This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (19) Citing Articles via Google Scholar Google Scholar Articles by Rathmell, J. P. Articles by Viani, B. A. Search for Related Content PubMed PubMed Citation Articles by Rathmell, J. P. Articles by Viani, B. A. Related Collections Regional Anesthesia Pain Pharmacology

---

PAIN MEDICINE

Intrathecal Morphine for Postoperative Analgesia: A Randomized, Controlled, Dose-Ranging Study After Hip and Knee Arthroplasty

Department of Anesthesiology, University of Vermont College of Medicine, Burlington, Vermont

Address correspondence and reprint requests to James P. Rathmell, MD, Department of Anesthesiology, University of Vermont College of Medicine, 111 Colchester Ave., Burlington, VT 05401. Address e-mail to james.rathmell{at}vtmednet.org

In this series, we examined analgesia and side effects of intrathecal morphine sulfate (ITMS) after hip and knee arthroplasty over a dose range of 0.0–0.3 mg. Eighty patients undergoing hip (n = 40) or knee (n = 40) arthroplasty were randomized to receive ITMS (0.0, 0.1, 0.2, or 0.3 mg). A patient-controlled analgesia (PCA) device provided free access to additional analgesics. Morphine use, pain relief, and side effects were recorded for 24 h. Data were analyzed with analysis of variance and linear regression. After hip arthroplasty, morphine use was less in patients receiving 0.1, 0.2, or 0.3 mg of ITMS than in control patients (P < 0.05). After knee arthroplasty, ITMS did not reduce postoperative morphine requirements. Nausea and vomiting and the incidence of oxygen saturation <93% were similar in all groups. Pruritus was more common after ITMS. Patients receiving 0.2 or 0.3 mg of ITMS were more satisfied with their pain control than those receiving 0.0 or 0.1 mg after both hip and knee arthroplasty. Analgesic needs are greater after knee arthroplasty than after hip arthroplasty. We conclude that combining small-dose (0.2 mg) ITMS with PCA morphine provides good to excellent pain control in most patients after total hip or knee arthroplasty. However, PCA morphine use was reduced by the addition of ITMS only after hip arthroplasty.

IMPLICATIONS: This series examined the need for supplemental analgesics, the quality of analgesia, and the incidence of side effects with intrathecal morphine sulfate (ITMS) for analgesia after hip and knee arthroplasty. Analgesic needs are greater after knee arthroplasty than hip arthroplasty. Combining small-dose (0.2 mg) ITMS with standard doses of PCA morphine provided good to excellent pain control in most patients and reduced patient-controlled analgesia morphine use after hip, but not knee, arthroplasty.

This article has been cited by other articles:

				T. T. Horlocker, S. L. Kopp, M. W. Pagnano, and J. R. Hebl Analgesia for total hip and knee arthroplasty: a multimodal pathway featuring peripheral nerve block. J. Am. Acad. Ortho. Surg., March 1, 2006; 14(3): 126 - 135. [Abstract] [Full Text] [PDF]

				J. P. Rathmell, T. R. Lair, and B. Nauman The Role of Intrathecal Drugs in the Treatment of Acute Pain Anesth. Analg., November 1, 2005; 101(5S_Suppl): S30 - 43. [Abstract] [Full Text] [PDF]

				J. Wallden, S.-E. Thorn, and M. Wattwil The Delay of Gastric Emptying Induced by Remifentanil Is Not Influenced by Posture Anesth. Analg., August 1, 2004; 99(2): 429 - 434. [Abstract] [Full Text] [PDF]