Efficacy of intrathecal morphine with fentanyl and hyperbaric bupivacaine in subarachnoid block for unilateral total knee arthroplasty
Ganga Prasad, Gopikrishnan A, MK Arora, Lokesh Kashyap and CS Yadav
All India Institute of medical sciences, India
: J Surg Clin Pract
Abstract
Present study investigated the effect of combination of fentanyl and morphine given intrathecally for reducing postoperative pain in total knee arthroplasty. Forty patients were randomly divided into 2 groups. In group FM (n=20), 12.5mg of hyperbaric bupivacaine [2.5 ml of 0.5%] + 25μg of fentanyl [0.5 ml] + 300μg of μg of preservative free morphine [0.1 ml] were given and in other group FN (n=20) 12.5 mg of hyperbaric bupivacaine [2.5 ml of 0.5%] + 25μg of fentanyl [0.5 ml] + normal saline [0.1 ml] were given in spinal anaesthesia. At the end of surgical procedure, PCA morphine was initiated, rescue morphine boluses given for postoperative analgesia. Both the groups were compared for duration of analgesia, VAS score, total morphine consumption in 24 hrs and side effects. The duration of analgesia was defined as time from intrathecal injection to 1st activation of PCA pump. The mean duration of analgesia was significantly longer in Group FM (242.25±113.12) min than Group FN (160.75±47.27) min, (p=0.0000). The 1st 24 hour period postoperative morphine consumption was significantly decreased in Group FM (17.45±7.61) mg than Group FN (39.35±10.75)mg. (p-0.000). There was no significant difference between the incidences of side effects between the 2 groups. Neuraxial opioid induced respiratory depression was seen in 1 patient in Group FM who required treatment with oxygen supplementation and intravenous naloxone. We concluded that the combination of opioids has prolonged the duration of postoperative analgesia and reduced the total postoperative morphine consumption in TKR patients.
Biography
Ganga Prasad has completed his MD degree in anaesthesiology in 1989 from University of Allahabad. He joined All India Institute of medical sciences, New Delhi, India as Assistant professor and professor at present. His area of interest in pediatric and regional anaesthesia. He published about 20 papers in various national and international journals.
E-mail: drgpd@yahoo.com
