Abstract
The authors conducted a randomized, prospective study comparing epidural morphine with patient-controlled intravenous (iv) morphine in 30 patients recovering from total hip or total knee arthroplasty. Six, 18, and 24 hr postoperatively, patients useda 10 cm visual-analogue scale to indicate both their current degree of discomfort and the maximum discomfort they had experienced since the previous evaluation. Pain at the time of evaluation did not differ between patients receiving epidural (2.6 ± 0.4 cm, mean ± SEM) and patient-controlled iv morphine (3.4 ± 0.3 cm). However, patients who received epidural morphine recalled less pain during the period preceding evaluation (4.2 ± 0.5 cm) than did those receiving patient-controlled analgesia (5.5 ± 0.4 cm, P < 0.05). Patients receiving epidural morphine were more likely to require treatment for pruritus (4 of 15) than patients who received patient-controlled iv morphine (none of 15, P < 0.05). Minimum respiratory rates were lower in patients receiving epidural morphine (15.0 ± 0.3) than in those receiving patient-controlled analgesia (16.5 ± 0.4, P < 0.05), but no patients required treatment for respiratory depression. The authors conclude that epidural morphine may provide more consistent analgesia following joint replacement surgery than patient-controlled morphine; however, there is a higher incidence of side-effects with the epidural technique.
Résumé
Les auteurs ont procédé à une étude prospective, randomisée, comparant la morphine épidurale avec l’administration intraveineuse (iv) de morphine controlée par le patient, chez 30 patients ayant subi une arthroplastie totale de la hanche ou du genoux. Les patients ont utilisé une échelle visuelle analogue de 10 cm à 6, 18 et 24 heures dans la période postopératoire pour indiquer le degré d’inconfort à ce moment et le degré d’inconfort maximal ressenti depuis l’évaluation précédente. La douleur, au moment de l’évaluation, n’était pas différente chez les patients sous morphine épidurale (2.6 ± 0.4 cm, moyenne ± ET) comparativement à la morphine IV sous le contrôle du patient (3.4 ± 0.3 cm). Cependant, les patients qui recevaient de la morphine épidurale étaient mains souffrants dans la période précédant l’évaluation (4.2 ± 0.5 cm) que ceux qui recevaient de l’analgésie contrôlée par le patient (5.5 ± 0.4 cm, P <0.05). Quatre des 15 patients recevant de la morphine epidurale ont été traités pour un prurit, comparativement à aucun des 15 patients recevant de la morphine iv sous controle du patient (P < 0.05). Le rythme respiratoire minimum était plus lent chez les patients recevant de la morphine épidurale (15.0 ± 0.3) que chez ceux recevant de l’analgésie controlée par le patient (16.5 ± 0.4, P < 0.05), mais aucun patient n’a dû être traité pour dépression respiratoire. Les auteurs concluent que la morphine épidurale pourrait procurer une analgésie plus consistante que la morphine iv sous controle du patient suite à une chirurgie pour remplacement articulaire; cependant, il y a une incidence plus élevée d’effets secondaires avec la technique épidurale.
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Weller, R., Rosenblum, M., Conard, P. et al. Comparison of epidural and patient-controlled intravenous morphine following joint replacement surgery. Can J Anaesth 38, 582–586 (1991). https://doi.org/10.1007/BF03008188
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DOI: https://doi.org/10.1007/BF03008188