[A bupivacaine-morphine combination by intrathecal route: correlation between pain relief and postoperative neuroendocrine response].
The purpose of the present study was to assess the repercussion of morphine injected in the intrathecal space on postoperative neuroendocrine response and the correlation with pain relief in the postop period. We studied 50 healthy patients (ASA I-II) submitted to orthopaedic surgery under general anaesthesia (N = 25) or spinal anaesthesia (N = 25). In the group under general anaesthesia we observed a hypersecretion of ADH, ACTH, cortisol and aldosterone during and after surgery. In the group un spinal anaesthesia, it was evident, on the contrary, a blockade of the neuroendocrine response during surgery, as well as an attenuation during postoperative period. Intraoperative and postoperative bleeding with spinal anaesthesia was significantly lower (p less than 0.01; p less than 0.05 respectively) than with general anaesthesia. Postoperative analgesia was excellent in group with spinal anaesthesia; the average duration of analgesia was 16.3 hours. We conclude that small intrathecal doses of morphine have beneficial effects and may be used usefulness in orthopaedic surgery.
Adrián
J R
JR
Servicio de Anestesiología y Reanimación, Hospital de Navarra, Pamplona.
Sanz Lipúzcoa
J
J
Sanz Fernández
J
J
Olmos
M
M
Ayesa
M A
MA
Arroyo
J L
JL
D000324:Adrenocorticotropic Hormone / Q000097:blood / Q000378:metabolism*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000450:Aldosterone / Q000097:blood / Q000378:metabolism*; D000698:Analgesia; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D002045:Bupivacaine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D005269:Femur / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism*; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D009490:Neurosecretory Systems / Q000187:drug effects*; D010027:Osteotomy; D010149:Postoperative Pain / Q000188:drug therapy*; D011183:Postoperative Complications / Q000517:prevention & control; D014667:Vasopressins / Q000097:blood / Q000378:metabolism*
D004338:Drug Combinations; D014667:Vasopressins; D000450:Aldosterone; D009020:Morphine; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone; D002045:Bupivacaine
Asociación bupivacaína-morfina por vía intratecal: correlación entre alivio del dolor y respuesta neuroendocrina postoperatoria.