Postoperative analgesia after intrathecal morphine in hip or knee surgery
ผลการระงับปวดหลังจากฉีดมอร์ฟีนเข้าช่องน้ำไขสันหลังในผู้ป่วยที่มาผ่าตัดข้อสะโพก
หรือข้อเข่า
Thavat Chanchayanon, Asst. Prof., D. of Anesthesiology, F. of Medicine, PSU.
Paramee Thongsuksai, Asst. Prof., D. of Pathology, F. of Medicine, PSU.
Apiradee Sriwattana, Nurse, D. of Anesthesiology, F. of Medicine, PSU.
Nussara Dilokrattanapichit, Nurse, D. of Anesthesiology, F. of Medicine, PSU.
Numphon Suwuttikul, Nurse, D. of Anesthesiology, F. of Medicine, PSU.
Ungsupranee Boonrasri, Nurse, D. of Anesthesiology, F. of Medicine, PSU.
Somkit Buhachat, Nurse, D. of Anesthesiology, F. of Medicine, PSU.
Apiradee Lim, Nurse, Epidemiology Unit, F. of Medicine, PSU.
Published : Thai J of Anesthesiology 2000, 26(2) : 73-79
Key words : hip or knee surgery, intrathecal morphine, postoperative analgesia,
randomized controlled trial
We designed this study to determine the optimal intrathecal dose of morphine in patient under-going hip or knee surgery. The optimal intrathecal dose was defined as the dose that provided effective analgesia with minimal side effects for 24 h after surgery. Sixty patients, scheduled for hip or knee surgery, were randomly allocated into 3 double-blinded groups. Group 1 and group 2 received intra-thecal morphine 0.3 mg and 0.5 mg respectively while group 3 received normal saline (NSS) 0.5 ml. All were given a standardized bupivacaine dose intrathecally. Pain scores, IV pethidine injection, and morphine - related side effects (respiratory depression, postoperative nausea and vomiting, pruritus, urinary retention and sedation) were recorded for 24 h after surgery. VAS score recorded postopera-tively at 6 and 12 h in both morphine groups were significantly less than NSS group. Time to first analgesic requirement was significantly longer in both morphine groups compared to NSS group (group 1 = 15.1ฑ6.7 h, group 2 = 14.7ฑ6.8 h, group 3 = 8.6ฑ5.4 h, p value = 0.0001). The number of additional pethidine injection required in the first 24 hours was significantly less in the morphine
groups (2.22, 2.82 and 4.83 in group 1, 2 and 3 respectively, p value = 0.0001 for group 1 and 2 versus group 3). Incidence of postoperative nausea and vomiting (PONV), pruritus and urinary retention
were significantly higher in both morphine groups compared to NSS group. Respiratory depression
did not occur in all patients. We conclude that 0.3 mg of intrathecal morphine is the optimal dose for pain relief after hip or knee surgery with acceptable side effects.
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