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Comparison of Intrathecal Fentanyl Infusion with Intrathecal Morphine Infusion or Bolus for Postoperative Pain Relief After Hip Arthroplasty

Department of Anesthesiology, IV Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland

The purpose of this study was to compare an intrathecal fentanyl infusion with intrathecal morphine infusion or bolus for postoperative pain relief after hip arthroplasty. Sixty patients scheduled to undergo hip joint replacement were studied. A 28-gauge (n = 12) or a 22-gauge (n = 48) spinal catheter was introduced through the L3–4 interspace, 3--4 cm into the subarach-noid space. Spinal anesthesia was induced with 2 mL of plain 0.5% bupivacaine; additional bupivacaine was given in 0.5-mL increments, as required. Patients were given in a random and double-blind fashion either 0.5 mL of saline as a single bolus, followed by an infusion of 120 pg of fentanyl in 24 h (Group I, n = 20), 0.5 mL of saline, followed by an infusion of 200 µg of morphine in 24 h (Group II, >n = 20), or 200 µg of morphine as a single bolus, followed by an infusion of 3 mL of saline in 24 h (Group III, n = 20) through the intrathecal catheter. In Group I, supplementary intramuscular (IM) opioid was required more often (46 doses) than in Group II (18 doses) in 24 h (P < 0.01). The number of patients given IM administered opioid was larger in Group I (18 patients) than in Group II (8 patients) (P < 0.01). The IM opioid was requested sooner in Group I (18 patients, mean 480 min) after the intrathecal injection than in Group III (13 patients, mean 786 min) (P < 0.01). In Group III, 13 patients required urinary bladder catheterization as compared to 6 patients in Group I (P < 0.05) and II in Group II. Nausea and pruritus occurred equally often in all three groups. We conclude that intrathecal infusion of fentanyl at 5 µg/h, instituted together with bupivacaine spinal block, was inadequate for postoperative analgesia after hip surgery in elderly patients. Intrathecal morphine (200 µg) as a single dose or as a continuous infusion provided better analgesia, and the quality of analgesia after the two modes of administration was similar for the first 18 h.

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				F. J. Singelyn, P. E. Vanderelst, and J.-M. A. Gouverneur Extended Femoral Nerve Sheath Block After Total Hip Arthroplasty: Continuous Versus Patient-Controlled Techniques Anesth. Analg., February 1, 2001; 92(2): 455 - 459. [Abstract] [Full Text] [PDF]

				R. Fournier, E. Van Gessel, A. Weber, and Z. Gamulin A Comparison of Intrathecal Analgesia with Fentanyl or Sufentanil After Total Hip Replacement Anesth. Analg., April 1, 2000; 90(4): 918 - 922. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999