Skip to main content
SpringerLink
Log in

Safety and side-effect profile of intrathecal morphine in a diverse patient population undergoing total knee and hip arthroplasty

  • Original Article • KNEE- ARTHROPLASTY
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Intrathecal morphine (ITM) can be useful for postoperative analgesia following lower extremity joint arthroplasty, but concerns exist regarding potential dose-related side effects. In this study, we examined the safety and efficacy of ITM in patients undergoing lower extremity joint arthroplasty. We hypothesized that there would be (1) direct relationship between dosing and side effects, and (2) an inverse relationship between ITM dosing and 24-hour postoperative opioid requirement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Johnson RL, Kopp SL, Burkle CM et al (2016) Neuraxial vs general anaesthesia for total hip and total knee arthroplasty: a systematic review of comparative-effectiveness research. Br J Anaesth 116:163–176. https://doi.org/10.1093/bja/aev455

    Article  CAS  PubMed  Google Scholar 

  2. Fischer HBJ, Simanski CJP, The PROSPECT working group (2005) A procedure-specific systematic review and consensus recommendations for analgesia after total hip replacement. Anaesthesia 60:1189–1202. https://doi.org/10.1111/j.1365-2044.2005.04382.x

    Article  CAS  PubMed  Google Scholar 

  3. Bowrey S, Hamer J, Bowler I et al (2005) A comparison of 0.2 and 0.5 mg intrathecal morphine for postoperative analgesia after total knee replacement. Anaesthesia 60:449–452

    Article  CAS  PubMed  Google Scholar 

  4. Brill S, Gurman GM, Fisher A (2003) A history of neuraxial administration of local analgesics and opioids. Eur J Anaesthesiol 20:682–689

    Article  CAS  PubMed  Google Scholar 

  5. Wang J, Nauss L, Thomas J (1979) Pain relief by intrathecally applied morphine in man. Anesthesiology 50:149–151

    Article  CAS  PubMed  Google Scholar 

  6. Rathmell JP, Pino CA, Taylor R et al (2003) Intrathecal morphine for postoperative analgesia: a randomized, controlled, dose-ranging study after hip and knee arthroplasty. Anesth Analg 97:1452–1457. https://doi.org/10.1213/01.ANE.0000083374.44039.9E

    Article  CAS  PubMed  Google Scholar 

  7. Samii K, Chauvin M, Viars P (1981) Postoperative spinal analgesia with morphine. Br J Anaesth 53:817–820

    Article  CAS  PubMed  Google Scholar 

  8. Moore R, Paterson G, Bullingham R (1984) Controlled comparison of intrathecal cinchocaine with intrathecal cinchocaine and morphine: clinical effects and plasma morphine concentrations. Br J Anaesth 56:837–841

    Article  CAS  PubMed  Google Scholar 

  9. Davis I (1987) Intrathecal morphine in aortic aneurysm surgery. Anaesthesia 42:491–497

    Article  CAS  PubMed  Google Scholar 

  10. Palmer C, Emerson S, Volgoropolous D, Alves D (1999) Dose-response relationship of intrathecal morphine for postcesarean analgesia. Anesthesiology 90:437–444

    Article  CAS  PubMed  Google Scholar 

  11. Bengtsson M, Lofstrom J, Merits H (1983) Postoperative pain relief with intrathecal morphine after major hip surgery. Reg Anesth 8:140–143

    Google Scholar 

  12. Kalso E (1983) Effects of ITMS, injected with bupivacaine, on pain after orthopaedic surgery. Br J Anaesth 55:415–421

    Article  CAS  PubMed  Google Scholar 

  13. Cole P, Craske D, Wheartley R (2000) Efficacy and respiratory effects of low-dose spinal morphine for post-operative analgesia following knee arthroplasty. Br J Anaesth 85:233–237

    Article  CAS  PubMed  Google Scholar 

  14. Jacobson L, Chabal C, Brody M (1988) A dose-response study of intrathecal morphine: efficacy, duration, optimal dose, and side effects. Anesth Analg 67:1082–1088

    Article  CAS  PubMed  Google Scholar 

  15. Goodarzi M, Narasimhan R (2001) The effect of large-dose intrathecal opioids on the autonomic nervous system. Anesth Analg 93:456–459

    CAS  PubMed  Google Scholar 

  16. Lydon A, Cooke T, Duggan F, Shorten G (1999) Delayed postoperative gastric emptying following intrathecal morphine and intrathecal bupivacaine. Can J Anesth 46:544–549

    Article  CAS  PubMed  Google Scholar 

  17. Carpenter R, Caplan R, Brown D et al (1992) Incidence and risk factors for side effects of spinal anaesthesia. Anesthesiology 76:906–916

    Article  CAS  PubMed  Google Scholar 

  18. Slappendel R, Weber E, Benraad B et al (2000) Itching after intrathecal morphine. Incidence and treatment. Eur J Anaesthesiol 17:616–621

    Article  CAS  PubMed  Google Scholar 

  19. Clergue F, Montembault C, Despierres O et al (1984) Respiratory effects of intrathecal morphine after upper abdominal surgery. Anesthesiology 61:677–685

    Article  CAS  PubMed  Google Scholar 

  20. Glass P (1984) Respiratory depression following only 0.4 mg of intrathecal morphine. Anesthesiology 60:256–257

    Article  CAS  PubMed  Google Scholar 

  21. Hassett P, Ansari B, Gnanamoorthy P et al (2008) Determination of the efficacy and side-effect profile of lower doses of intrathecal morphine in patients undergoing total knee arthroplasty. BMC Anesthesiol 8:5. https://doi.org/10.1186/1471-2253-8-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Hindle A (2008) Intrathecal opioids in the management of acute postoperative pain. Contin Educ Anaesth Crit Care Pain 8:81–85. https://doi.org/10.1093/bjaceaccp/mkn016

    Article  Google Scholar 

  23. Gehling M, Tryba M (2009) Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: a meta-analysis. Anaesthesia 64:643–651. https://doi.org/10.1111/j.1365-2044.2008.05817.x

    Article  CAS  PubMed  Google Scholar 

  24. Gwirtz KH, Young JV, Byers RS et al (1999) The safety and efficacy of intrathecal opioid analgesia for acute postoperative pain: seven years’ experience with 5969 surgical patients at Indiana University Hospital. Anesth Analg 88:599–604

    CAS  PubMed  Google Scholar 

  25. Sinclair DR, Chung F, Mezei G (1999) Can postoperative nausea and vomiting be predicted? Anesthesiology 91:109–118

    Article  CAS  PubMed  Google Scholar 

  26. Cheah JW, Sing DC, Hansen EN et al (2018) Does intrathecal morphine in spinal anesthesia have a role in modern multimodal analgesia for primary total joint arthroplasty? J Arthroplast. https://doi.org/10.1016/j.arth.2018.01.016

    Article  Google Scholar 

  27. Shaikh SI, Nagarekha D, Hegade G, Marutheesh M (2016) Postoperative nausea and vomiting: a simple yet complex problem. Anesth Essays Res 10:388–396. https://doi.org/10.4103/0259-1162.179310

    Article  PubMed  PubMed Central  Google Scholar 

  28. Apfel CC, Läärä E, Koivuranta M et al (1999) A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 91:693. https://doi.org/10.1097/00000542-199909000-00022

    Article  CAS  Google Scholar 

  29. Aly M, Ibrahim A, Farrag W et al (2018) Pruritus after intrathecal morphine for cesarean delivery: incidence, severity and its relation to serum serotonin level. Int J Obstet Anesth. https://doi.org/10.1016/j.ijoa.2018.02.004

    Article  PubMed  Google Scholar 

  30. Murphy PM, Stack D, Kinirons B, Laffey JG (2003) Optimizing the dose of intrathecal morphine in older patients undergoing hip arthroplasty. Anesth Analg 97:1709–1715. https://doi.org/10.1213/01.ANE.0000089965.75585.0D

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedics, Center for Orthopedic Research and Education, The CORE Institute, 18444 N. 25th Ave, Phoenix, AZ, 85023, USA

    Shane R. Hess

  2. Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA

    Laura A. Lahaye

  3. Greater Pittsburgh Orthopaedic Associates, Pittsburgh, PA, USA

    Andrew C. Waligora

  4. Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA

    Adam P. Sima

  5. Duke University Medical Center, Durham, NC, USA

    William A. Jiranek

  6. Department of Orthopaedic Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA

    Gregory J. Golladay

Authors
  1. Shane R. Hess
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura A. Lahaye
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrew C. Waligora
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adam P. Sima
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. William A. Jiranek
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gregory J. Golladay
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shane R. Hess.

Ethics declarations

Conflicts of interest

Shane R. Hess, Laura A. Lahaye, Andrew C. Waligora, and Adam P. Sima have no conflicts of interest. William A. Jiranek discloses he is a paid consultant, receives royalties, had has stock with DePuy Synthes, and receives research support from DePuy Synthes and Stryker. Gregory J. Golladay discloses he is a paid consultant for OrthoSensor Inc., receives royalties and research support, has stock, and gives paid presentations for OrthoSensor Inc.; he is the deputy editor for Arthroplasty Today, on the editorial board for Journal of Arthroplasty, and is the publications committee chair for AAHKS.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hess, S.R., Lahaye, L.A., Waligora, A.C. et al. Safety and side-effect profile of intrathecal morphine in a diverse patient population undergoing total knee and hip arthroplasty. Eur J Orthop Surg Traumatol 29, 125–129 (2019). https://doi.org/10.1007/s00590-018-2293-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-018-2293-9

Keywords

Search

Navigation