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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2017 Mar 03
Copyright © 2017 EDIZIONI MINERVA MEDICA
Intraspinal administration of morphine hydrochloride combined with low doses of bupivacaine in hemorrhoidectomy: a clinical randomised trial
Manuel RUIZ-CASTRO 1, 2 ✉, Marta SAN JOSÉ SANTOS 3, Antonio RODRÍGUEZ-MIGUEL 4, Francisco J. de ABAJO IGLESIAS 4, 5
1 Anesthesiology, Resuscitation and Pain Treatment Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain; 2 Department of Surgery, Medical and Social Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain; 3 Anesthesiology, Resuscitation and Pain Treatment Department, Hospital del Henares, Madrid, Spain; 4 Clinical Pharmacology Unit, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain; 5 Department of Biomedical Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
BACKGROUND: Intrathecal local anesthetics, associated or not to opioids, is commonplace in anorectal surgery, but it is unknown which is the option with the best risk-benefit ratio. The main aim was to assess whether the combination of morphine (50 mcg) with low-dose bupivacaine (3 mg) in an intradural solution has a better analgesic short-term effect than bupivacaine alone at standard doses (5 mg) in hemorrhoidectomy.
METHODS: 66 patients of any sex were randomly assigned to two alternative treatments and 63 patients were considered valid for analysis. Hyperbaric bupivacaine 3 mg combined with 50 mcg of intradural morphine hydrochloride (BUP-MOR group) was compared with 5 mg hyperbaric bupivacaine (BUP group). The primary outcome was pain evaluated through a visual analog scale (from 0 to 100 mm) at 24 hours post-surgery. The proportion of patients requiring rescue analgesia, and those presenting with motor blockade and other adverse events was also compared between the two groups.
RESULTS: BUP-MOR group showed a higher efficacy than BUP group in the visual analog scale at 24 hours post-surgery (1512 vs. 3322 mm; p<0.001). Also, BUP-MOR group presented a lower percentage of patients who needed rescue analgesia at resuscitation room (6.7% vs. 24.2%; p=0.08) and a lower proportion of patients who had motor blockade (23.3% vs. 51.5%; p=0.02), while they presented a non-significant increased incidence of urinary retention (23.3% vs. 9.0%; p=0.17).
CONCLUSIONS: The addition of intradural morphine allows a reduction in the dosage of local anesthetic improves short-term postoperative analgesia and is associated with less motor blockade.
KEY WORDS: Intradural - Morphine - Bupivacaine - Hemorrhoidectomy