Korean J Anesthesiol.  2008 May;54(5):544-551. 10.4097/kjae.2008.54.5.544.

The Effect of Intrathecal Morphine Added to Continuous Femoral 3-in-1 Nerve Block for Analgesia after Total Knee Replacement

• Park CK
• Cho CK
• Shin HH
• Cho JH

• KMID: 2236551
• DOI: http://doi.org/10.4097/kjae.2008.54.5.544

Abstract

BACKGROUND: Most of the patients who received a 3-in-1 nerve block for analgesia after total knee replacement (TKR) complained of pain in the back of the knee. We investigated the value of an intrathecal (IT) morphine in patients receiving continuous 3-in-1 nerve block with a PCA technique for pain control after unilateral TKR.
METHODS
Group 1 (n = 20) received spinal anesthesia with IT fentanyl 10microgram. Group 2 (n = 20) received spinal anesthesia with IT morphine 0.1 mg. All patients received continuous 3-in-1 nerve block performed with 20 ml of 0.25% bupivacaine with epinephrine 1 : 200000, followed by a continuous infusion of 0.125% bupivacaine at the rate of 2 ml/h plus PCA boluses of 1 ml with a lockout of 10 min. The intensity of pain at rest and on movement was assessed by the patients using a visual analog scale (VAS) for the first 2 postoperative days.
RESULTS
Patients in Group 2 reported significantly lower VAS pain scores at rest than those in Group 1 for the first 1 day (P < 0.05). Cumulative PCA bolus use of 0.125% bupivacaine in Group 2 was significantly lower than those in Group 1 for the first 2 days (P < 0.05). The incidences of pruritus in Groups 1 and 2 were 0 and 50%, respectively (P < 0.01).
CONCLUSIONS
We determined that the addition of IT morphine 0.1 mg to continuous femoral 3-in-1 nerve block improves postoperative analgesia after TKR.

Keyword

intrathecal fentanyl; intrathecal morphine; 3-in-1 block; visual analog scale

MeSH Terms

Analgesia
Anesthesia, Spinal
Arthroplasty, Replacement, Knee
Bupivacaine
Epinephrine
Fentanyl
Humans
Incidence
Knee
Morphine
Nerve Block
Passive Cutaneous Anaphylaxis
Pruritus
Bupivacaine
Epinephrine
Fentanyl
Morphine