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

Citation
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
ISSN journal
0832-610X → ACNP
Volume
48
Issue
6
Year of publication
2001
Pages
551 - 556
Database
ISI
SICI code
0832-610X(200106)48:6<551:IBWMON>2.0.ZU;2-1
Abstract
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.