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Intrathekal verabreichtes Morphin bei orthopädischen Eingriffen

Optimierte Dosis bei Koanalgesie mit Metamizol

Intrathecal morphine in orthopaedic surgery patients

Optimised dose in patients receiving dipyrone

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Zusammenfassung

Hintergrund

Die postoperative Analgesie unterschiedlicher Dosierungen von intrathekal verabreichtem Morphin wurde bei orthopädischen Patienten untersucht. Als Analgetikum der ersten Wahl war Metamizol bis zu einer Dosis von 6 g/Tag erlaubt.

Methodik

Es wurde eine prospektive, doppelblinde, placebokontrollierte Untersuchung durchgeführt. Je 15 Patienten/Gruppe erhielten randomisiert Placebo, 0,05 mg, 0,1 mg oder 0,2 mg Morphin als Zusatz zu einer Spinalanästhesie mit isobarem Bupivacain.

Ergebnisse

Die Anzahl der Patienten, die kein Opioid anforderten, betrug 3, 8, 14 und 14 in der Placebogruppe resp. nach 0,05 mg (p=0,128), 0,1 mg (p=0,0001) und 0,2 mg (p=0,0001) intrathekaler Morphingabe. Die Dauer bis zur ersten Opioidanforderung stieg dosisabhängig von 10,3±7,9 h bis 23,9±0,3 h (p<0,0001).

Schlussfolgerung

Durch die intrathekale Gabe von 0,1 mg oder 0,2 mg Morphin konnte eine signifikante Verzögerung der Opioidanforderung nach orthopädischen Eingriffen erzielt werden. Wenn die Verabreichung von Metamizol erlaubt ist, kann regelmäßig auf zusätzliche Opioide in den ersten 24 h nach Operation verzichtet werden.

Abstract

Introduction

The influence of different postoperative doses of intrathecal morphine on the time of first opioid request by orthopaedic patients was investigated. The first choice analgesic was dipyrone and a maximum dose of 6 mg/day was allowed.

Methods

A prospective, double-blind, placebo-controlled, clinical trial was conducted with 15 patients in each group receiving intrathecally either a placebo, 0.05 mg morphine, 0.1 mg morphine or 0.2 mg morphine in combination with a spinal anaesthesia with isobaric bupivacaine.

Results

The number of patients without opioid requirement during the first 24 h after surgery were 3, 8, 14 and 14 in the placebo group and after 0.05 mg (p=0.128), 0.1 mg (p=0.0001) and 0.2 mg (p=0.0001) intrathecal morphine, respectively. The average time until first opioid requirement increased in a dose-dependent manner from 10.3 h to 23.9 h (p<0.0001).

Conclusion

In orthopaedic patients with dipyrone as the primary analgesic, the addition of 0.1 mg or 0.2 mg morphine to spinal anaesthesia provided a simple long-lasting postoperative analgesia and the use of additional opioids could be avoided during the 24h postoperative period.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Die Autoren haben in den vergangenen 3 Jahren finanzielle Unterstützung bei klinischen Studien durch die Firma Mundipharma erhalten.

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  1. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum Kassel GmbH, Mönchebergstr. 41–43, 34125, Kassel, Deutschland

    M. Gehling & M. Tryba

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  2. M. Tryba
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Correspondence to M. Gehling.

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Gehling, M., Tryba, M. Intrathekal verabreichtes Morphin bei orthopädischen Eingriffen. Anaesthesist 57, 347–354 (2008). https://doi.org/10.1007/s00101-008-1341-y

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