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Minerva Anestesiologica 2017 September;83(9):930-8

DOI: 10.23736/S0375-9393.17.11762-1


lingua: Inglese

Intraspinal administration of morphine hydrochloride combined with low doses of bupivacaine in hemorrhoidectomy: a clinical randomized trial

Manuel RUIZ-CASTRO 1, 2 , Marta SAN JOSÉ SANTOS 3, Antonio RODRÍGUEZ-MIGUEL 4, Francisco J. de ABAJO IGLESIAS 4, 5

1 Department of Anesthesiology, Resuscitation and Pain Treatment, Príncipe de Asturias University Hospital, Alcalá de Henares, Spain; 2 Department of Surgery, Medical and Social Sciences, University of Alcalá, Alcalá de Henares, Spain; 3 Department of Anesthesiology, Resuscitation and Pain Treatment, Henares Hospital, Madrid, Spain; 4 Unit of Clinical Pharmacology, Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain; 5 Department of Biomedical Sciences, University of Alcalá, Alcalá de Henares, Spain


BACKGROUNDː 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.
METHODSː Sixty-six 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.
RESULTSː BUP-MOR group showed a higher efficacy than BUP group in the visual analog scale at 24 hours postsurgery (15±12 vs. 33±22 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).
CONCLUSIONSː 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: Injections, spinal - Morphine - Bupivacaine - Hemorrhoidectomy

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