Mg Of Intrathecal Morphine Research Articles

Impact of Arterial Hypotension During Spinal Anesthesia for Cesarean Delivery on the Newborn at Kouba Hospital

Introduction: Spinal anesthesia is commonly used for cesarean deliveries but can lead to maternal hypotension, a frequent complication that may adversely affect the fetus. The objective of this study was to determine the incidence of post-spinal hypotension for cesarean delivery and identify associated risk factors. Methods: This was a prospective descriptive study conducted at Kouba Hospital over one month. Inclusion criteria were patients admitted for scheduled or emergency cesarean under spinal anesthesia after informed consent, without absolute contraindication to spinal anesthesia, baseline blood pressure ≥100 mmHg, and heart rate ≤100 bpm. Patients were excluded if hypotensive, vagotonic, had pre-existing cardiac disease, or received general anesthesia. All patients received 8 mg 0.5% bupivacaine, 2.5 μg sufentanil, and 100 μg intrathecal morphine with standard monitoring and 250 ml fluid preloading. Hypotension was defined as ≥20% decrease from baseline blood pressure. Data collected included demographics, obstetric history, and anesthetic/surgical details. Analysis was done using EPI Info software. Results: 42 parturients were included, mostly ASA II, with mean BMI 26.5±4.1 kg/m2 and gestational age 37.4±2.1 weeks. 50% had a history of hypotension in previous cesareans, and 68% underwent emergency cesarean. Sensory block reached T4 level on average. Hypotension incidence was 80%, with 40% requiring additional fluids and mean 15±10 mg ephedrine. Despite hypotension, most neonates had satisfactory Apgar scores. High BMI, emergency cesarean, and previous hypotension history were significantly associated with increased hypotension risk. Discussion: The high 80% hypotension incidence aligns with literature reports of 70-90%, likely exacerbated by using isobaric/hypobaric rather than hyperbaric bupivacaine. Identified risk factors were consistent with published data. Prompt management likely prevented major neonatal consequences. Conclusion: Intraoperative hypotension is frequent after spinal anesthesia for cesarean delivery. Guidelines recommend a standardized approach with fluid loading, vasopressors, and lateral tilt positioning to prevent maternal and fetal complications. Larger studies are needed to further characterize risk factors.

Effectiveness and safety of intrathecal morphine for percutaneous endoscopic lumbar discectomy under low-dose ropivacaine: a prospective, randomized, double-blind clinical trial

BACKGROUND CONTEXTPercutaneous endoscopic lumbar discectomy (PELD) is a surgical setting that requires minimal motor impairment. Low-dose spinal ropivacaine induces little motor blockade and could be ideal for maintaining safety of PELD, but its analgesic efficacy is questionable. An adjunct analgesic approach is needed to maximize the benefits of low-dose spinal ropivacaine for PELD. PURPOSEThis study aimed to explore the effectiveness and safety of 100 µg intrathecal morphine (ITM) as an adjuvant analgesic method for PELD under low-dose spinal ropivacaine. STUDY DESIGNA double-blind, randomized, placebo-controlled trial. Trial registration: ChiCTR2000039842 (www.chictr.org.cn). SAMPLENinety patients scheduled for elective single-level PELD under low-dose spinal ropivacaine. OUTCOME MEASURESThe primary outcome was the overall intraoperative visual analogue scale (VAS) score for pain. Secondary outcomes were intraoperative VAS scores assessed at multiple timepoints; intraoperative rescue analgesic requirement; postoperative VAS scores; disability scale; patients’ satisfaction with anesthesia; adverse events; and radiographic outcomes. METHODSPatients were randomized to receive low-dose ropivacaine spinal anesthesia with (ITM group, n=45) or without (control group, n=45) 100 µg ITM. RESULTSThe overall intraoperative VAS score in the ITM group was significantly lower than that in the control group (0 [0, 1] vs 2 [1, 3], p<.001). During operation, the VAS scores at cannula insertion, 30 minutes after insertion, 60 minutes after insertion, and 120 minutes after insertion were all significantly lower in the ITM group (all p<.05). Less patients in the ITM group required rescue analgesia during operation compared with those in the control group (14% vs 42%, p= .003). The VAS score for back pain in the ITM group was lower than that in the control group at 1 hour, 12 hours, and 24 hours postoperatively. Besides, the satisfaction score in the ITM group was significantly higher than that in the control group (p=.017). For adverse events, 8/43 of ITM and 1/44 of control participants experienced pruritus (p=.014), with a relative risk (95% confidence interval) of 8.37 (1.09–64.16). The incidence of other adverse events was similar between the two groups. Of note, respiratory depression occurred in one ITM-treated patient. CONCLUSIONThe addition of 100 µg ITM to low-dose ropivacaine appears to be effective in analgesia without compromised motor function for PELD; however, ITM increased the risk of pruritus and clinicians should be vigilant about its potential risk of respiratory depression.

Randomized Double-Blind Controlled Trial Comparing 0.2 mg, 0.1 mg, and No Intrathecal Morphine Combined With Periarticular Injection for Unilateral Total Knee Arthroplasty.

BackgroundThe addition of intrathecal morphine (ITM) to neuraxial anesthesia during total knee arthroplasty (TKA) to achieve postoperative analgesia can elicit opioid-related side effects. The other methods of pain alleviation and side effect reduction, including multimodal analgesia, are challenging. This study aimed to determine the efficacy of various ITM dosages for primary unilateral TKA with periarticular injection (PI).MethodsThis randomized double-blind controlled trial was conducted at Vajira Hospital between April 2018 and March 2019. Patients undergoing TKA were randomized into 3 groups: no ITM (M0), ITM 0.1 mg (M1), and ITM 0.2 mg (M2). All patients received PI. Postoperative pain scores, side effects of ITM, and orthopedic outcomes were compared.ResultsThe trial enrolled 102 patients: M0 (n = 32), M1 (n = 35), and M2 (n = 35). The postoperative pain scores and rescue analgesic consumption of groups M1 and M2 did not differ significantly within the first 24 hours and were significantly lower than those in group M0. Nausea and vomiting were observed more frequently 4 hours postoperatively in M2 than in groups M1 and M0 (77%, 51%, and 6%, respectively; P < .05), which required second-line antiemetic administration (29%, 9%, and 13%, respectively; P = .09).ConclusionPostoperative pain control achieved with PI combined with ITM 0.1 mg after primary unilateral TKA was comparable to that achieved with ITM 0.2 mg. PI without ITM resulted in higher pain scores and rescue analgesic consumption. The frequency and severity of nausea and vomiting 4 hours postoperatively were also lower in patients administered 0.1 mg of ITM than those in patients administered 0.2 mg of ITM.

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.

Relative Contributions of Intraoperative Low Dose Ketamine, Lidocaine and Ketamine-Lidocaine Combination in Addition to Intrathecal Morphine for Postoperative Analgesia in Open Liver Resection: A Prospective, Randomized, Four-Arm, Triple Blind, Placebo-Controlled Trial

Background and Aims: Open liver resection requiring an upper abdominal incision is associated with significant opioid use due to postoperative pain. We tested the hypothesis that the intraoperative combination of low dose lidocaine and ketamine would reduce opioid consumption when given in conjunction with intrathecal morphine for liver resection surgery. Methods: In this triple blind, parallel group four-arm placebo-controlled trial, we randomized 124 adult ASA 2 - 4 liver resection patients to receive intraoperative lidocaine 0.33 mg/kg/h (group L), ketamine 70 μg/kg/h (group K), combination of lidocaine 0.33 mg/kg/h and ketamine 70 μg/kg/h (group KL) and saline (group P). All patients received 300 μg intrathecal morphine prior to induction of anesthesia. All infusions were started immediately after intubation and continued until the end of surgery. Primary outcome measurements included opioid consumption at 24-hours. Secondary outcomes included pain scores, opioid consumption at 48 and 72-hours and side effects including nausea, vomiting, dizziness, hallucinations, headaches and signs of local anaesthetic toxicity. Patients were followed up for 12 weeks. Results: There was no difference in the primary outcome of opioid consumption within all 4 groups at rest or movement at 24-hours. Secondary outcome of 48-hour rest pain score was significantly higher in the L group (p = 0.03) but without any difference in opioid use. There was no difference in any other outcomes between the groups at any time points. Conclusions: Low dose lidocaine and its combination with ketamine did not add any analgesic/morphine sparing benefit in the presence of single dose intrathecal morphine in patients with major liver resection.

Impact of patient choice for different postcesarean delivery analgesic protocols on opioid consumption: a randomized prospective clinical trial

BackgroundChoice of postcesarean delivery analgesic protocol may improve pain experience and reduce analgesic requirements.MethodsCesarean delivery patients were randomly assigned either to choose their postcesarean delivery analgesia protocol or to have...

(281) Does Intravenous Nalbuphine Decrease Urinary Retention Caused by Intrathecal Morphine? A Randomized Controlled Trial

Opioids are commonly used as analgesics during the perioperative period . Morphine is the standard opioid analgesic for pain control, however many patients may shift to an alternative opioid because of its intolerable adverse effects. 60 Patients randomly allocated as follows: group 1: received standard intrathecal dose of 2.5 ml of 0.5% bupivacaine in 8% dextrose and intravenous 0.9% saline solution (placebo),3ml every 6 hours for 24 hours group 2: received 0.15 mg of intrathecal morphine plus standard intrathecal dose of 2.5 ml of 0.5% bupivacaine in 8% dextrose and intravenous 0.9% saline solution (placebo), 3ml every 6 hours for 24 hours . group 3: received 0.15 mg of intrathecal morphine plus standard intrathecal dose of 2.5 ml of 0.5% bupivacaine in 8% dextrose and intravenous nalbuphine, 3mg every 6 hours for 24 hours. Groups 2 and 3 had significantly more itching and vomiting than group 1 (p . value 0.001). Groups 2 and 3 did not differ from group 1 in urinary retention, sedation and respiratory depression. Groups 2 and 3 had better analgesia and satisfaction than group 1 (p. value 0.001). Groups 2 and 3 did not differ regarding pain, itching, vomiting, urinary retention, sedation and respiratory depression. Group 3 had better satisfaction when compared to group 2 (p-value

Three Different Doses of Intrathecal Morphine as Part of a Multimodal Regimen for Post-Cesarean Delivery Analgesia: A Randomized Double-Blinded Trial

Brazil is one of the countries that carry out cesarean delivery in the world. The pain after cesarean delivery (CD) is one of the main concerns of parturient. Intrathecal Morphine (ITM) is widely used for the treatment of pain after CD; however, the optimal dose with minimal side effects is to be established. Objectives: To compare the analgesia and side effects resulted by three different doses of ITM as part of a multimodal regimen for post-cesarean delivery analgesia. Methods: One hundred ninety-four patients were sampled in this randomized, double-blinded, three-arm study (group 0.075: ITM 0.75 mg; group 0.1: ITM 0.1 mg and group 0.15: ITM 0.15 mg). All patients received intravenous dexamethasone, dipyrone and ketoprofen. The primary endpoint was pain intensity measured at rest and on movement, while the secondary endpoint was overall satisfaction with pain relief, the incidence of nausea and vomiting, intensity of pruritus, and the use of additional tramadol, antipruritic and antiemetic use within 24 hours after postoperation. Results: The three groups showed similar pain intensity at rest and on movement. The pain intensity on movement was significantly higher than at rest in the groups (p < 0.001). There were no significant differences among the groups regarding secondary endpoint. Conclusions: Our findings suggest that in cases of an elective CD, 0.075 mg of ITM produces postoperative analgesia of similar quality that provided by 0.1 or 0.15 mg ITM. The patients should have a multimodal analgesia approach that includes: ITM, anti-inflammatory agents and access to additional systemic analgesic if necessary.

Transcutaneous Carbon Dioxide Measurements in Women Receiving Intrathecal Morphine for Cesarean Delivery: A Prospective Observational Study

(Anesth Analg. 2017;124(3):872–878) Neuraxial morphine, which is commonly used after cesarean delivery, has a favorable safety profile with a reported incidence of respiratory depression of only 0.07% to 0.9%. However, there is no standard definition of respiratory depression. The most sensitive measure may be hypercapnia (threshold of 50 mm Hg), which can be measured using the noninvasive, transcutaneous Topological Oscillation Search with Kinematical Analysis (TOSCA) monitor, which estimates arterial carbon dioxide levels (TcCO2). Thus, the authors of the present study estimated the incidence of respiratory depression as defined by hypercapnia events (TcCO2 &gt;50 mm Hg for ≥2 min) using the TOSCA monitor in women receiving 150 μg intrathecal morphine for postcesarean analgesia.

Randomized Study of Postcesarean Analgesia With Intrathecal Morphine Alone or Combined With Clonidine

(J Clin Anesth. 2016;33:395–402) Intrathecal morphine provides long-lasting pain relief after cesarean deliveries but can be difficult to dose properly (range is 25 to 500 μg). It is possible that the concomitant use of clonidine, an alpha-2-adrenoceptor agonist, with morphine may help to improve the quality of analgesia and reduce opioid consumption and side effects. Therefore, the authors of the present study compared the efficacy of 50 μg intrathecal morphine combined with 75 μg clonidine to the efficacy of 50 μg or 100 μg intrathecal morphine alone for postcesarean analgesia.

Transcutaneous Carbon Dioxide Measurements in Women Receiving Intrathecal Morphine for Cesarean Delivery: A Prospective Observational Study

Neuraxial morphine is the most commonly used analgesic technique after cesarean delivery. The incidence of respiratory depression is reported to be very low (0%-1.2%) in this patient population as measured by pulse oximetry and respiratory rates. However, hypercapnia may be a more sensitive measure of respiratory depression. In the current study, the incidence of hypercapnia events (transcutaneous CO2 [TcCO2] >50 mm Hg) for ≥2-minute duration was evaluated using the Topological Oscillation Search with Kinematical Analysis monitor in women who received intrathecal morphine for postcesarean delivery analgesia. Healthy women (>37 weeks of gestation) scheduled for a cesarean delivery with spinal anesthesia with intrathecal morphine were recruited. Baseline STOP-BANG sleep apnea questionnaire and TcCO2 readings were obtained. Spinal anesthesia was initiated with 12 mg hyperbaric bupivacaine, 15 µg fentanyl, and 150 µg morphine. The Topological Oscillation Search with Kinematical Analysis monitor was reapplied in the postanesthesia care unit and TcCO2 measurements obtained for up to 24 hours. Supplemental opioid administration and adverse respiratory events were recorded. The primary outcome was the incidence of hypercapnia events, defined as a TcCO2 reading >50 mm Hg for ≥2 minutes in the first 24 hours after delivery. Of the 120 women who were recruited, 108 completed the study. Thirty-five women (32%; 99.15% confidence interval, 21%-45%) reached the primary outcome of a sustained hypercapnia event. The median time (interquartile range [IQR]) from intrathecal morphine administration to the hypercapnia event was 300 (124-691) minutes. The median (IQR) number of events was 3 (1-6) and longest duration of an event was 25.6 (8.4-98.7) minutes. Baseline median (IQR) TcCO2 measurements were 35 (30-0) mm Hg and postoperatively, median (IQR) TcCO2 measurements were 40 (36-43) mm Hg, a difference of 5 mm Hg (99.15% confidence interval of the difference 2-8 mm Hg, P < .001). The incidence of hypercapnia events was 5.4% in women with a baseline TcCO2 value ≤31 mm Hg, 22.5% with a baseline TcCO2 between 32 and 38 mm Hg, and 77.4% with a baseline TcCO2 >38 mm Hg (P < .001). Hypercapnia events (>50 mm Hg for ≥2-minute duration) occurred frequently in women receiving 150 μg intrathecal morphine for postcesarean analgesia. Higher baseline TcCO2 readings were observed in women who had hypercapnia events.

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

Efficacy of intrathecal morphine combined with intravenous analgesia versus thoracic epidural analgesia after gastrectomy.

PurposeEpidural analgesia has been the preferred analgesic technique after major abdominal surgery. On the other hand, the combined use of intrathecal morphine (ITM) and intravenous patient controlled analgesia (IVPCA) has been shown to be a viable alternative approach for analgesia. We hypothesized that ITM combined with IVPCA is as effective as patient controlled thoracic epidural analgesia (PCTEA) with respect to postoperative pain control after conventional open gastrectomy.Materials and MethodsSixty-four patients undergoing conventional open gastrectomy due to gastric cancer were randomly allocated into the intrathecal morphine combined with intravenous patient-controlled analgesia (IT) group or patient-controlled thoracic epidural analgesia (EP) group. The IT group received preoperative 0.3 mg of ITM, followed by postoperative IVPCA. The EP group preoperatively underwent epidural catheterization, followed by postoperative PCTEA. Visual analog scale (VAS) scores were assessed until 48 hrs after surgery. Adverse effects related to analgesia, profiles associated with recovery from surgery, and postoperative complications within 30 days after surgery were also evaluated.ResultsThis study failed to demonstrate the non-inferiority of ITM-IVPCA (n=29) to PCTEA (n=30) with respect to VAS 24 hrs after surgery. Furthermore, the IT group consumed more fentanyl than the EP group did (1247.2±263.7 µg vs. 1048.9±71.7 µg, p<0.001). The IT group took a longer time to ambulate than the EP group (p=0.021) and had higher incidences of postoperative ileus (p=0.012) and pulmonary complications (p=0.05) compared with the EP group.ConclusionITM-IVPCA is not as effective as PCTEA in patients undergoing gastrectomy, with respect to pain control, ambulation, postoperative ileus and pulmonary complications.

Pre-emptif uygulanan intravenöz, spinal ve epidural morfinin erken postoperatif analjezi ve stres yanıt üzerine etkileri

In this study, it was aimed to determine the effects of preemptive intravenous, spinal and epidural morphine on analgesic consumption, and stress response in the early postoperative period. Sixty ASA I-II patients who were undergoing lower abdominal surgery were randomly divided into three groups. Group I patients were admisnistered 5 mg iv morphine 5 minutes before induction, Grup II patients were administered 0.5 mg of intrathecal morphine 5 minutes before induction, Group III patients were administered 5 mg epidural morphine 30 min before induction of anesthesia. Induction of anesthesia, was performed with 0.1 mg kg fentanyl and 4-7 mg kgthiopental sodium. For muscle relaxation 0.1 mg kg vecuronium were given. Anaesthesia was maintained with 1-2% sevoflurane and 50% NO. Pre and postoperative hemodynamic parameters, VAS (Visual Analog Pain Scale) scores, time to first analgesic requirement, total analgesic consumption were recorded. In addition, to evaluate the stress response blood samples were taken three times before the administration of preoperative medications, preoperative 30th minute, and postoperative and 2nd hour. In our study, postoperative VAS scores between groups was significantly different at all times for the iv group and the spinal group and iv group and epidural group (P<0.05). In terms of time to first analgesic requirement, total analgesic consumption of group iv and iv with a group of spinal epidural group and the difference between groups was significant (P<0.05). Operative in terms of prolactin and ACTH between groups was significantly different at all times for the iv group and the spinal group and iv group and epidural group (P<0.05). Cortisol, glucose, and insulin levels postoperatively for 2. hour intravenous group and the spinal epidural group and iv group and the difference between groups was significant (P<0.05). As a result of preemptive spinal and epidural morphine in relieving postoperative pain and suppress the stress response was found to be effective in group iv.

Analgesia after Cesarean delivery: a retrospective comparison of intrathecal hydromorphone and morphine

Study ObjectiveTo compare analgesia and opioid-related side effects of intrathecal morphine and intrathecal hydromorphone after elective Cesarean delivery. DesignRetrospective, comparative study. SettingLabor and delivery unit of an academic hospital. Patients114 parturients age ≥ 18 years, presenting for elective Cesarean delivery. InterventionsPatients who received 0.04 mg intrathecal hydromorphone were compared to a random sample of patients who received 0.1 mg intrathecal morphine for postoperative analgesia. MeasurementsThe primary outcome was the presence of any opioid-related complication (pruritus, nausea or vomiting, respiratory depression) requiring treatment within 24 hours of intrathecal opioid administration. Secondary outcomes included total opioid consumption (in oral morphine equivalents) within 24 hours of intrathecal opioid administration and verbal pain score (0 = none, 10 = worst) at 4, 8, 12, 18, and 24 hours after intrathecal opioid administration. Main Results38 patients who received intrathecal hydromorphone 0.04 mg were compared with 76 patients given 0.1 mg of intrathecal morphine for elective Cesarean delivery. No significant differences in demographics were noted between groups. There were no statistically significant differences between the intrathecal hydromorphone and intrathecal morphine groups in overall frequency of opioid-related complications (50% vs 34.2%; P = 0.11), 24-hour opioid consumption (33 mg oral morphine equivalent [OME] vs 8 mg OME; P = 0.27), or pain scores at any time point up to 24 hours. ConclusionsOverall, analgesia and incidence of opioid-related side effects after 0.04 mg of intrathecal hydromorphone did not differ statistically from 0.1 mg of intrathecal morphine.

Effect of coadministration of dexamethasone with intrathecal morphine on postoperative outcomes after cesarean delivery

Objective To investigate the effect of intrathecal dexamethasone administered with intrathecal morphine at cesarean delivery on postoperative adverse effects and patient satisfaction. Methods A triple-blind, randomized, placebo-controlled trial conducted between February 2008 and December 2009 of 120 pregnant women scheduled to undergo cesarean delivery. The patients were randomized into 2 groups: group 1 received 0.2 mg of intrathecal morphine plus 8 mg of intrathecal dexamethasone, while group 2 received 0.2 mg of intrathecal morphine plus 0.9% saline solution (placebo). The occurrence of postoperative nausea and vomiting (PONV), postoperative itching, number of vomiting attacks, and need for antiemetics were recorded in both groups. Overall patient satisfaction was also recorded. Results PONV was 3 times less likely to occur in the dexamethasone group than in the placebo group. When vomiting did occur, the number of attacks was lower in the dexamethasone group (23 vs 87 attacks; OR 0.26, 95% CI, 0.18–0.39). Administration of antiemetics was markedly lower in the dexamethasone group (18 vs 49 shots; OR 0.10, 95% CI, 0.04–0.23) and less postoperative itching was experienced (OR 0.39; 95% CI, 0.19–0.81). The dexamethasone group reported significantly higher mean overall satisfaction scores (77 ± 17 vs 51 ± 22; mean difference 26.00; 95% CI, 18.97–33.03). Conclusion Intrathecal administration of dexamethasone with morphine significantly decreased PONV and improved overall patient satisfaction after cesarean delivery.

Comparison of spinal anesthesia with general anesthesia on morphine requirement after abdominal hysterectomy

The aim of this study was to compare morphine consumption with patient-controlled analgesia (PCA) between spinal anesthesia (SA) (bupivacaine, morphine and fentanyl) and general anesthesia (GA) (sufentanil) after an abdominal hysterectomy. Forty women were randomly assigned to receive SA with bupivacaine 15 mg, 0.15 mg of intrathecal morphine and 15 microg of fentanyl or GA with sufentanil, both combined with PCA. The primary outcome was morphine consumption with the PCA device. The secondary outcomes were post-operative pain at rest and under stress on a visual analog scale, nausea, pruritus and respiratory depression on a standardized scale. Outcome measures were recorded at 6, 12, 18, 24 and 48 h post-anesthesia. The duration of post-anesthesia care unit (PACU) and hospital stay were recorded. Patients in the SA group consumed at least two times less morphine at each time interval than the GA group: at 48 h, they used 19 +/- 17 vs. 81 +/- 31 mg (P<0.0001). Post-operative pain at rest was lower in the SA group until the 18th hour and under stress until the 48th. There was more sedation in the GA group until the 18th hour. Little difference was observed in the incidence of pruritus. Nausea was more intense at the 6th hour in the GA group. There was no difference in the respiratory rate. The duration of PACU stay was shorter for the SA group (52 +/- 9 vs. 73 +/- 11 min, P<0.0001) as was the duration of hospital stay (2.2 +/- 0.4 vs. 3.3 +/- 0.7 days, P=0.01). It is concluded that intrathecal morphine 0.15 mg with 15 microg of fentanyl decreases post-operative pain and morphine consumption by PCA without increasing adverse reactions for women undergoing an abdominal hysterectomy.

Ultra Low‐Dose Naloxone and Tramadol/Acetaminophen in Elderly Patients Undergoing Joint Replacement Surgery: A Pilot Study

A pilot study was conducted to assess whether both the rationale and feasibility exist for future randomized clinical trials to evaluate the combined use of naloxone infusion and tramadol/acetaminophen as opioid-sparing drugs in elderly patients undergoing lower extremity joint replacement surgery. Ten patients 70 years of age or older undergoing either total knee (n=7) or total hip (n=3) arthroplasty were treated prospectively. Each patient received two tablets of tramadol/acetaminophen (Tramacet; Janssen-Ortho Inc, Canada) preoperatively and every 6 h postoperatively, as well as a naloxone infusion started preoperatively at 0.25 microg/kg/h and continued up to 48 h postoperatively. In addition, standard intraoperative care was provided with 0.2 mg of intrathecal morphine, 1.4 mL of 0.75% bupivacaine, and an intra-articular infiltration of 100 mL of 0.3% ropivacaine and 30 mg of ketorolac, as well as standard postoperative morphine via patient-controlled analgesia orders and celecoxib 200 mg twice daily for five days. Compared with seven historical controls, also 70 years of age or older, who had undergone either a total knee (n=4) or total hip (n=3) arthroplasty, postoperative opioid use was reduced by 80%. Except for transient nausea and vomiting in 40% and 20% of patients, respectively, the 10 patients on tramadol/acetaminophen and naloxone tolerated the new regimen without difficulty. Consequently, a randomized, double-blinded clinical trial comparing standard therapy versus standard therapy plus these two drugs seems warranted. In such a trial, it would require approximately 20 subjects per treatment arm to detect a 80% decrease in morphine use.

Priapism as a Complication after Total Hip Arthroplasty: A Case Report and Review of the Literature

Priapism is defined as a prolonged engorgement or erection of the penis or clitoris that is unrelated to sexual arousal. Recent studies have determined the incidence of priapism to be between 1.5 and 2.9 per 100,000 person years. The incidence of priapism following elective orthopedic surgery is rare. Defining the etiology of a case of postoperative priapism following orthopedic surgery can be difficult, and many times cannot be determined. This case represents the first report of priapism following an elective total hip arthroplasty (THA) performed under spinal anesthesia, and focuses on a review of the literature and potential etiologies of this rare complication. A 44-year-old man with a history of right hip osteoarthritis underwent elective minimally invasive cementless right THA under spinal anesthesia (1 mg of Intrathecal Morphine and 100 mg of intravenous Fentanyl) without initial complication. A preoperative Foley catheter was placed without incident and the patient was placed into the left lateral decubitus position. Surgical time was recorded at 60 minutes. Nine hours after the Foley catheter was removed, the patient developed a persistent painless erection. Successful emergent treatment included a penile Winter shunt, to irrigate blood from the corpora. A computed tomography scan of the pelvis ruled out pelvic deep vein thrombosis as an etiology. This case represents the first report of priapism after an elective THA. The incidence of priapism as a complication is well described and has been associated with numerous medical conditions discussed in this article.

Intrathecal Morphine for Analgesia After Postpartum Bilateral Tubal Ligation

Postpartum bilateral tubal ligation (PPBTL) causes postoperative pain. We designed this study to determine the efficacy of 50 microg intrathecal morphine for analgesia after PPBTL. Sixty-five women received spinal anesthesia with 12.75 mg hyperbaric bupivacaine, 20 microg of fentanyl, and either 50 microg of morphine (morphine group) or 0.05 mL of saline (control group). Postoperative analgesia was provided with regular naproxen 500 mg and oxycodone 5 mg/acetaminophen 325 mg mixture as needed. Overall, satisfaction was higher (P=0.003) and pain was less intense at rest (P=0.008) and on movement (P <0.0001) in the morphine group. There was no significant overall difference in nausea, pruritus, or sedation scores, but vomiting occurred more frequently in the morphine group (21.4% versus 3.5%; P=0.052). In post hoc comparisons, pain at rest within the morphine group was significantly less at 4 h (P=0.006), pain on movement was significantly less at 4 h (P=0.002) and 12 h (P=0.0004), and pruritus was significantly more frequent at 12 h (P=0.002) compared with the control group. Oxycodone 5 mg/acetaminophen 325 mg mixture consumption was significantly smaller (P=0.006) and the time to first request of analgesia was significantly longer (P=0.006) in the morphine group. We conclude that the addition of 50 microg of morphine to intrathecal hyperbaric bupivacaine and fentanyl provides improved postoperative analgesia in women undergoing PPBTL.