title: [Intrathecal morphine in orthopaedic surgery patients. Optimised dose in patients receiving dipyrone].
abstract: BACKGROUND
  The influence of different postoperative doses of intrathecal morphine on the time of first opioid request by orthopaedic patients was investigated. The first choice analgesic was dipyrone and a maximum dose of 6 mg/day was allowed.
  
  
  METHODS
  A prospective, double-blind, placebo-controlled, clinical trial was conducted with 15 patients in each group receiving intrathecally either a placebo, 0.05 mg morphine, 0.1 mg morphine or 0.2 mg morphine in combination with a spinal anaesthesia with isobaric bupivacaine.
  
  
  RESULTS
  The number of patients without opioid requirement during the first 24 h after surgery were 3, 8, 14 and 14 in the placebo group and after 0.05 mg (p=0.128), 0.1 mg (p=0.0001) and 0.2 mg (p=0.0001) intrathecal morphine, respectively. The average time until first opioid requirement increased in a dose-dependent manner from 10.3 h to 23.9 h (p<0.0001).
  
  
  CONCLUSIONS
  In orthopaedic patients with dipyrone as the primary analgesic, the addition of 0.1 mg or 0.2 mg morphine to spinal anaesthesia provided a simple long-lasting postoperative analgesia and the use of additional opioids could be avoided during the 24h postoperative period.
authors.affiliation: Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum Kassel GmbH, Mönchebergstr. 41-43, 34125, Kassel. gehling@klinikum-kassel.de
authors.forename: M
authors.initials: M
authors.lastname: Gehling
authors.forename: M
authors.initials: M
authors.lastname: Tryba
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D002045:Bupivacaine; D004177:Dipyrone / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019637:Orthopedic Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004177:Dipyrone; D009020:Morphine; D002045:Bupivacaine