Intrathecal Morphine for Unilateral Total Knee Arthroplasty
Efficacy and Side Effects of Intrathecal Morphine in Multimodal Analgesia for Unilateral Total Knee Arthroplasty
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Intrathecal opioid is effective postoperative analgesia for orthopedic lower extremity surgery. However there are some limitations such as nausea, vomiting, pruritus, dizziness. Nowadays multimodal analgesia is used in unilateral total knee arthroplasty include oral analgesic drugs, adductor canal block and local analgesia infiltration.
This study evaluates whether intrathecal opioid should be added in the role of multimodal analgesia in total knee arthroplasty.
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Bangkok
-
Bangkok Noi, Bangkok, Thailand, 10700
- Faculty of Medicine Siriraj Hospital, Mahidol University
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Aged more than 18 years old undergoing unilateral total knee arthroplasty
- American Society of Anesthesiologists physical status classification 1-3
Exclusion Criteria:
- Participants deny to enroll the study
- Allergy to local anesthetics, opioid and NSAIDs
- Hepatic disease
- Contraindication for neuraxial block or adductor canal block
- Uncontrolled cardiovascular disease
- Creatinine clearance less than 50 ml/min
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: DOUBLE
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
EXPERIMENTAL: No IT morphine
Spinal block with 0.5% isobaric with no intrathecal morphine
|
Spinal block with bupivacaine and intrathecal morphine 0 ug
intrathecal morphine
0.5 isobaric bupivacaine
|
|
EXPERIMENTAL: 50 ug IT morphine
Spinal block with 0.5% isobaric with 50 ug intrathecal morphine
|
intrathecal morphine
0.5 isobaric bupivacaine
Spinal block with bupivacaine and intrathecal morphine 50 ug
|
|
EXPERIMENTAL: 100 ug IT morphine
Spinal block with 0.5% isobaric with 100 ug intrathecal morphine
|
intrathecal morphine
0.5 isobaric bupivacaine
Spinal block with bupivacaine and intrathecal morphine 100 ug
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Numerical rating scale
Time Frame: Within 48 hours
|
Numerical rating scale 0-10
|
Within 48 hours
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Morphine requirement
Time Frame: Within 48 hours
|
Systemic morphine requirement
|
Within 48 hours
|
|
Nausea vomiting
Time Frame: Within 48 hours
|
Incidence and severity of nausea and vomiting
|
Within 48 hours
|
|
Pruritus
Time Frame: Within 48 hours
|
Incidence and severity of pruritus
|
Within 48 hours
|
Collaborators and Investigators
Sponsor
Sponsor
Publications and helpful links
General Publications
- McCartney CJ, Nelligan K. Postoperative pain management after total knee arthroplasty in elderly patients: treatment options. Drugs Aging. 2014 Feb;31(2):83-91. doi: 10.1007/s40266-013-0148-y.
- Stowers MD, Lemanu DP, Coleman B, Hill AG, Munro JT. Review article: Perioperative care in enhanced recovery for total hip and knee arthroplasty. J Orthop Surg (Hong Kong). 2014 Dec;22(3):383-92. doi: 10.1177/230949901402200324.
- Rathmell JP, Pino CA, Taylor R, Patrin T, Viani BA. Intrathecal morphine for postoperative analgesia: a randomized, controlled, dose-ranging study after hip and knee arthroplasty. Anesth Analg. 2003 Nov;97(5):1452-1457. doi: 10.1213/01.ANE.0000083374.44039.9E.
- Ibrahim MS, Alazzawi S, Nizam I, Haddad FS. An evidence-based review of enhanced recovery interventions in knee replacement surgery. Ann R Coll Surg Engl. 2013 Sep;95(6):386-9. doi: 10.1308/003588413X13629960046435.
- Hassett P, Ansari B, Gnanamoorthy P, Kinirons B, Laffey JG. Determination Of The Efficacy And Side-effect Profile Of Lower Doses Of Intrathecal Morphine In Patients Undergoing Total Knee Arthroplasty. BMC Anesthesiol. 2008 Sep 24;8:5. doi: 10.1186/1471-2253-8-5.
- Nakai T, Tamaki M, Nakamura T, Nakai T, Onishi A, Hashimoto K. Controlling pain after total knee arthroplasty using a multimodal protocol with local periarticular injections. J Orthop. 2013 Mar 17;10(2):92-4. doi: 10.1016/j.jor.2013.02.001. eCollection 2013.
- Kunopart M, Chanthong P, Thongpolswat N, Intiyanaravut T, Pethuahong C. Effects of single shot femoral nerve block combined with intrathecal morphine for postoperative analgesia: a randomized, controlled, dose-ranging study after total knee arthroplasty. J Med Assoc Thai. 2014 Feb;97(2):195-202.
Study record dates
Study Major Dates
Study Start (ACTUAL)
Study Start
Primary Completion (ACTUAL)
Primary Completion
Study Completion (ACTUAL)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (ACTUAL)
First Posted
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Joint Diseases
- Musculoskeletal Diseases
- Rheumatic Diseases
- Arthritis
- Osteoarthritis
- Osteoarthritis, Knee
- Physiological Effects of Drugs
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Anesthetics
- Analgesics, Opioid
- Narcotics
- Anesthetics, Local
- Bupivacaine
- Morphine
Other Study ID Numbers
Other Study ID Numbers
- Si 331/2017
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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