Top

European Journal of Orthopaedic Surgery & Traumatology

Published in:

01-01-2019 | Original Article • KNEE- ARTHROPLASTY

Safety and side-effect profile of intrathecal morphine in a diverse patient population undergoing total knee and hip arthroplasty

Authors: Shane R. Hess, Laura A. Lahaye, Andrew C. Waligora, Adam P. Sima, William A. Jiranek, Gregory J. Golladay

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 1/2019

Abstract

Intrathecal morphine (ITM) can be useful for postoperative analgesia following lower extremity joint arthroplasty, but concerns exist regarding potential dose-related side effects. In this study, we examined the safety and efficacy of ITM in patients undergoing lower extremity joint arthroplasty. We hypothesized that there would be (1) direct relationship between dosing and side effects, and (2) an inverse relationship between ITM dosing and 24-hour postoperative opioid requirement.

Johnson RL, Kopp SL, Burkle CM et al (2016) Neuraxial vs general anaesthesia for total hip and total knee arthroplasty: a systematic review of comparative-effectiveness research. Br J Anaesth 116:163–176. https://doi.org/10.1093/bja/aev455 CrossRefPubMed

Fischer HBJ, Simanski CJP, The PROSPECT working group (2005) A procedure-specific systematic review and consensus recommendations for analgesia after total hip replacement. Anaesthesia 60:1189–1202. https://doi.org/10.1111/j.1365-2044.2005.04382.x CrossRefPubMed

Bowrey S, Hamer J, Bowler I et al (2005) A comparison of 0.2 and 0.5 mg intrathecal morphine for postoperative analgesia after total knee replacement. Anaesthesia 60:449–452CrossRefPubMed

Brill S, Gurman GM, Fisher A (2003) A history of neuraxial administration of local analgesics and opioids. Eur J Anaesthesiol 20:682–689CrossRefPubMed

Wang J, Nauss L, Thomas J (1979) Pain relief by intrathecally applied morphine in man. Anesthesiology 50:149–151CrossRefPubMed

Rathmell JP, Pino CA, Taylor R et al (2003) Intrathecal morphine for postoperative analgesia: a randomized, controlled, dose-ranging study after hip and knee arthroplasty. Anesth Analg 97:1452–1457. https://doi.org/10.1213/01.ANE.0000083374.44039.9E CrossRefPubMed

Samii K, Chauvin M, Viars P (1981) Postoperative spinal analgesia with morphine. Br J Anaesth 53:817–820CrossRefPubMed

Moore R, Paterson G, Bullingham R (1984) Controlled comparison of intrathecal cinchocaine with intrathecal cinchocaine and morphine: clinical effects and plasma morphine concentrations. Br J Anaesth 56:837–841CrossRefPubMed

Davis I (1987) Intrathecal morphine in aortic aneurysm surgery. Anaesthesia 42:491–497CrossRefPubMed

10.

Palmer C, Emerson S, Volgoropolous D, Alves D (1999) Dose-response relationship of intrathecal morphine for postcesarean analgesia. Anesthesiology 90:437–444CrossRefPubMed

11.

Bengtsson M, Lofstrom J, Merits H (1983) Postoperative pain relief with intrathecal morphine after major hip surgery. Reg Anesth 8:140–143

12.

Kalso E (1983) Effects of ITMS, injected with bupivacaine, on pain after orthopaedic surgery. Br J Anaesth 55:415–421CrossRefPubMed

13.

Cole P, Craske D, Wheartley R (2000) Efficacy and respiratory effects of low-dose spinal morphine for post-operative analgesia following knee arthroplasty. Br J Anaesth 85:233–237CrossRefPubMed

14.

Jacobson L, Chabal C, Brody M (1988) A dose-response study of intrathecal morphine: efficacy, duration, optimal dose, and side effects. Anesth Analg 67:1082–1088CrossRefPubMed

15.

Goodarzi M, Narasimhan R (2001) The effect of large-dose intrathecal opioids on the autonomic nervous system. Anesth Analg 93:456–459PubMed

16.

Lydon A, Cooke T, Duggan F, Shorten G (1999) Delayed postoperative gastric emptying following intrathecal morphine and intrathecal bupivacaine. Can J Anesth 46:544–549CrossRefPubMed

17.

Carpenter R, Caplan R, Brown D et al (1992) Incidence and risk factors for side effects of spinal anaesthesia. Anesthesiology 76:906–916CrossRefPubMed

18.

Slappendel R, Weber E, Benraad B et al (2000) Itching after intrathecal morphine. Incidence and treatment. Eur J Anaesthesiol 17:616–621CrossRefPubMed

19.

Clergue F, Montembault C, Despierres O et al (1984) Respiratory effects of intrathecal morphine after upper abdominal surgery. Anesthesiology 61:677–685CrossRefPubMed

20.

Glass P (1984) Respiratory depression following only 0.4 mg of intrathecal morphine. Anesthesiology 60:256–257CrossRefPubMed

21.

Hassett P, Ansari B, Gnanamoorthy P et al (2008) Determination of the efficacy and side-effect profile of lower doses of intrathecal morphine in patients undergoing total knee arthroplasty. BMC Anesthesiol 8:5. https://doi.org/10.1186/1471-2253-8-5 CrossRefPubMedPubMedCentral

22.

Hindle A (2008) Intrathecal opioids in the management of acute postoperative pain. Contin Educ Anaesth Crit Care Pain 8:81–85. https://doi.org/10.1093/bjaceaccp/mkn016 CrossRef

23.

Gehling M, Tryba M (2009) Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: a meta-analysis. Anaesthesia 64:643–651. https://doi.org/10.1111/j.1365-2044.2008.05817.x CrossRefPubMed

24.

Gwirtz KH, Young JV, Byers RS et al (1999) The safety and efficacy of intrathecal opioid analgesia for acute postoperative pain: seven years’ experience with 5969 surgical patients at Indiana University Hospital. Anesth Analg 88:599–604PubMed

25.

Sinclair DR, Chung F, Mezei G (1999) Can postoperative nausea and vomiting be predicted? Anesthesiology 91:109–118CrossRefPubMed

26.

Cheah JW, Sing DC, Hansen EN et al (2018) Does intrathecal morphine in spinal anesthesia have a role in modern multimodal analgesia for primary total joint arthroplasty? J Arthroplast. https://doi.org/10.1016/j.arth.2018.01.016 CrossRef

27.

Shaikh SI, Nagarekha D, Hegade G, Marutheesh M (2016) Postoperative nausea and vomiting: a simple yet complex problem. Anesth Essays Res 10:388–396. https://doi.org/10.4103/0259-1162.179310 CrossRefPubMedPubMedCentral

28.

Apfel CC, Läärä E, Koivuranta M et al (1999) A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 91:693. https://doi.org/10.1097/00000542-199909000-00022 CrossRef

29.

Aly M, Ibrahim A, Farrag W et al (2018) Pruritus after intrathecal morphine for cesarean delivery: incidence, severity and its relation to serum serotonin level. Int J Obstet Anesth. https://doi.org/10.1016/j.ijoa.2018.02.004 CrossRefPubMed

30.

Murphy PM, Stack D, Kinirons B, Laffey JG (2003) Optimizing the dose of intrathecal morphine in older patients undergoing hip arthroplasty. Anesth Analg 97:1709–1715. https://doi.org/10.1213/01.ANE.0000089965.75585.0D CrossRefPubMed

Title: Safety and side-effect profile of intrathecal morphine in a diverse patient population undergoing total knee and hip arthroplasty
Authors: Shane R. Hess
Laura A. Lahaye
Andrew C. Waligora
Adam P. Sima
William A. Jiranek
Gregory J. Golladay
Publication date: 01-01-2019
Publisher: Springer Paris
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 1/2019
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-018-2293-9

At a glance: The STEP trials

Springer Medicine

Safety and side-effect profile of intrathecal morphine in a diverse patient population undergoing total knee and hip arthroplasty

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2019

PoCUS evaluating blunt thoracic trauma: a retrospective analysis of 18 months of emergency department activity

Five-pointed star lattice sutures for fixation of patella transverse fractures: a clinical study

How to reduce osteopenia in total knee arthroplasty?

Osteochondral flap fracture of the coronoid in pediatric elbow dislocation: a case report and literature review

Uncemented total hip arthroplasty in octogenarian and nonagenarian patients

Sacral chordoma: clinical experience of a series of 11 patients over 18 years