Abstract
Intrathecal morphine is widely and successfully used to prevent postoperative pain after orthopedic surgery, but it is frequently associated with side effects. The aim of this study was to evaluate the effect of dexamethasone or ondansetron when compared to placebo to reduce the occurrence of these undesirable effects and, consequently, to improve the quality of recovery based on patient's perspective. Methods. One hundred and thirty-five patients undergoing lower extremity orthopedic surgery under spinal anesthesia using bupivacaine and morphine were randomly assigned to receive IV dexamethasone, ondansetron, or saline. On the morning following surgery, a quality of recovery questionnaire (QoR-40) was completed. Results. No differences were detected in the global and dimensional QoR-40 scores following surgery; however, following postanesthesia care unit (PACU) discharge, pain scores were higher in patients receiving ondansetron compared with patients who received dexamethasone. Conclusion. Neither ondansetron nor dexamethasone improves the quality of recovery after lower limbs orthopedic surgery under spinal anesthesia using intrathecal morphine.
Highlights
Intrathecal morphine administration is recognized as one of the most efficacious approaches to preventing postoperative pain following lower extremity orthopedic surgery
We evaluate postoperative pain scores; the incidence of nausea, vomiting, pruritus, and urinary retention; use of analgesics; and postanesthesia care unit (PACU) length of stay
In the current investigation, when compared to placebo, neither ondansetron nor dexamethasone improved the quality of recovery (QoR-40) in patients undergoing lower extremity orthopedic surgery under spinal anesthesia with bupivacaine and intrathecal morphine (0.1 mg)
Summary
Intrathecal morphine administration is recognized as one of the most efficacious approaches to preventing postoperative pain following lower extremity orthopedic surgery. E administration of prophylactic therapies, such as dexamethasone [5] or ondansetron [6, 7], may reduce the occurrence of these complications To this point, Szarvas et al [8] evaluated the effect of single or combination therapy on the prevention of nausea, vomiting, and pruritus in patients undergoing orthopedic surgery under spinal anesthesia using bupivacaine and morphine. The global evaluation of the quality of postanesthetic recovery, from the patient’s perspective, has become recognized as an important outcome measure in clinical trials comparing therapeutic alternatives To this end, we have designed a prospective, randomized, double-blinded, and placebocontrolled study to evaluate, as a primary outcome, the quality of recovery, using the Quality of Recovery Questionnaire (QoR-40) [10], in patients undergoing lower extremity orthopedic surgery under spinal anesthesia using intrathecal morphine (0.1 mg) and receiving either ondansetron, dexamethasone, or placebo. We evaluate postoperative pain scores; the incidence of nausea, vomiting, pruritus, and urinary retention; use of analgesics; and PACU length of stay
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