Publication: Comparison of the efficacy of intrathecal fentanyl 20mcg versus intrathecal morphine 0.2 mg as an Adjuvant therapy in spinal anesthesia in lower
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Date
2020
Authors
May, Lee Jun
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Abstract
Background Spinal anesthesia is the preferred method of anesthesia for majority of
the lower limb surgery. Intrathecal Morphine is an adjuvant used to provide prolonged
analgesia post operatively. The objective of this study was to investigate the efficacy
of adding Intrathecal morphine 0.2mg by assessing the analgesic effect 24hours post
spinal anesthesia and to access the proportion of complication that ensues.
Methods
43 patients scheduled for various lower limb orthopedic surgery were studied in a
prospective, single blinded controlled clinical trial. They were divided into 2 groups;
Patient in ITF group receive 2.8mls of 0.5% hyperbaric bupivacaine with 20mcg of
fentanyl added whilst patient in ITM group received 2.8mls of 0.5% hyperbaric
bupivacaine with 0.2 mg of morphine added. The primary outcome was the pain score
within 24 hours post operatively while the secondary endpoint was to determine the
proportion of complications (nausea, vomiting, pruritus and sedation) between the 2
groups.
Results:
Intrathecal morphine group revealed significantly lower median score at 6th, 12th,
18th and 24th hour post op. There was a significant difference in VAS score between
the ITF and ITM group over 24 hours post operatively. There is no difference in
terms of incidence of nausea between 2 groups (p=0.098), higher incidence of
vomiting (n=9, 39.1%, p=0.002 ) and pruritus (n=10, 43.5%, p=0.001) in ITM
group, No incidence of respiratory depression was recorded in both ITF and ITM
group.
Conclusion:
Intrathecal morphine 0.2 mg as an adjuvant to spinal anesthesia provided prolonged
24 hours analgesia with no respiratory depression but at the expense of increased
nausea, vomiting and pruritus which can be prophylactically treated with
antiemetics,