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PAIN MEDICINE

Optimizing the Dose of Intrathecal Morphine in Older Patients Undergoing Hip Arthroplasty

P. M. Murphy, MB FCARCSI^*, D. Stack, MB FCARCSI^*, B. Kinirons, MB FFARCSI^*, and J. G. Laffey, MD MA, BSc, FFARCSI^*,

*Department of Anaesthesia, Merlin Park Regional Hospital, Galway; and Clinical Sciences Institute, National University of Ireland, Galway, Ireland

Address correspondence to J. G. Laffey, MD, MA, BSc, FFARCSI, Department of Anesthesia, Clinical Sciences Institute, National University of Ireland, Galway, Ireland. Address e-mail to john.laffey{at}nuigalway.ie Reprints will not be available from the authors.

Intrathecal (IT) morphine provides excellent postoperative analgesia but may result in many side effects, including postoperative nausea and vomiting, pruritus, and respiratory depression, particularly at larger doses. Older patients may be at particular risk. The optimal dose of spinal morphine in older patients undergoing hip arthroplasty is not known. We designed this prospective, randomized, controlled, double-blinded study to evaluate the analgesic efficacy and side effect profile of 50–200 µg of IT morphine in older patients undergoing elective hip arthroplasty. Sixty patients older than 65 years undergoing elective hip arthroplasty were enrolled. Patients were randomized to receive spinal anesthesia with 15 mg of bupivacaine and IT morphine in four groups: 1) 0 µg, 2) 50 µg, 3) 100 µg, and 4) 200 µg. IT morphine 100 and 200 µg produced effective pain relief and decreased the postoperative requirement for morphine compared with control. IT morphine 50 µg did not provide effective pain relief. Both 100 and 200 µg of IT morphine provided comparable levels of postoperative analgesia. There were no between-group differences in postoperative nausea and vomiting, sedation, respiratory depression, or urinary retention. Pruritus was significantly more frequent with 200 µg of IT morphine. In conclusion, 100 µg of IT morphine provided the best balance between analgesic efficacy and side effect profile in older patients undergoing hip arthroplasty.

IMPLICATIONS: The dosage of intrathecal morphine that provides the best balance between analgesic efficacy and side effect profile in the older patient undergoing hip arthroplasty is not known. This prospective, randomized, controlled, double-blinded clinical trial demonstrates that a dose of 100 µg of intrathecal morphine provides the best balance between efficacy and side effects, compared with doses of 0, 50, and 200 µg of morphine, in this patient population.

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				C. R.K. Grant and M. R. Checketts Analgesia for primary hip and knee arthroplasty: the role of regional anaesthesia CEACCP, April 1, 2008; 8(2): 56 - 61. [Full Text] [PDF]

				S. Eschertzhuber, M. Hohlrieder, C. Keller, E. Oswald, G. Kuehbacher, and P. Innerhofer Comparison of high- and low-dose intrathecal morphine for spinal fusion in children Br. J. Anaesth., April 1, 2008; 100(4): 538 - 543. [Abstract] [Full Text] [PDF]

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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