The Dose Comparison of Intrathecal Morphine for Postoperative Analgesia in Total Knee Arthroplasty Under Spinal Anesthesia: A Single Institute Retrospective Study
Background and purpose of the study Intrathecal morphine (ITM) provides effective postoperative analgesia in patients undergoing total knee arthroplasty (TKA) under spinal anesthesia. However, the ideal dose at which maximal analgesic effects can be delivered with minimal side effects is not clearly...
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| description | Background and purpose of the study Intrathecal morphine (ITM) provides effective postoperative analgesia in patients undergoing total knee arthroplasty (TKA) under spinal anesthesia. However, the ideal dose at which maximal analgesic effects can be delivered with minimal side effects is not clearly known. This retrospective study is aimed to compare two different doses of ITM with respect to analgesia benefits and side effects. Methods This is a retrospective, descriptive, single-center study approved by the Institutional Review Board (IRB) at the University of Alabama at Birmingham. Three patient groups were selected: a control group receiving continuous adductor canal block (CCACB) under spinal anesthesia, and two experimental groups receiving single-dose adductor canal block (SSACB) under spinal anesthesia with either 100 mcg or 150 mcg of ITM. The sample size included 75 patients (25 per group) who were 18 years and older, American Society of Anesthesiology (ASA) class 1-3 who were undergoing primary TKA. Patients with chronic pain or opioid use exceeding 30 days and those undergoing surgeries other than primary TKA were excluded. Outcome data, including opioid use (from which post-operative oral morphine equivalents (OME) were calculated), antiemetic use, visual analog pain scale (VAS) scores, distance ambulated at 24 hours, and length of hospital stay, were extracted by chart review. Results In the post-anesthesia care unit (PACU), patients in both ITM groups experienced significantly lower opioid consumption and pain scores compared to the control group (p |
| doi_str_mv | 10.7759/cureus.49350 |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10749179</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2908068321</sourcerecordid><originalsourceid>FETCH-LOGICAL-c343t-fba08094922002bc2af1f6f789ed6660ee8ef8b079371db45576053a3c9764723</originalsourceid><addsrcrecordid>eNpdks1u1DAUhS0EotXQHWtkiQ0LpvgniW02aDRAW7UIxEzXlpPcTFxl7NR2Ks3r8KS4M6VqWdny_e6x7_FB6C0lp0KU6lMzBZjiaaF4SV6gY0YrOZdUFi-f7I_QSYw3hBBKBCOCvEZHXNKCl0odoz_rHvBXHwEv_XY0wUbvsO_whUvBpB4aM-AfPoy9dYA7H_AvH5MfIRftHeCFM8MGojXYOrz2KdOXDvJ5SH3w42Bi2uFr10LAq9FmOHdAzLq55TNe4JV1mwHybTHZNCXAvyEFH0do9vKrNLW7N-hVZ4YIJw_rDF1__7Zens-vfp5dLBdX84YXPM272hBJVKEYI4TVDTMd7apOSAVtVVUEQEInayIUF7Sti7IUFSm54Y0SVSEYn6EvB91xqrfQNnBvwaDHYLcm7LQ3Vj-vONvrjb_T2ddC0aw7Qx8eFIK_nfKcemtjA8NgHPgpaqZIKSQTVGb0_X_ojZ9CNmhPSVJJzmimPh6oJpsSA3SPr6FE3wdAHwKg9wHI-LunEzzC_76b_wU6i6_2</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2908068321</pqid></control><display><type>article</type><title>The Dose Comparison of Intrathecal Morphine for Postoperative Analgesia in Total Knee Arthroplasty Under Spinal Anesthesia: A Single Institute Retrospective Study</title><source>PubMed Central Open Access</source><source>PubMed Central</source><creator>Kukreja, Promil ; Peabody Lever, Jacelyn E ; Hussey, Hanna ; Piennette, Paul ; Nagi, Peter ; Mabry, Scott ; Feinstein, Joel ; Vining, Brooke ; Gerlak, Jason ; Paul, Christopher A ; Kalagara, Hari</creator><creatorcontrib>Kukreja, Promil ; Peabody Lever, Jacelyn E ; Hussey, Hanna ; Piennette, Paul ; Nagi, Peter ; Mabry, Scott ; Feinstein, Joel ; Vining, Brooke ; Gerlak, Jason ; Paul, Christopher A ; Kalagara, Hari</creatorcontrib><description>Background and purpose of the study Intrathecal morphine (ITM) provides effective postoperative analgesia in patients undergoing total knee arthroplasty (TKA) under spinal anesthesia. However, the ideal dose at which maximal analgesic effects can be delivered with minimal side effects is not clearly known. This retrospective study is aimed to compare two different doses of ITM with respect to analgesia benefits and side effects. Methods This is a retrospective, descriptive, single-center study approved by the Institutional Review Board (IRB) at the University of Alabama at Birmingham. Three patient groups were selected: a control group receiving continuous adductor canal block (CCACB) under spinal anesthesia, and two experimental groups receiving single-dose adductor canal block (SSACB) under spinal anesthesia with either 100 mcg or 150 mcg of ITM. The sample size included 75 patients (25 per group) who were 18 years and older, American Society of Anesthesiology (ASA) class 1-3 who were undergoing primary TKA. Patients with chronic pain or opioid use exceeding 30 days and those undergoing surgeries other than primary TKA were excluded. Outcome data, including opioid use (from which post-operative oral morphine equivalents (OME) were calculated), antiemetic use, visual analog pain scale (VAS) scores, distance ambulated at 24 hours, and length of hospital stay, were extracted by chart review. Results In the post-anesthesia care unit (PACU), patients in both ITM groups experienced significantly lower opioid consumption and pain scores compared to the control group (p<.001). Furthermore, cumulative OME at 24 hours was significantly less in the ITM groups compared to the control, but there was no difference between ITM doses (p=0.004; mean cumulative OME for control was 77.2 OME vs 43.4 OME for 100 mcg ITM vs 42.6 OME for 150 mcg ITM). Antiemetic usage did not increase in the ITM groups. Although there was no statistically significant difference in ambulation at 24 hours, both ITM groups exhibited a trend toward greater average ambulation distance compared to the control group (p=0.095; mean distance walked for control was 67.6 feet, 76.6 feet for 100 mcg ITM vs 98.8 feet for 150 mcg ITM). Hospital length of stay did not significantly differ between the groups. Conclusion ITM doses of 100 mcg and 150 mcg provide effective analgesia for patients undergoing lower extremity total knee arthroplasty under spinal anesthesia. Patients receiving ITM had better pain scores in the immediate post-operative period and had overall less oral morphine equivalent consumption when compared to control. In addition, the safety and side effect profile for ITM is similar for both doses as there was no incidence of respiratory depression and antiemetic usage did not differ between all study arms. Future studies should explore the use of higher ITM doses and consider a broader patient population to further understand the advantages and potential drawbacks of ITM in TKA surgery.</description><identifier>ISSN: 2168-8184</identifier><identifier>EISSN: 2168-8184</identifier><identifier>DOI: 10.7759/cureus.49350</identifier><identifier>PMID: 38143599</identifier><language>eng</language><publisher>United States: Cureus Inc</publisher><subject>Anesthesia ; Anesthesiology ; Antiemetics ; Joint replacement surgery ; Knee ; Length of stay ; Morphine ; Narcotics ; Orthopedics ; Pain ; Pain Management ; Patient satisfaction</subject><ispartof>Curēus (Palo Alto, CA), 2023-11, Vol.15 (11), p.e49350-e49350</ispartof><rights>Copyright © 2023, Kukreja et al.</rights><rights>Copyright © 2023, Kukreja et al. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright © 2023, Kukreja et al. 2023 Kukreja et al.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c343t-fba08094922002bc2af1f6f789ed6660ee8ef8b079371db45576053a3c9764723</citedby><cites>FETCH-LOGICAL-c343t-fba08094922002bc2af1f6f789ed6660ee8ef8b079371db45576053a3c9764723</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10749179/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10749179/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27923,27924,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38143599$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kukreja, Promil</creatorcontrib><creatorcontrib>Peabody Lever, Jacelyn E</creatorcontrib><creatorcontrib>Hussey, Hanna</creatorcontrib><creatorcontrib>Piennette, Paul</creatorcontrib><creatorcontrib>Nagi, Peter</creatorcontrib><creatorcontrib>Mabry, Scott</creatorcontrib><creatorcontrib>Feinstein, Joel</creatorcontrib><creatorcontrib>Vining, Brooke</creatorcontrib><creatorcontrib>Gerlak, Jason</creatorcontrib><creatorcontrib>Paul, Christopher A</creatorcontrib><creatorcontrib>Kalagara, Hari</creatorcontrib><title>The Dose Comparison of Intrathecal Morphine for Postoperative Analgesia in Total Knee Arthroplasty Under Spinal Anesthesia: A Single Institute Retrospective Study</title><title>Curēus (Palo Alto, CA)</title><addtitle>Cureus</addtitle><description>Background and purpose of the study Intrathecal morphine (ITM) provides effective postoperative analgesia in patients undergoing total knee arthroplasty (TKA) under spinal anesthesia. However, the ideal dose at which maximal analgesic effects can be delivered with minimal side effects is not clearly known. This retrospective study is aimed to compare two different doses of ITM with respect to analgesia benefits and side effects. Methods This is a retrospective, descriptive, single-center study approved by the Institutional Review Board (IRB) at the University of Alabama at Birmingham. Three patient groups were selected: a control group receiving continuous adductor canal block (CCACB) under spinal anesthesia, and two experimental groups receiving single-dose adductor canal block (SSACB) under spinal anesthesia with either 100 mcg or 150 mcg of ITM. The sample size included 75 patients (25 per group) who were 18 years and older, American Society of Anesthesiology (ASA) class 1-3 who were undergoing primary TKA. Patients with chronic pain or opioid use exceeding 30 days and those undergoing surgeries other than primary TKA were excluded. Outcome data, including opioid use (from which post-operative oral morphine equivalents (OME) were calculated), antiemetic use, visual analog pain scale (VAS) scores, distance ambulated at 24 hours, and length of hospital stay, were extracted by chart review. Results In the post-anesthesia care unit (PACU), patients in both ITM groups experienced significantly lower opioid consumption and pain scores compared to the control group (p<.001). Furthermore, cumulative OME at 24 hours was significantly less in the ITM groups compared to the control, but there was no difference between ITM doses (p=0.004; mean cumulative OME for control was 77.2 OME vs 43.4 OME for 100 mcg ITM vs 42.6 OME for 150 mcg ITM). Antiemetic usage did not increase in the ITM groups. Although there was no statistically significant difference in ambulation at 24 hours, both ITM groups exhibited a trend toward greater average ambulation distance compared to the control group (p=0.095; mean distance walked for control was 67.6 feet, 76.6 feet for 100 mcg ITM vs 98.8 feet for 150 mcg ITM). Hospital length of stay did not significantly differ between the groups. Conclusion ITM doses of 100 mcg and 150 mcg provide effective analgesia for patients undergoing lower extremity total knee arthroplasty under spinal anesthesia. Patients receiving ITM had better pain scores in the immediate post-operative period and had overall less oral morphine equivalent consumption when compared to control. In addition, the safety and side effect profile for ITM is similar for both doses as there was no incidence of respiratory depression and antiemetic usage did not differ between all study arms. Future studies should explore the use of higher ITM doses and consider a broader patient population to further understand the advantages and potential drawbacks of ITM in TKA surgery.</description><subject>Anesthesia</subject><subject>Anesthesiology</subject><subject>Antiemetics</subject><subject>Joint replacement surgery</subject><subject>Knee</subject><subject>Length of stay</subject><subject>Morphine</subject><subject>Narcotics</subject><subject>Orthopedics</subject><subject>Pain</subject><subject>Pain Management</subject><subject>Patient satisfaction</subject><issn>2168-8184</issn><issn>2168-8184</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdks1u1DAUhS0EotXQHWtkiQ0LpvgniW02aDRAW7UIxEzXlpPcTFxl7NR2Ks3r8KS4M6VqWdny_e6x7_FB6C0lp0KU6lMzBZjiaaF4SV6gY0YrOZdUFi-f7I_QSYw3hBBKBCOCvEZHXNKCl0odoz_rHvBXHwEv_XY0wUbvsO_whUvBpB4aM-AfPoy9dYA7H_AvH5MfIRftHeCFM8MGojXYOrz2KdOXDvJ5SH3w42Bi2uFr10LAq9FmOHdAzLq55TNe4JV1mwHybTHZNCXAvyEFH0do9vKrNLW7N-hVZ4YIJw_rDF1__7Zens-vfp5dLBdX84YXPM272hBJVKEYI4TVDTMd7apOSAVtVVUEQEInayIUF7Sti7IUFSm54Y0SVSEYn6EvB91xqrfQNnBvwaDHYLcm7LQ3Vj-vONvrjb_T2ddC0aw7Qx8eFIK_nfKcemtjA8NgHPgpaqZIKSQTVGb0_X_ojZ9CNmhPSVJJzmimPh6oJpsSA3SPr6FE3wdAHwKg9wHI-LunEzzC_76b_wU6i6_2</recordid><startdate>20231124</startdate><enddate>20231124</enddate><creator>Kukreja, Promil</creator><creator>Peabody Lever, Jacelyn E</creator><creator>Hussey, Hanna</creator><creator>Piennette, Paul</creator><creator>Nagi, Peter</creator><creator>Mabry, Scott</creator><creator>Feinstein, Joel</creator><creator>Vining, Brooke</creator><creator>Gerlak, Jason</creator><creator>Paul, Christopher A</creator><creator>Kalagara, Hari</creator><general>Cureus Inc</general><general>Cureus</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20231124</creationdate><title>The Dose Comparison of Intrathecal Morphine for Postoperative Analgesia in Total Knee Arthroplasty Under Spinal Anesthesia: A Single Institute Retrospective Study</title><author>Kukreja, Promil ; Peabody Lever, Jacelyn E ; Hussey, Hanna ; Piennette, Paul ; Nagi, Peter ; Mabry, Scott ; Feinstein, Joel ; Vining, Brooke ; Gerlak, Jason ; Paul, Christopher A ; Kalagara, Hari</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c343t-fba08094922002bc2af1f6f789ed6660ee8ef8b079371db45576053a3c9764723</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Anesthesia</topic><topic>Anesthesiology</topic><topic>Antiemetics</topic><topic>Joint replacement surgery</topic><topic>Knee</topic><topic>Length of stay</topic><topic>Morphine</topic><topic>Narcotics</topic><topic>Orthopedics</topic><topic>Pain</topic><topic>Pain Management</topic><topic>Patient satisfaction</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kukreja, Promil</creatorcontrib><creatorcontrib>Peabody Lever, Jacelyn E</creatorcontrib><creatorcontrib>Hussey, Hanna</creatorcontrib><creatorcontrib>Piennette, Paul</creatorcontrib><creatorcontrib>Nagi, Peter</creatorcontrib><creatorcontrib>Mabry, Scott</creatorcontrib><creatorcontrib>Feinstein, Joel</creatorcontrib><creatorcontrib>Vining, Brooke</creatorcontrib><creatorcontrib>Gerlak, Jason</creatorcontrib><creatorcontrib>Paul, Christopher A</creatorcontrib><creatorcontrib>Kalagara, Hari</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Curēus (Palo Alto, CA)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kukreja, Promil</au><au>Peabody Lever, Jacelyn E</au><au>Hussey, Hanna</au><au>Piennette, Paul</au><au>Nagi, Peter</au><au>Mabry, Scott</au><au>Feinstein, Joel</au><au>Vining, Brooke</au><au>Gerlak, Jason</au><au>Paul, Christopher A</au><au>Kalagara, Hari</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Dose Comparison of Intrathecal Morphine for Postoperative Analgesia in Total Knee Arthroplasty Under Spinal Anesthesia: A Single Institute Retrospective Study</atitle><jtitle>Curēus (Palo Alto, CA)</jtitle><addtitle>Cureus</addtitle><date>2023-11-24</date><risdate>2023</risdate><volume>15</volume><issue>11</issue><spage>e49350</spage><epage>e49350</epage><pages>e49350-e49350</pages><issn>2168-8184</issn><eissn>2168-8184</eissn><abstract>Background and purpose of the study Intrathecal morphine (ITM) provides effective postoperative analgesia in patients undergoing total knee arthroplasty (TKA) under spinal anesthesia. However, the ideal dose at which maximal analgesic effects can be delivered with minimal side effects is not clearly known. This retrospective study is aimed to compare two different doses of ITM with respect to analgesia benefits and side effects. Methods This is a retrospective, descriptive, single-center study approved by the Institutional Review Board (IRB) at the University of Alabama at Birmingham. Three patient groups were selected: a control group receiving continuous adductor canal block (CCACB) under spinal anesthesia, and two experimental groups receiving single-dose adductor canal block (SSACB) under spinal anesthesia with either 100 mcg or 150 mcg of ITM. The sample size included 75 patients (25 per group) who were 18 years and older, American Society of Anesthesiology (ASA) class 1-3 who were undergoing primary TKA. Patients with chronic pain or opioid use exceeding 30 days and those undergoing surgeries other than primary TKA were excluded. Outcome data, including opioid use (from which post-operative oral morphine equivalents (OME) were calculated), antiemetic use, visual analog pain scale (VAS) scores, distance ambulated at 24 hours, and length of hospital stay, were extracted by chart review. Results In the post-anesthesia care unit (PACU), patients in both ITM groups experienced significantly lower opioid consumption and pain scores compared to the control group (p<.001). Furthermore, cumulative OME at 24 hours was significantly less in the ITM groups compared to the control, but there was no difference between ITM doses (p=0.004; mean cumulative OME for control was 77.2 OME vs 43.4 OME for 100 mcg ITM vs 42.6 OME for 150 mcg ITM). Antiemetic usage did not increase in the ITM groups. Although there was no statistically significant difference in ambulation at 24 hours, both ITM groups exhibited a trend toward greater average ambulation distance compared to the control group (p=0.095; mean distance walked for control was 67.6 feet, 76.6 feet for 100 mcg ITM vs 98.8 feet for 150 mcg ITM). Hospital length of stay did not significantly differ between the groups. Conclusion ITM doses of 100 mcg and 150 mcg provide effective analgesia for patients undergoing lower extremity total knee arthroplasty under spinal anesthesia. Patients receiving ITM had better pain scores in the immediate post-operative period and had overall less oral morphine equivalent consumption when compared to control. In addition, the safety and side effect profile for ITM is similar for both doses as there was no incidence of respiratory depression and antiemetic usage did not differ between all study arms. Future studies should explore the use of higher ITM doses and consider a broader patient population to further understand the advantages and potential drawbacks of ITM in TKA surgery.</abstract><cop>United States</cop><pub>Cureus Inc</pub><pmid>38143599</pmid><doi>10.7759/cureus.49350</doi><oa>free_for_read</oa></addata></record> |
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| source | PubMed Central Open Access; PubMed Central |
| subjects | Anesthesia Anesthesiology Antiemetics Joint replacement surgery Knee Length of stay Morphine Narcotics Orthopedics Pain Pain Management Patient satisfaction |
| title | The Dose Comparison of Intrathecal Morphine for Postoperative Analgesia in Total Knee Arthroplasty Under Spinal Anesthesia: A Single Institute Retrospective Study |
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