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REGIONAL ANESTHESIA AND PAIN MANAGEMENT

Optimization of the Dose of Intrathecal Morphine in Total Hip Surgery: A Dose-Finding Study

Robert Slappendel, MD^*, Eric W. G. Weber, MD^*, Ris Dirksen, PhD, MD, Mathieu J. M. Gielen, PhD, MD, and Jacques van Limbeek, PhD, MD^*

Departments of Anesthesiology, *Sint Maartenskliniek and University Hospital Nijmegen, Nijmegen, The Netherlands

Address correspondence and reprint requests to Robert Slappendel, MD, Department of Anesthesiology, Sint Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands.

We designed this study to determine the optimal intrathecal dose of morphine in total hip surgery. The optimal intrathecal dose was defined as that providing effective analgesia and minimal side effects 24 h after total hip surgery. Patients (n = 143) scheduled for total hip surgery were randomized to four double-blinded groups with a standardized bupivacaine dose but different doses of intrathecal morphine (Group I = 0.025 mg, Group II = 0.05 mg, Group III = 0.1 mg, and Group IV = 0.2 mg). Pain scores, IV morphine intake (patient-controlled analgesia), and morphine-related side effects (respiratory depression, postoperative nausea and vomiting, itching, urinary retention) were recorded for 24 h after surgery. Excellent postoperative pain relief was present in all groups. The highest pain scores were found in Group I. The mean use of systemic morphine administered by patient-controlled analgesia infusion pump was 23.7, 17.8, 10.9, and 9.9 mg in Groups I—IV, respectively (P < 0.01 for Groups III and IV versus Group I). We conclude that 0.1 mg of intrathecal morphine is the optimal dose for pain relief after hip surgery with minimal side effects.

Implications: Earlier studies showed excellent postoperative pain relief after intrathecal morphine. However, the severity of side effects resulted in decreased enthusiasm for this anesthesia technique. In the present study, we show that an intrathecal dose of 0.1 mg of morphine can be used safely in total hip surgery with excellent postoperative pain relief.

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