivacaine with or without morphine for postoperative analgesia after hip and knee arthroplasty
Department of Anaesthesia, Toolo Hospital, Helsinki University Central Hospital, Topeliuksenkatu 5, FIN-00260 Helsinki, Finland
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