May, Lee Jun
(2020)
Comparison of the Efficacy of Intrathecal Fentanyl
20mcg versus Intrathecal Morphine 0.2 mg as an
adjuvant therapy in spinal anesthesia in lower limb
surgery.
Masters thesis, Universiti Sains Malaysia.
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 assess 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 sedation and respiratory
depression between the 2 groups.
Results:
Intrathecal morphine group revealed significantly lower median pain 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 vomiting
and pruritus which can be prophylactically treated with antiemetics.
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