Postoperative intrathecal analgesia for primary total hip arthroplasty--comparative clinical examination of two different small doses of morphium hydrochloride.

OBJECTIVE: To prospectively compare the spinal analgesia with two different small doses of morphium hydrochloride after primary total hip arthroplasty. BACKGROUND: In total hip arthroplasty, several techniques for postoperative analgesia can be used. In this study, we examined analgesia and side effects of intrathecal morphium hydrochloride (MCh) after primary total hip arthroplasty in small doses, namely 0.05 mg and 0.1 mg. METHODS: Forty patients were randomized to receive either 0.5 ml/0.05 mg, or 0.5 ml/0.1 mg of MCh intrathecally together with 3.5 ml of 0.5% isobaric bupivacine hydrochloride. The duration of postoperative analgesia, the intensity of the initial pain sensation and the frequency of opioid side effects were recorded for the first 24 hours. RESULTS: The mean duration of analgesia in group M 0.05 was 14.3 +/- 1.1 hours and was significantly shorter than 19.7 +/- 1.7 hours in the M 0.1 group (p < 0.05). Visual analogue scale (VAS) score for the initial pain intensity in M 0.05 group was 5 (median value). That in M 0.1 group was 3 (median value). The difference was not significant (p < 0.05). There was no respiratory depression in the groups. The difference in the frequency of nausea and vomiting was not significant but that of itching was (p < 0.05). CONCLUSION: Intrathecal usage of 0.05 mg and 0.1 mg of MCh provides a long-lasting postoperative analgesia. It is a practical method to be provided after primary total hip arthroplasty. The efficacy of 0.1 mg of MCh is greater compared to that of 0.05 mg of MCh. These doses of MCh do not cause respiratory depression but cause nausea, vomiting and itching (Tab. 4, Fig. 1, Ref. 11).

Caesarean section in isobaric spinal anesthesia with and without direct preoperative hydration with crystalloids.

BACKGROUND: Because the direct preoperative hydration with crystalloids (20 ml/kg) does not adequately prevent spinal hypotension during cesarean section, the authors investigated whether a continuous intravenous infusion of ephedrine (50 mg/500 ml of Ringer solution) without preoperative hydration would prevent the spinal hypotension more effectively. METHODS: Forty parturients with ASA status I were randomized either to receive a preoperative hydration with 20 ml/kg of Ringer solution, or to receive continuous ephedrine infusion, simultaneously with spinal anesthesia. The infusion rate was adjusted according to systolic blood pressure. Significant hypotension was defined as a systolic blood pressure below 100 mmHg. Rescue boluses consisted of ephedrine 10 mg in parturients with prehydration and ephedrine 5 mg in parturients with ephedrine infusion. RESULTS: Significant hypotension occurred less frequently in the ephedrine group than in the volume group: 40% versus 60% (p < 0.05). Nausea and vomiting occurred less frequently in the ephedrine group than in the volume group: 40% and 30% versus 60% and 50%, respectively (p < 0.05). The mean quantity of infused Ringer solution was 370 ml +/- 31 in the ephedrine group, i.e. significantly lower than 1,640 ml +/- 192 in the volume group (p < 0.05). The mean quantity of ephedrine given in the ephedrine group was 30 mg +/- 4.1. The mean quantity of ephedrine given in the volume group was 25 mg +/- 2. The difference was not significant. Apgar scores were similarly good in both groups. CONCLUSION: The continuous infusion of ephedrine simultaneously with spinal anesthesia is superior to direct preoperative hydration with crystalloids in preventing the spinal hypotension and its clinical manifestations in parturients delivered with C-section (Tab. 3, Ref. 20).