Ph. Tan et al., Intrathecal bupivacaine with morphine or neostigmine for postoperative analgesia after total knee replacement surgery, CAN J ANAES, 48(6), 2001, pp. 551-556
Citations number
22
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Journal title
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE
Purpose: To compare the postoperative analgesic efficacy and safety of intr
athecal (IT) neostigmine 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 rece
ived IT 0.5% hyperbaric bupivacaine 15 mg with either normal saline 0.5 mL,
neostigmine 50 mug, or morphine 300 mug The maximal level of sensory block
, duration of analgesia, time to use of rescue analgesia, the overall 24-hr
and four-hour interval visual analogue scale (VAS) pain score, and the inc
idence of adverse effects were recorded for 24 hr after administration.
Results: There was no significant difference in maximal level of sensory bl
ock among the three groups. The morphine group had a later onset of postsur
gical pain and longer time to first rescue analgesics than the neostigmine
group (P <0.05). Overall 24-hr VAS pain scores were significantly higher in
the saline group vs the morphine and neostigmine groups (P <0.05). Motor b
lock lasted significantly longer in the neostigmine group than in the morph
ine and saline groups (P <0.05). The incidence of adverse effects was simil
ar in the neostigmine and morphine groups except for pruritus (70%) occurri
ng more frequently in the morphine group than in the neostigmine and saline
groups (0%; P <0.05). Overall satisfaction rates were better in the neosti
gmine group than in the morphine and saline groups (P <0.05).
Conclusions: IT neostigmine 50 mug produced postoperative analgesia lasting
about seven hours with fewer side effects and better satisfaction ratings
than IT morphine 300 mug.