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Intrathecal morphine provides better postoperative analgesia than psoas compartment block after primary hip arthroplasty

[L’administration intrathécale de morphine procure une meilleure analgésie postopératoire que le bloc du plexus lombaire à la suite d’une arthroplastie primaire de la hanche]

Vincent Souron, MD^*, Laurent Delaunay, MD^* and Patrick Schifrine, MD

^* From the Departments of Anesthesiology,
and Orthopedic Surgery, Clinique Générale, Annecy, France.

Address correspondence to: Dr. Vincent Souron, Department of Anesthesiology, Clinique Générale, 4, chemin de la tour La Reine, 74000 Annecy, France. Phone: 33 (0)4 50 33 03 20; Fax: 33 (0)4 50 33 03 21; E-mail: vsouron{at}club-internet.fr

Purpose: Intrathecal morphine and psoas compartment block represent two accepted techniques to provide postoperative analgesia after hip arthroplasty. We designed a prospective, randomized, single-blinded study to compare these two techniques.

Methods: Patients scheduled for primary hip arthroplasty under general anesthesia were randomized to receive either an intrathecal administration of 0.1 mg morphine (Group I, n = 27) or a psoas compartment block with ropivacaine 0.475% 25 mL (Group II, n = 26). Pain scores, morphine consumption, associated side-effects were assessed for 48 hr postoperatively. In addition, patient’s acceptance and satisfaction of the postoperative analgesic technique were also recorded.

Results: During the first 24 hr, pain scores (3.3 ± 9.6 mm vs 22.8 ± 27.1 at H+6, 3.3 ± 8.3 mm vs 25 ± 26.7 mm at H+12, 7 ± 14.9 mm vs 21.9 ± 29 mm at H+18) and morphine consumption (0.56 ± 2.12 mg vs 9.42 ± 10.13 mg) were lower in Group I than in Group II. Urinary retention was the more frequent side-effect occurring in 37% of cases in Group I vs 11.5% in Group II (P < 0.05). No major complication occurred. Despite better analgesia provided by the use of intrathecal morphine, there was no difference in the satisfaction scores between groups.

Conclusion: 0.1 mg intrathecal morphine administration provides better postoperative analgesia than single-shot psoas compartment block after primary hip arthroplasty.

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