Mini-dose (0.05 mg) intrathecal morphine provides effective analgesia after transurethral resection of the prostate

Abstract

P Pu ur rp po os se e: : To determine the optimal dose of intrathecal morphine that produces satisfactory analgesia with minimum side effects in elderly patients undergoing transurethral resection of the prostate (TURP). M Me et th ho od ds s: :In this double-blind prospective study, 42 patients undergoing TURP with spinal anesthesia were allocated to one of three groups. Group A (n = 14) received tetracaine, 10 mg, alone. Group B (n = 13) and Group C (n = 15) received morphine 0.05 mg and 0.10 mg, respectively, in combination with tetracaine. Postoperative pain, nausea and pruritus were evaluated using visual analogue scales (VAS). SpO 2 and respiratory rate were also assessed.R Re es su ul lt ts s: : At three, five, seven and 24 hr after spinal anesthesia, the VAS scores for pain in Groups B and C were significantly less than in Group A. Group C experienced significantly greater VAS scores for pruritus as compared to Groups A and B. There was no significant difference in the intensity of nausea among the three groups. No patient experienced hypoxemia (SpO 2 < 90%) and respiratory depression (respiratory rate < 10 beats·min -1 ) in any group. C Co on nc cl lu us si io on n: : A dose of 0.05 mg in intrathecal morphine with spinal anesthesia would be optimal for elderly patients undergoing TURP. Objectif : Déterminer la dose optimale de morphine intrathécale pour obtenir une analgésie satisfaisante et le moins d'effets secondaires possibles chez des patients âgés devant subir la résection transurétrale de la prostate (RTUP). Méthode : L'étude prospective et à double insu comportait Résultats : À trois, cinq et 24 h après la rachianesthésie, les scores de douleur à l'EVA ont été significativement plus bas dans les groupes B et C que dans le groupe A. Dans le groupe C, les patients ont eu des scores de prurit significativement plus élevés que ceux des groupes A et B. Il n'y a pas eu de différence intergroupe significative quant à l'intensité des vomissements. Aucun patient n'a souffert d'hypoxémie (SpO 2 < 90 %) ou de dépression respiratoire (fréquence respiratoire < 10 respirations·min -1 ). Conclusion : Une dose de 0,05 mg de morphine intrathécale combinée à la rachianesthésie serait optimale chez des patients âgés qui subissent une RTUP.FTER transurethral resection of the prostate (TURP), patients often suffer from pain caused by detrusor muscle spasm. 1,2 Intrathecal morphine provides an excellent long-lasting analgesia and the addition of morphine to spinal anesthesia has been used for postoperative analgesia after many surgical procedures. [3][4][5][6][7][8][9][10] Cunningham et al. demonstrated that intrathecal morphine was effective for analgesia after TURP. 11 On the other hand, intrathecal morphine is often accompanied by adverse effects such as pruritus, nausea and respiratory depression. Clinicians tend to use smaller doses to reduce the incidence of adverse effects. This study was carried out to examine the efficacy and adverse effects associated with low-dose intrathecal morphine in patients undergoi...

Postoperative analgesia with minidose intrathecal morphine for bipolar hip prosthesis in extremely elderly patients

“…It is not known whether 0.05 mg of intrathecal morphine is the optimal dose for seniors undergoing bipolar hip prosthesis, but the dose-dependent effect would not need to be evaluated because it has been reported that 0.1 mg of intrathecal morphine showed good analgesic results after THA [3]. Although we found no disadvantageous effects, further study is needed to clarify the safety of intrathecal morphine for seniors.…”

“…Intrathecal morphine is associated with adverse effects, including respiratory depression, pruritus, and nausea [1][2][3][4][12][13][14]. Palmer et al [15] reported the disadvantageous effects of an increased dose of intrathecal morphine.…”

“…THA), cesarean section, or transurethral resection of the prostate [1][2][3][4]. Murphy et al [1] reported that 0.1 mg of intrathecal morphine provided the best balance between analgesic effi cacy and side-effect profi le in older patients (older than 65 years) undergoing THA.…”

Intrathekal verabreichtes Morphin bei orthopädischen Eingriffen

“…In zahlreichen Studien, die intrathe kale Morphingaben mit ≤0,25 mg unter suchten, wurde keine Atemdepression be obachtet [1,2,5,7,14,17,28,33]. Vereinzelt werden aber auch Atemdepressionen be schrieben, sodass das diesbezügliche Ri siko auch bei geringen Dosierungen von intrathekal verabreichtem Morphin nicht ausgeschlossen werden kann [21,24] In einer früheren Untersuchung führ te die Kombination von 100 mg Indome thacin zu einer Spinalanästhesie mit Zu satz von Morphin und Fentanyl zu einer Verzögerung der ersten Analgetikaanfor derung von 9 auf 39 h [26].…”

Comparison of 50 μg and 25 μg doses of intrathecal morphine on postoperative analgesic requirements in patients undergoing transurethral resection of the prostate with intrathecal anesthesia

“…The addition of morphine to spinal anesthesia has been used effectively for postoperative analgesia after TURP [2][3][4]. Cunningham et al showed that one mg of spinal morphine produces excellent postoperative analgesia with considerable frequency of nausea or vomiting, pruritus, and danger of delayed respiratory depression [2].…”