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

[L'administration intrathécale de bupivacaïne avec morphine ou néostigmine comme analgésie postopératoire suivant la mise en place d'une prothèse totale de genou]

Ping-Heng Tan, MD^*, Yuan-Yi Chia, MD, Yuan Lo, MD, Kang Liu, MD, Lin-Cheng Yang, MD^* and Tsung-Hsing Lee, MD^*

^* From the Department of Anesthesia, Chang-Gung Memorial Hospital, Kaohsiung; and the
Department of Anesthesia, Veterans General Hospital-Kaohsiung, National Yang-Ming University School of Medicine, Taiwan, Republic of China.

Address correspondence to: Dr. Ping-Heng Tan, 2, LN 183, Rong-Jong Rd., Kaohsiung 813, Taiwan, Republic of China. Phone: 886-7-3477902; Fax: 886-7-3423348; E-mail: tanph{at}gcn.net.tw

Purpose: To compare the postoperative analgesic efficacy and safety of intrathecal (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 received IT 0.5% hyperbaric bupivacaine 15 mg with either normal saline 0.5 mL, neostigmine 50 µg, or morphine 300 µg. The maximal level of sensory block, duration of analgesia, time to use of rescue analgesics, the overall 24-hr and four-hour interval visual analogue scale (VAS) pain score, and the incidence of adverse effects were recorded for 24 hr after administration.

Results: There was no significant difference in maximal level of sensory block among the three groups. The morphine group had a later onset of postsurgical 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 block lasted significantly longer in the neostigmine group than in the morphine and saline groups (P <0.05). The incidence of adverse effects was similar in the neostigmine and morphine groups except for pruritus (70%) occurring more frequently in the morphine group than in the neostigmine and saline groups (0%; P <0.05). Overall satisfaction rates were better in the neostigmine group than in the morphine and saline groups (P <0.05).

Conclusions: IT neostigmine 50 µg produced postoperative analgesia lasting about seven hours with fewer side effects and better satisfaction ratings than IT morphine 300 µg.

This article has been cited by other articles:

				P. F. White The Changing Role of Non-Opioid Analgesic Techniques in the Management of Postoperative Pain Anesth. Analg., November 1, 2005; 101(5S_Suppl): S5 - 22. [Abstract] [Full Text] [PDF]