title: Reduction in pulmonary embolism after total joint arthroplasty: three years of experience with extended-release epidural morphine.
abstract: A retrospective analysis of 659 patients who had undergone a hip or knee arthroplasty was undertaken to determine the incidence of pulmonary embolism (PE) during the 48-hour period following surgery. Data related to pain control, concomitant medications, length of stay, and adverse reactions were also collated. Patients were evenly divided between those receiving extended-release epidural morphine (EREM: n = 327; mean dose 9.7 mg, range 5 mg to 15 mg) or a control group receiving other treatment for postoperative pain (control: n = 332; 44% of controls had an epidural catheter in place). The incidence of PE was significantly higher in the control group than in the EREM group (control: n = 6 or 1.80% vs. EREM: n = 0). Pain control (by a 10-point verbal numerical rating scale) was significantly improved in the EREM group compared with the control group 48 hours after surgery (2.3 +/- 1.8 vs. 4.7 +/- 2.6) and length of stay was significantly reduced (3.9 +/- 1.5 days vs. 4.5 +/- 2.0 days). Adverse event profiles of the EREM and control groups were consistent with prior published studies with EREM. The use of EREM following lower extremity joint arthroplasty may be associated with a significant reduction in the incidence of PE.
authors.affiliation: Skaggs Regional Medical Center, Department of Surgery and Anesthesiology, Branson, Missouri, USA. rossted@mac.com
authors.forename: Robert H
authors.initials: RH
authors.lastname: Blackshear
authors.forename: Kelli C
authors.initials: KC
authors.lastname: Crosson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001178:Arthroplasty / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine