Intrathecal bupivacaine with morphine or neostigmine for postoperative analgesia after total knee replacement surgery

  • Ping-Heng TanEmail author
  • Yuan-Yi Chia
  • Yuan Lo
  • Kang Liu
  • Lin-Cheng Yang
  • Tsung-Hsing Lee
Regional Anesthesia and Pain



To compare the postoperative analgesic efficacy and safety of intrathecal (IT) néostigmine and IT morphine in patients undergoing total knee replacement under spinal anesthesia. Methods: Sixty patients scheduled for elective total knee replacement under spinal anesthesia were randomly divided into three equal groups which received IT 0.5% hyperbaric bupivacaine 15 mg with either normal saline 0.5 ml_, néostigmine 50 μg, or morphine 300μg. The maximal level of sensory block, duration of analgesia, time to use of rescue analgesics, the overall 24-hr and four-hour interval visual analogue scale (VAS) pain score, and the incidence of adverse effects were recorded for 24 hr after administration.


There was no significant difference in maximal level of sensory block among the three groups. The morphine group had a later onset of postsurgical pain and longer time to first rescue analgesics than the néostigmine group (P < 0.05). Overall 24-hr VAS pain scores were significantly higher in the saline groupvs the morphine and néostigmine groups (P < 0.05). Motor block lasted significantly longer in the néostigmine group than in the morphine and saline groups (P < 0.05). The incidence of adverse effects was similar in the néostigmine and morphine groups except for pruritus (70%) occurring more frequently in the morphine group than in the néostigmine and saline groups (0%; P < 0.05). Overall satisfaction rates were better in the néostigmine group than in the morphine and saline groups (P < 0.05).


IT néostigmine 50 μg produced postoperative analgesia lasting about seven hours with fewer side effects and better satisfaction ratings than IT morphine 300 μg.


Morphine Spinal Anesthesia Total Knee Replacement Neostigmine Postoperative Analgesia 
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L’administration intrathécale de bupivacaïne avec morphine ou néostigmine comme analgésie postopératoire suivant la mise en place d’une prothèse totale de genou



Comparer l’efficacité et l’innocuité analgésique postopératoire de l’administration intrathécale (IT) de néostigmine et de morphine chez des patients devant subir une arthroplastie totale du genou sous rachianesthésie.


Soixante patients devant recevoir une prothèse totale de genou sous rachianesthésie ont été répartis au hasard en trois groupes égaux. Ils ont reçu 15 mg de bupivacaine hyperbare IT à 0,5 % et, soit 0,5 mL de solution salée, soit 50 μg de néostigmine, soit 300 μg de morphine. Le niveau maximal du bloc sensitif, la durée de l’analgésie, l’heure des premières demandes d’analgésiques de secours, les scores de douleur des 24 h d’observation et de chaque intervalle de quatre heures selon l’échelle visuelle analogique (EVA) et l’incidence d’effets indésirables ont été enregistrés pendant 24 h après l’administration médicamenteuse.


Le niveau maximal de blocage sensitif n’a pas présenté de différence intergroupe significative. Chez les patients avec morphine, la douleur post-chirurgicale s’est installée plus tard et leur première demande d’analgésie de secours a donc eu lieu plus tard que chez les patients avec néostigmine (P < 0,05). Les scores de douleur à l’EVA ont été, sur 24 h, signifcativement plus élevés avec la solution salée vs la morphine ou la néostigmine (P < 0,05). La durée du blocage moteur a été signifcativement plus longue avec la néostigmine qu’avec la morphine ou la solution salée (P < 0,05). L’incidence d’effets indésirables a été similaire avec la néostigmine et la morphine, sauf pour le prurit (70%) qui a été plus fréquent avec la morphine qu’avec la néostigmine ou la solution salée (0 %; P < 0,05). Le taux de satisfaction générale a été meilleur avec la néostigmine qu’avec la morphine ou la solution salée (P < 0,05).


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Copyright information

© Canadian Anesthesiologists 2001

Authors and Affiliations

  • Ping-Heng Tan
    • 1
    Email author
  • Yuan-Yi Chia
    • 2
  • Yuan Lo
    • 2
  • Kang Liu
    • 2
  • Lin-Cheng Yang
    • 1
  • Tsung-Hsing Lee
    • 1
  1. 1.Department of AnesthesiaChang-Gung Memorial HospitalKaohsiung
  2. 2.Department of Anesthesia, Veterans General Hospital-KaohsiungNational Yang-Ming University School of MedicineTaiwan, Republic of China

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