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Epidural morphine improves postoperative analgesia in patients after total knee arthroplasty: A randomized controlled trial
- Source :
- PLoS ONE, Vol 14, Iss 7, p e0219116 (2019), PLoS ONE
- Publication Year :
- 2019
- Publisher :
- Public Library of Science (PLoS), 2019.
-
Abstract
- Background Patients after total knee arthroplasty (TKA) often develop moderate to severe pain. This study compared the analgesic effect of low-dose epidural morphine vs. a comparable saline injection in patients following TKA surgery. Methods This randomized, double-blinded, and placebo-controlled trial was conducted in a tertiary hospital in Beijing between July 1, 2017 and May 30, 2018. One hundred and ten patients following TKA under combined spinal-epidural anesthesia were randomized to receive either epidural morphine (2 mg diluted to 5 ml normal saline, the epidural morphine group) or placebo (5 ml normal saline, the placebo group). For all patients, single-injection femoral nerve block was performed, and a supplementary patient-controlled intravenous analgesia pump was provided. The severity of pain was assessed with the numerical rating scale (NRS, an 11-point scale where 0 = no pain and 10 = the worst pain) at 6, 12, 24, 36, and 48 hours after surgery. The primary endpoint was moderate to severe pain (NRS pain score ≥4) within 48 hours after surgery. Results The percentage with moderate to severe pain within 48 hours was lower in the epidural morphine group than in the placebo group (58.2% [32/55] with epidural morphine vs. 76.4% [42/55] with placebo; OR 0.43, 95% CI 0.19–0.98; p = 0.042). Furthermore, the cumulative morphine consumption within 48 hours was lower (18.4±6.1 mg vs. 22.4±7.3 mg; p = 0.002) whereas the mental component summary score of 30-day quality of life was higher (63.8±2.9 vs. 61.9±4.2; p = 0.008) in the epidural morphine group than in the placebo group. Conclusions For patients following TKA, the addition of epidural morphine to single-injection femoral nerve block improves the quality of analgesia within 48 hours, without increasing adverse events. Trial registration ClinicalTrials.gov NCT03203967.
- Subjects :
- Male
Total Knee Arthroplasty
medicine.medical_treatment
law.invention
Epidural Block
0302 clinical medicine
Quality of life
Randomized controlled trial
030202 anesthesiology
law
Anesthesiology
Clinical endpoint
Medicine and Health Sciences
Anesthesia
Arthroplasty, Replacement, Knee
Saline
Pain Measurement
Aged, 80 and over
030222 orthopedics
Analgesics
Pain, Postoperative
Multidisciplinary
Morphine
Pharmaceutics
Drugs
Nerve Block
Middle Aged
Analgesia, Epidural
Treatment Outcome
Medicine
Female
Femoral Nerve
medicine.drug
Research Article
Science
Surgical and Invasive Medical Procedures
Placebo
Arthroplasty
03 medical and health sciences
Musculoskeletal System Procedures
Drug Therapy
Double-Blind Method
medicine
Pain Management
Humans
Adverse effect
Aged
Pharmacology
business.industry
Analgesia, Patient-Controlled
Opioids
Nerve block
Quality of Life
Local and Regional Anesthesia
Analgesia
business
Subjects
Details
- Language :
- English
- ISSN :
- 19326203
- Volume :
- 14
- Issue :
- 7
- Database :
- OpenAIRE
- Journal :
- PLoS ONE
- Accession number :
- edsair.doi.dedup.....fc342225c283dbac18f998fa488b4c0a