Spinal anesthesia for arthroscopic knee surgery

Acta Anaesthesiol Scand. 2004 Apr;48(4):513-7. doi: 10.1111/j.1399-6576.2004.00353.x.

Abstract

Background and objective: The purpose of the study was to compare the effects of adding 50 microg of morphine, 25 microg of fentanyl or saline to 6 mg of hyperbaric bupivacaine on postoperative analgesia and time to urination in patients undergoing arthroscopic knee surgery under spinal anesthesia.

Methods: The study was designed in a prospective, randomized, double-blinded and placebo-controlled manner. Sixty ASA I-II patients were randomized into the following three groups: Group BM: 6 mg of bupivacaine and 50 microg of morphine, Group BF: 6 mg of bupivacaine and 25 microg of fentanyl, and Group BS: 6 mg of bupivacaine and saline. Selective spinal anesthesia was performed in a lateral decubitus position, with the operative knee dependent for 10 min.

Results: In all groups satisfactory anesthesia was provided during the operation. There was a statistically significant difference between all the groups in times to voiding [Group BM 422 +/- 161 min; Group BF 244 +/- 163 min; Group BS 183 +/- 54 min (mean +/- SD)]. The incidence of pruritus was significantly greater in Group BM (80%) and BF (65%) in comparison with Group BS (no pruritus) (P < 0.05). The incidence of nausea was significantly increased in Group BM (35%) in comparison with Group BF (10%) and Group BS (P < 0.05). Analgesic consumption was significantly greater in Group BS in comparison with Groups BM and BF (P < 0.01).

Conclusions: We conclude that during spinal anesthesia even mini-dose intrathecal morphine is not acceptable for outpatient surgery due to side-effects, especially severely prolonged time to urination.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / therapeutic use
  • Analgesics, Opioid / urine
  • Anesthesia, Spinal / methods*
  • Anesthetics, Local / adverse effects
  • Anesthetics, Local / therapeutic use
  • Anesthetics, Local / urine
  • Arthroscopy / methods*
  • Bupivacaine / adverse effects
  • Bupivacaine / therapeutic use*
  • Bupivacaine / urine
  • Double-Blind Method
  • Female
  • Fentanyl / adverse effects
  • Fentanyl / therapeutic use*
  • Fentanyl / urine
  • Humans
  • Knee Joint / surgery*
  • Length of Stay
  • Male
  • Middle Aged
  • Morphine / adverse effects
  • Morphine / therapeutic use*
  • Morphine / urine
  • Pain, Postoperative / drug therapy
  • Prospective Studies
  • Pruritus / chemically induced
  • Sodium Chloride / administration & dosage
  • Sodium Chloride / adverse effects
  • Sodium Chloride / urine
  • Urination / drug effects

Substances

  • Analgesics, Opioid
  • Anesthetics, Local
  • Sodium Chloride
  • Morphine
  • Fentanyl
  • Bupivacaine