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Comparison of 75 and 150 µg doses of intrathecal morphine for postoperative analgesia after transurethral resection of the prostate under spinal anesthesia

Halime Özbek, MD, Mustafa N. Deniz, MD, Arzum Erakgun, MD, Elvan Erhan, MD

Abstract


Objective: The administration of single dose intrathecal (IT) morphine with local anesthetics during spinal anesthesia produces an effective postoperative analgesia. In this study, we evaluated the efficacy and safety of two different doses of IT morphine with bupivacaine for postoperative analgesia after transurethral resection of prostate (TURP).

Study design: Prospective, randomized study.

Setting: Urology Department.

Patients, participants: Sixty patients who were scheduled to undergo TURP with spinal anesthesia.

Methods: Patients were allocated to receive IT morphine (75 µg) with bupivacaine heavy (group I) and IT morphine (150 µg) with bupivacaine heavy (group II). Postoperative pain was evaluated by Visual Analogous Scale during 24 hours. The need for rescue analgesia, adverse effects and patient satisfaction were recorded.

Results: Groups were comparable with respect to demographic data. VAS scores were similarly low in both groups. However, the request for analgesia was significantly higher in group I (27 percent) than group II (7 percent; p = 0.04). The incidence of postoperative nausea was similarly low in both groups. No patients reported pruritis in group I where as six patients (20 percent) reported mild pruritis not necessitating treatment in group II (p = 0.036) Patients satisfaction was similarly high in both the groups.

Conclusions: IT morphine 150 µg reduced the need for rescue analgesia compared to IT morphine 75 µg in patients undergoing TURP under spinal anesthesia. As the incidence of pruritis was low with no treatment, IT morphine 150 µg may be a suitable dose for postoperative analgesia for patients undergoing TURP under spinal anesthesia.


Keywords


spinal anesthesia, morphine, postoperative analgesia, transurethral resection of prostate

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References


Morgan GE, Mikhail MS, Murray MJ, et al.: Anesthesia for genitourinary surgery. Morgan GE, Mikhail MS, Murray MJ, et al., (eds.): Clinical Anesthesiology, 3rd ed. New York City, NY: McGraw-Hill Companies, 2002: 692-707.

Hahn RG: Fluid absorption in endoscopic surgery. Br J Anaesth. 2006; 96(1): 8-20.

Gravenstein D: Transurethral resection of the prostate (TURP) Transurethral resection of the prostate (TURP). Anaesth Analg. 1997; 84(2): 438-446.

Cooney KA, Strawderman MS, Wojno KJ, et al.: Age-specific distribution of serum prostate-specific antigen in a community-based study of African-American men. Urology. 2001; 57(1): 91-96.

Kirson LE, Goldman JM, Slover RB: Low-dose intrathecal morphine for postoperative pain control in patients undergoing transurethral resection of the prostate. Anesthesiology. 1989; 71(2): 192-195.

Rathmell JP, Lair TR, Nauman B: The role of intrathecal drugs in the treatment of acute pain. Anesth Analg. 2005; 101(5): 30-43.

Meylan N, Elia N, Lysakowski C, et al.: Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing mojor surgery: Meta-analysis of randomized trials. Br J Anaesth. 2009; 102(2): 156-167.

Gehling M, Tryba M: Risks and side-effects of inrathecal morphine combined with spinal anaesthesia: A meta-analysis. Anaesthesia. 2008; 64(6): 643-651.

Daniel MP, Elia N, Marret E, et al.: Opioids added to local anesthetic for single-shot intrathecal anesthesia in patients undergoing surgery: A meta-analysis of randomized trials. Pain. 2012; 153(4): 784-793.

Cunningham AJ, McKenna JA, Skene DS.: Single injection spinal anaesthesia with amethocaine and morphine for transurethral prostatectomy. Br J Anaesth. 1983; 55(5): 423-427.

Sakai T, Use T, Shimamoto H, et al.: Mini-dose (0.05mg) intrathecal morphine provides effective analgesia after transurethral resection of the prostate. Can J Anaesth. 2003; 50(10): 1027-1030.

Duman A, Apiliogullari S, Balasar M, et al.: Comparison of 50 _g and 25 _g doses of intrathecal morphine on postoperative analgesic requirements in patients undergoing transurethral resection of the prostate with intrathecal anesthesia. J Clin Anesth. 2010; 22(5): 329-333.

Kararmaz A, Kaya S, Turhanoglu S, et al.: Low-dose bupivacaine-fentanyl spinal anaesthesia for transurethral prostatectomy. Anesthesia. 2003; 58(6): 526-530.

Gustafsson LL, Schildt B, Jacobsen K: Adverse effects of extradural and intrathecal opiates: Report of a nationwide survey in Sweden. Br J Anaesth. 1982; 54(5): 479-485.




DOI: https://doi.org/10.5055/jom.2013.0184

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