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

  • Shane R. HessEmail author
  • Laura A. Lahaye
  • Andrew C. Waligora
  • Adam P. Sima
  • William A. Jiranek
  • Gregory J. Golladay
Original Article • KNEE- ARTHROPLASTY
  • 154 Downloads

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.

Keywords

Intrathecal morphine Neuraxial Anesthesia Spinal Arthroplasty Hip Knee 

Notes

Compliance with ethical standards

Conflicts of interest

Shane R. Hess, Laura A. Lahaye, Andrew C. Waligora, and Adam P. Sima have no conflicts of interest. William A. Jiranek discloses he is a paid consultant, receives royalties, had has stock with DePuy Synthes, and receives research support from DePuy Synthes and Stryker. Gregory J. Golladay discloses he is a paid consultant for OrthoSensor Inc., receives royalties and research support, has stock, and gives paid presentations for OrthoSensor Inc.; he is the deputy editor for Arthroplasty Today, on the editorial board for Journal of Arthroplasty, and is the publications committee chair for AAHKS.

References

  1. 1.
    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 CrossRefGoogle Scholar
  2. 2.
    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 CrossRefGoogle Scholar
  3. 3.
    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 60:449–452CrossRefGoogle Scholar
  4. 4.
    Brill S, Gurman GM, Fisher A (2003) A history of neuraxial administration of local analgesics and opioids. Eur J Anaesthesiol 20:682–689CrossRefGoogle Scholar
  5. 5.
    Wang J, Nauss L, Thomas J (1979) Pain relief by intrathecally applied morphine in man. Anesthesiology 50:149–151CrossRefGoogle Scholar
  6. 6.
    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 CrossRefGoogle Scholar
  7. 7.
    Samii K, Chauvin M, Viars P (1981) Postoperative spinal analgesia with morphine. Br J Anaesth 53:817–820CrossRefGoogle Scholar
  8. 8.
    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 56:837–841CrossRefGoogle Scholar
  9. 9.
    Davis I (1987) Intrathecal morphine in aortic aneurysm surgery. Anaesthesia 42:491–497CrossRefGoogle Scholar
  10. 10.
    Palmer C, Emerson S, Volgoropolous D, Alves D (1999) Dose-response relationship of intrathecal morphine for postcesarean analgesia. Anesthesiology 90:437–444CrossRefGoogle Scholar
  11. 11.
    Bengtsson M, Lofstrom J, Merits H (1983) Postoperative pain relief with intrathecal morphine after major hip surgery. Reg Anesth 8:140–143Google Scholar
  12. 12.
    Kalso E (1983) Effects of ITMS, injected with bupivacaine, on pain after orthopaedic surgery. Br J Anaesth 55:415–421CrossRefGoogle Scholar
  13. 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 85:233–237CrossRefGoogle Scholar
  14. 14.
    Jacobson L, Chabal C, Brody M (1988) A dose-response study of intrathecal morphine: efficacy, duration, optimal dose, and side effects. Anesth Analg 67:1082–1088CrossRefGoogle Scholar
  15. 15.
    Goodarzi M, Narasimhan R (2001) The effect of large-dose intrathecal opioids on the autonomic nervous system. Anesth Analg 93:456–459Google Scholar
  16. 16.
    Lydon A, Cooke T, Duggan F, Shorten G (1999) Delayed postoperative gastric emptying following intrathecal morphine and intrathecal bupivacaine. Can J Anesth 46:544–549CrossRefGoogle Scholar
  17. 17.
    Carpenter R, Caplan R, Brown D et al (1992) Incidence and risk factors for side effects of spinal anaesthesia. Anesthesiology 76:906–916CrossRefGoogle Scholar
  18. 18.
    Slappendel R, Weber E, Benraad B et al (2000) Itching after intrathecal morphine. Incidence and treatment. Eur J Anaesthesiol 17:616–621CrossRefGoogle Scholar
  19. 19.
    Clergue F, Montembault C, Despierres O et al (1984) Respiratory effects of intrathecal morphine after upper abdominal surgery. Anesthesiology 61:677–685CrossRefGoogle Scholar
  20. 20.
    Glass P (1984) Respiratory depression following only 0.4 mg of intrathecal morphine. Anesthesiology 60:256–257CrossRefGoogle Scholar
  21. 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 CrossRefGoogle Scholar
  22. 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 CrossRefGoogle Scholar
  23. 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 CrossRefGoogle Scholar
  24. 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 88:599–604Google Scholar
  25. 25.
    Sinclair DR, Chung F, Mezei G (1999) Can postoperative nausea and vomiting be predicted? Anesthesiology 91:109–118CrossRefGoogle Scholar
  26. 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 Google Scholar
  27. 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 CrossRefGoogle Scholar
  28. 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 CrossRefGoogle Scholar
  29. 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 Google Scholar
  30. 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 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Shane R. Hess
    • 1
    Email author
  • Laura A. Lahaye
    • 2
  • Andrew C. Waligora
    • 3
  • Adam P. Sima
    • 4
  • William A. Jiranek
    • 5
  • Gregory J. Golladay
    • 6
  1. 1.Department of Orthopedics, Center for Orthopedic Research and EducationThe CORE InstitutePhoenixUSA
  2. 2.Department of AnesthesiologyVirginia Commonwealth UniversityRichmondUSA
  3. 3.Greater Pittsburgh Orthopaedic AssociatesPittsburghUSA
  4. 4.Department of BiostatisticsVirginia Commonwealth UniversityRichmondUSA
  5. 5.Duke University Medical CenterDurhamUSA
  6. 6.Department of Orthopaedic SurgeryVirginia Commonwealth University Medical CenterRichmondUSA

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