Efficacy and Side Effect Profile of Intrathecal Morphine versus Distal Femoral Triangle Nerve Block for Analgesia following Total Knee Arthroplasty: A Randomized Trial

Abstract

(1) Background: The management of postoperative pain after knee replacement is an important clinical problem. The best results in the treatment of postoperative pain are obtained using multimodal therapy principles. Intrathecal morphine (ITM) and single-shot femoral nerve block (SSFNB) are practiced in the treatment of postoperative pain after knee replacement, with the most optimal methods still under debate. The aim of this study was to compare the analgesic efficacy with special consideration of selected side effects of both methods. (2) Materials and methods: Fifty-two consecutive patients undergoing knee arthroplasty surgery at the Department of Orthopedics and Traumatology of the Medical University of Warsaw were included in the study. Patients were randomly allocated to one of two groups. In the ITM group, 100 micrograms of intrathecal morphine were used, and in the SSFNB group, a femoral nerve block in the distal femoral triangle was used as postoperative analgesia. The other elements of anesthesia and surgery did not differ between the groups. (3) Results: The total dose of morphine administered in the postoperative period and the effectiveness of pain management did not differ significantly between the groups (cumulative median morphine dose in 24 h in the ITM group 31 mg vs. SSFNB group 29 mg). The incidence of nausea and pruritus in the postoperative period differed significantly in favor of patients treated with a femoral nerve block. (4) Conclusions: Although intrathecal administration of morphine is similarly effective in the treatment of pain after knee replacement surgery as a single femoral triangle nerve block, it is associated with a higher incidence of cumbersome side effects, primarily nausea and pruritus.

Novel Techniques for Musculoskeletal Pain Management after Orthopedic Surgical Procedures: A Systematic Review

“…Some investigations, such as the studies by Domagalska et al, (2023), Mellecker et al, (2012), and Haeseler et al, (2017) [55,56,59], have delved into the effectiveness of diverse interventions, including nerve blocks, oral medications, and non-pharmacological approaches. Comparative efficacy was observed in studies such as Janiak et al, (2023) [53], which highlighted the effectiveness of intrathecal morphine similar to single-shot femoral nerve blocks, although it was associated with a higher incidence of cumbersome side effects like nausea and pruritus. Intrathecal morphine (ITM) showed similar effectiveness in pain treatment post knee replacement as SSFNB.…”

“…The reviewer thoroughly assessed the methodological quality and risk of bias of the 15 included studies [53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] using a modified ROBVIS tool (Figure 2). Overall, the studies were well conducted, with low risk of bias ratings across most domains.…”

“…Outcome assessors were blinded in all the randomized trials, overcoming detection bias. Attrition and reporting bias were minimal, as most studies had complete outcome data and fully reported their pre-specified outcomes [53][54][55][56][57][58][59][60][61][62][63][64][65][66][67]. Overall judgments took these minor uncertainties into account, but the studies were still considered to have a reasonably low risk of bias.…”

Intrathecal Morphine Use Improves Postoperative Analgesia and Reduces Opioid Consumption in Patients Undergoing Total Knee Arthroplasty Under Spinal Anesthesia: A Retrospective Study

“…A systematic review published in 2021 by Wang et al indicates that the efficacy of intrathecal morphine (ITM) for total joint replacement has yet to be fully established [3]. Furthermore, despite the various advantages of ITM, including the efficiency of administration and cost-effectiveness, there are concerns regarding the safety and side-effect profile of ITM, including pruritus, respiratory depression, urinary retention, and PONV [3,[5][6][7][11][12][13][14].…”