Low Dose Of Intrathecal Morphine Research Articles

Effect of different low doses of intrathecal morphine (0.1 and 0.2 mg) on pain and vital functions in patients undergoing total hip arthroplasty: a randomised controlled study

BackgroundOrthopaedic surgeries are among the most painful procedures. By adding low-dose morphine to intrathecal bupivacaine for spinal anaesthesia, the analgesic effect can be improved. The objeсtive of the study was tо compare the efficacy and safety of lоw-dоse (0.1 mg аnd 0.2 mg) intrаtheсаl mоrphine (ITM).MethodsА prоspeсtive rаndоmised study was соnduсted at the Hоspitаl оf Trаumаtоlоgy аnd Оrthоpaediсs, Riga, Latvia (February 2020 tо May 2021) and enrolled 90 patients undergoing primary hip arthroplasty. All subjects were randomised intо three study grоups, using the online tool оn www.randomiser.org. Treatment groups were allocated to intrathecal morphine (0.1 mg and 0.2 mg) in addition to bupivacaine (15 to 18 mg). The primary outcome was postoperative pain intensity among the three study groups within 24 hours by NRS. The secondary outcomes: pain at rest 4 h, 7 h, 12 h, 24 h postoperatively, respiratory rate, SpО2, morphine соnsumptiоn, оxygen supply, opioid-related аdverse reасtiоns within 24 hours postoperatively. Dаtа were аnаlysed using R version 4.2.0, applying the Mann-Whitney test, Pearson’s chi-squared test, Fisher’s exact test, Friedman test, Wilcoxon test.ResultsThe primary outcome in the control, ITM 0.1 mg, ITM 0.2 mg groups, respectively: 2.56, 0.87, 0.28 (p < 0.001). The secondary outcomes in the control, ITM 0.1 mg, ITM 0.2 mg group, respectively: pain scores 4h – 1.21, 0.48, 0.17 (p = 0.068); 7 h – 2.62, 1.00, 0.17 (p < 0.001); 12 h – 3.08, 0.65, 0.37 (p < 0.001); 24 h – 2.50, 1.20, 0.41 (p < 0.001); rescue medication requests (incidence, %): 77%, 16.7%, 13.3% (p < 0.001); mean respiratory rate (breath/min) – 15.2; 15.2 (p > 0.05); mean SpO2 (%): 96.7%; 95.7%; 96.07%. Significant adverse effects: pruritus in ITM 0.2 mg group (23% of subjects, p < 0.001).ConclusionsAdult patients undergoing THA under spinal anaesthesia with bupivacaine and 0.2 mg morphine had superior analgesia to patients who received spinal analgesia with bupivacaine or bupivacaine and 0.1 mg morphine.Trial registrationStudy ID ISRCTN37212222; 20/04/2022 (registered retrospectively)

Preemptive analgesia with a single low dose of intrathecal morphine in multilevel posterior lumbar interbody fusion surgery: a double-blind, randomized, controlled trial

Patients undergoing lumbar spinal surgery may experience considerable pain in the early postoperative period, and poor pain control after multilevel lumbar spinal fusion surgery is frequently associated with multiple complications and delayed discharge from hospital. The current study evaluated the efficacy and safety of preemptive analgesia with intrathecal morphine (ITM) in patients undergoing multilevel posterior lumbar spinal fusion surgery. Double-blinded, randomized, controlled trial. Ninety-two patients aged between 18 and 80 years who were scheduled to undergo elective lumbar laminectomy (L3-S1) and dual-level fusions. The primary endpoint was the degree of postoperative pain at rest and during movement evaluated using a 10-point visual analogue scale. The secondary outcomes included the consumption of analgesics, the patient-assessed postoperative and satisfaction scores, adverse effects, time to first ambulation, and length of hospital stay. Patients were randomly allocated to either the ITM group that received 0.2 mg of ITM or the control (CON) group that received 2 ml of 0.9% saline as a skin infiltration 30 minutes prior to anesthesia induction. The ITM group had a significantly lower visual analogue scale score than the CON group during the first 3 days postoperatively (at rest, P=0.000, during movement, P=0.000). The ITM group used significantly less sufentanil than the CON group in the first 3 days postoperatively (p=.000) in patient-controlled intravenous analgesia, as well as in supplemental analgesic demands. The ITM group reported a greater degree of satisfaction with the whole hospitalization experience than the CON group (2.4±0.6 vs. 1.9±0.6, p=.000). The two groups did not significantly differ regarding adverse effects, length of hospital stay, and time taken to regain the ability to walk without support. Preemptive analgesia with ITM results in significantly improved early postoperative pain control and decreased postoperative patient-controlled intravenous analgesia consumption, with no increase in adverse effects.

Efficacy and safety of intrathecal morphine for post cesarean section analgesia

Background: Government of Nepal has been conducting Cesarean section under “Safe Motherhood” program all over country. The purpose of this study was to evaluate the efficacy and safety of intrathecal morphine for post cesarean analgesia under spinal anesthesia. Methods: A total of 300 parturients posted for Cesarean section under spinal anesthesia were divided into two groups of 150 each in this prospective randomized case-control study. Morphine group received 0.15 mg of intrathecal morphine mixed in 12 mg of 0.5% bupivacaine heavy while control group received 12 mg of 0.5% bupivacaine heavy alone, after proper preparation of spinal anesthesia. The parturients were assessed for first request of analgesic as per Visual Analog Scale, frequency of analgesics required within 24 hr, nausea, vomiting, pruritus, sedation and respiratory depression.Results: Postoperative analgesia was significantly greater in morphine group as compare to control group (12.1 ± 7.6 vs 3.7 ± 2.9 hr). Frequency of analgesics requirements was also significantly lower in morphine group (1.7 ± 2.0 vs 3.4 ± 8.1). Visual Analog Scale was below 4 at most of time in morphine group. The incidence of nausea, vomiting and pruritus were more in morphine group as compare to control group but without any respiratory depression. There was no significant difference in APGAR score among fetus. Conclusion: Mixing low dose of intrathecal morphine in standard dose of spinal anesthesia effectively prolongs the duration of post cesarean analgesia and decreases the frequency of analgesics requirement without any major complication in parturients or fetus.Journal of Society of Anesthesiologists 2014 1(1): 13-17

Is a single low dose of intrathecal morphine a useful adjunct to patient-controlled analgesia for postoperative pain control following lumbar spine surgery? A preliminary report.

Several studies addressing intrathecal morphine (ITM) use following spine surgery have been published either involving the pediatric population, using mid- to high-dose ITM, or not in conjunction with morphine patient-controlled analgesia (PCA). To determine whether low-dose ITM is a useful adjunct to PCA for postoperative pain control following elective lumbar spine surgery in adults. Thirty-two patients were enrolled in a double-blinded randomized controlled trial, and received either ITM or intrathecal placebo. Postoperatively, all patients were given a PCA pump and observed for the first 24 h in a step-down unit. Measurements of: total PCA morphine consumed in the first 24 h; intensity of pain; pruritus; nausea at 4 h, 8 h and 24&nbsp;h; time to first ambulation; length of hospital stay; and occurrences of respiratory depression were recorded. The total PCA use was significantly lower in the ITM group. There were lower average pain scores in the ITM group, which increased to that of the intrathecal placebo group over 24 h; however, this failed to attain statistical significance. There were no differences in nausea, pruritus, time to first ambulation or hospital length stay. There were no cases of respiratory depression in either group. ITM may be a useful adjunct to PCA, but did not decrease time to ambulation or length of stay.

The Use of Combined Spinal-Epidural Analgesia Utilizing Intrathecal Morphine for Labor Pain in a Community Hospital

Purpose: To assess the incidence of adverse outcomes in pre-selected laboring patients who received low dose intrathecal morphine as part of the regional technique for labor analgesia. Methods: Retrospective observational study of 205 laboring patients who delivered at a large community hospital between January 2007 and December 2010. All patients received Duramorph, 250 μg, and fentanyl, 25 μg intrathecally. The primary adverse outcome was delayed maternal respiratory depression. Secondary adverse outcomes included high pain scores, low Apgar scores, and postpartum hemorrhage. Results: No cases of respiratory depression requiring naloxone administration were reported during the study. No infants had Apgar scores 4. Conclusion: This study demonstrates that regional analgesia utilizing low doses of intrathecal morphine and fentanyl in selected laboring patients is safe and effective.

Intrathecal hydromorphone instead of the old intrathecal morphine

Intrathecal hydromorphone instead of the old intrathecal morphine

Sparing Effect of a Low Dose of Intrathecal Morphine on Fentanyl Requirements During Spinal Surgery: A Preliminary Clinical Investigation in Dogs

To evaluate the effect of preoperative intrathecal administration of a low dose of morphine on intraoperative fentanyl requirements in dogs undergoing cervical and thoracolumbar spinal surgery. Prospective randomized clinical study. Dogs (n=18) matched by surgical procedure administered intrathecal morphine (MG) or no-treatment (control group, CG). After premedication with romifidine (4 microg/kg, intravenously) and induction with propofol, anesthesia was maintained with sevoflurane in oxygen. Intrathecal morphine 0.03 (0.023-0.034) mg/kg was administered at lumbar level 41 (25-65) minutes before surgery in MG. Ketamine (0.5 mg/kg) was administered hourly, starting before incision. Fentanyl infusion (1.2 and 4.2 microg/kg/h in MG and CG, respectively) was administered after a loading dose (5 and 10 microg/kg in MG and CG, respectively), and boluses were given if an increase >20% in heart rate and arterial blood pressure was observed. Total amount of fentanyl administered was recorded, to calculate hourly requirements and predict plasma concentration using a computer simulation. Hourly fentanyl consumption and predicted plasma concentrations at the time of response to surgery were significantly lower in MG compared with CG. Preoperative administration of a low dose of intrathecal morphine has a sparing effect on intraoperative fentanyl requirements. Preoperative intrathecal administration of a low dose of morphine at the lumbar level represented a safe and effective mean of providing intraoperative analgesia in dogs undergoing cervical and thoracolumbar spinal surgery.

Implantable Intrathecal Pumps for the Treatment of Noncancer Chronic Pain in Elderly Population: Drug Dose and Clinical Efficacy

Objective. This study aims to assess long-term follow-up of efficacy and quality of life for 34 geriatric patients (10 men, 24 women, mean age 72.3±11.6years) with intrathecal (IT) drug delivery systems (IDDS), implanted between 1994 and 2002, for the treatment of severe noncancer chronic pain. Methods. Patients equal to or older than 64years, who had no pain relief after administration of a placebo injection (subcutaneous saline), and who responded positively to an IT trial (morphine and bupivacaine at low doses) with pain relief greater 70% without intolerable adverse effects were included into our study. Clinical assessment forms and questionnaires assessing pain intensity, adverse events, complications, concommitent use of analgesics, and doses of IT drugs administered were filled out by our patients prior to and after IT drug delivery implantation. Results. Pain intensity was substantially reduced (60%) at three-month follow-up after commencing IT therapy and was consistently reduced at 48-month follow-up. The mean visual analog scale (VAS) value decreased from 8.09 (±1.25) before implantation to 1.68 (±0.63) after implantation at 48-month follow-up. This benefit, at 48months, was achieved using mean low doses of IT morphine and bupivacaine, 1.03±0.61mg and 1.15±0.58mg, respectively. Only two out of 34 patients (5.9%) had complications related to the implantation procedure, itself. Side-effects of therapy were reported by 50% of the patients, the most frequent being constipation (34.4%), drowsiness (21.9%), nausea (21.9%), and urinary retention (18.8%). No side-effects of therapy resulted in removal of the IDDS. Conclusion. The use of IT drug delivery through IDDS for the treatment of non-cancer- and cancer-related pain in geriatric patients is successful.

Effect of subarachnoid morphine administration on extubation time after coronary artery bypass graft surgery

Objective: To determine the effects of 2 low doses of intrathecal morphine on extubation time and on postoperative analgesic requirements after coronary artery bypass graft (CABG) surgery. Design: A prospective, randomized, double-blind, placebo-controlled study. Setting: Tertiary-care university hospital. Participants: Fifty adult patients scheduled for elective primary CABG surgery. Interventions: Patients were randomized to receive placebo, 250 μg, or 500 μg intrathecal morphine, preoperatively. Intraoperative fentanyl and midazolam were limited to 15 μg/kg and 20 μg/kg intravenously. Patients were extubated in the intensive care unit by a blinded observer using predefined extubation criteria. Measurements and Main Results: Time to extubation and postoperative requirements for morphine, midazolam, nitroglycerin, and sodium nitroprusside were recorded by a blinded observer. Extubation times were 441 ± 207 minutes versus 325 ± 188 minutes versus 409 ± 245 minutes for the placebo, 250-μg, and 500-μg groups (p = 0.27). Postoperative morphine requirements in the 250-μg and 500-μg groups were 13.6 ± 7.8 mg and 11.7 ± 7.4 mg, compared with 21.3 ± 6.2 mg in the placebo group (p = 0.001). There were no differences among the study groups with regard to postoperative midazolam, nitroglycerin, and sodium nitroprusside requirements. Conclusions: Despite decreased postoperative morphine requirements, intrathecal morphine administration did not have a clinically relevant effect on extubation time after CABG surgery. This study suggests that 250 μg is the optimal dose of intrathecal morphine to provide significant postoperative analgesia without delaying tracheal extubation. Copyright © 2000 by W.B. Saunders Company

Itching after intrathecal morphine. Incidence and treatment

This study was designed to determine whether low doses of intrathecal morphine still result in itching and it evaluates the outcome of a standardized treatment using promethazine and - for intractable itch - naloxone. Patients (n = 143) scheduled for total hip surgery were allocated to four groups (in a double blind manner) with bupivacaine 20 mg in 4 mL but different doses of intrathecal morphine: Group I, 0.025 mg, Group II, 0.05 mg, Group III, 0.1 mg and Group IV, 0.2 mg. The presence or absence of itching was noted every three hours for a 24-h period. When required, standardized treatment was provided. The incidence of itching was: Group I: 14.3%; Group II: 21.6%; Group III: 48.6%; and, Group IV: 61.7%. Itch was treated by administering promethazine intramuscularly in 2.9% (Group I); 8.1% (Group II); 10.8% (Group III), and 8.9% (Group IV), respectively. Only in group IV there was a single patient who needed naloxone to treat itching. The incidence and severity of itching is a dose-related side-effect in the dose range of 0.025-0.2 mg of intrathecal morphine. Itching still occurs after the low doses of intrathecal morphine, but symptoms vanish after promethazine 25 mg intramuscularly.

Low dose intrathecal morphine and pain relief following caesarean section

Healthy women who underwent caesarean section under spinal anaesthesia were studied to determine the extent of postoperative analgesia and side-effects produced by low doses of intrathecal morphine. Patients were randomly allocated to receive, in double-blind fashion, 0 mg (group 1: control group), 0.05 mg (group 2), 0.1 mg (group 3), or 0.2 mg (group 4) of morphine, with 10 mg tetracaine in 10% dextrose 2.5 ml. (n = 20 × 4 groups). The effect of intrathecal morphine was examined in terms of the duration until the first supplemental analgesic was needed and the numbers of the doses within the first postoperative 48 h. Pain relief was significantly greater in groups 3 and 4 than in group 1. The incidence of nausea, vomiting and pruritus increased in a dose-dependent manner. No patient developed respiratory depression. Our results suggest that postoperative analgesia lasts more than 24 h with 0.1 mg or 0.2 mg of intrathecal morphine. Since the incidence of side-effects was higher at 0.2 mg, 0.1 mg may be the optimum dose for caesarean section.

Intrathecal morphine and bupivacaine in advanced cancer pain patients implanted at home

Fifteen patients with pain due to advanced cancer who no longer obtained relief from conventional treatment using oral or parenteral opioids were administered morphine and bupivacaine by continuous intrathecal infusion. Thirteen patients were implanted at home due to poor medical condition or refusal to be hospitalized. A summary score was derived to monitor the effects of the treatment. Thirteen patients required low doses of intrathecal morphine and bupivacaine and all reported good pain relief until death. Only minor side effects were evidenced. Implantation at home of an intrathecal catheter to administer morphine and bupivacaine provided a degree of pain relief during the last days of life that would have otherwise been impossible and did so without producing important complications.

Intrathecal morphine for postoperative analgesia in children after selective dorsal rhizotomy

The authors report their experience with low doses (0.007-0.015 mg/kg), moderate doses (0.016-0.025 mg/kg), and high doses (0.026-0.035 mg/kg) of intrathecal morphine for postoperative analgesia after selective dorsal root rhizotomy surgery in 50 children, aged 3 to 12 years. After closure of the dura, a single dose of preservative-free morphine was injected into the subarachnoid space, and patients were assessed for 48 hours for level of comfort and side effects. The three doses of morphine provided equivalent analgesia and similar side effects. The duration of postoperative analgesia ranged from 3 to 48 hours (mean, 12.2 +/- 9.5 h). Common side effects were limited to nausea and vomiting (42%) and mild facial pruritus. No patient experienced late respiratory depression or generalized pruritus. The authors conclude that low doses of intrathecal morphine is as effective as moderate or high doses of morphine for reducing pain in the immediate postoperative period. Intrathecal morphine provides excellent analgesia after selective dorsal rhizotomy.

Intrathecal morphine for postoperative analgesia in children after selective dorsal root rhizotomy

The authors report their experience with low doses (0.007-0.015 mg/kg), moderate doses (0.016-0.025 mg/kg), and high doses (0.026-0.035 mg/kg) of intrathecal morphine for postoperative analgesia after selective dorsal root rhizotomy surgery in 50 children, aged 3 to 12 years. After closure of the dura, a single dose of preservative-free morphine was injected into the subarachnoid space, and patients were assessed for 48 hours for level of comfort and side effects. The three doses of morphine provided equivalent analgesia and similar side effects. The duration of postoperative analgesia ranged from 3 to 48 hours (mean, 12.2 +/- 9.5 h). Common side effects were limited to nausea and vomiting (42%) and mild facial pruritus. No patient experienced late respiratory depression or generalized pruritus. The authors conclude that low doses of intrathecal morphine is as effective as moderate or high doses of morphine for reducing pain in the immediate postoperative period. Intrathecal morphine provides excellent analgesia after selective dorsal rhizotomy.

Intrathecal Morphine for Postoperative Analgesia in Children after Selective Dorsal Root Rhizotomy

Abstract The authors report their experience with low doses (0.007-0.015 mg/kg);, moderate doses (0.016-0.025 mg/kg);, and high doses (0.026-0.035 mg/kg); of intrathecal morphine for postoperative analgesia after selective dorsal root rhizotomy surgery in 50 children, aged 3 to 12 years. After closure of the dura, a single dose of preservative-free morphine was injected into the subarachnoid space, and patients were assessed for 48 hours for level of comfort and side effects. The three doses of morphine provided equivalent analgesia and similar side effects. The duration of postoperative analgesia ranged from 3 to 48 hours (mean, 12.2 ± 9.5 h);. Common side effects were limited to nausea and vomiting (42%); and mild facial pruritus. No patient experienced late respiratory depression or generalized pruritus. The authors conclude that low doses of intrathecal morphine is as effective as moderate or high doses of morphine for reducing pain in the immediate postoperative period. Intrathecal morphine provides excellent analgesia after selective dorsal rhizotomy.