Comparison of the Use of Different Doses of Intrathecal Morphine Added to Levobupivacaine for Spinal Anaesthesia During Unilateral Inguinal Hernia Repair
Abstract
Background: Spinal anaesthesia offers safe and comfortable surgery in inguinal hernia repair. Local anaesthetic and opioid combinations are gaining popularity in intrathecal anaesthesia due to many advantages both in terms of providing patient and surgical satisfaction in addition to acceptable complication rates. In this study we aimed to compare different morphine doses added to levobupivacaine for intratechal anesthesia in unilateral inguinal hernia repair. Material and Methods Patients were randomly divided into three groups: 12 mg/ 2.5 ml levobupivacaine only (Group L), 12 mg levobupivacaine with 50μg morphine (Group LM50), 12 mg levobupivacaine with 100μg morphine (Group LM100). Then, groups were compared for vital signs, sensorial neural block levels, motor block levels, side effects and drug therapies at the post anaesthesia period. Time of sensory and motor block, first mobilization, urination and discharge were also recorded for all patients. Results: Mean sensory block level of patients in Group L at 20th minute was significantly lower than those in Group LM50 and Group LM100 (p<0.05). The mean time required to achieve maximum motor block were significantly shorter in Group LM50 and Group LM100 than that in Group L (p=0.008 and p=0.001 respectively). The duration of motor block was significantly longer in Group LM50 and Group LM100 than that in Group L (p=0.020, p=0.019, respectively). The mean time for first postoperative analgesic demand in Group L was significantly shorter than those in Group LM50 and Group LM100 (p=0.001 and p<0.0001 respectively). Conclusion: We can state that combination of levobupivacaine with different morphine doses of 50 or 100 µg results in increased perioperative anaesthesia and analgesia quality without any significant post-anaesthesia complication during elective unilateral inguinal hernia repair.References
- Gristwood RW, Greaves JL. Levobupivacaine: A new safer long acting local anaesthetic agent. Exp Opin Invest Drugs 1999;8: 861-76.
- Foster RH, Markham A. Levobupivacaine A review of its pharmacology and use as a local anesthesic. Drugs 2000; 59: 551-79.
- Leone S, Di Cianni S, Casati A, Fanelli G. Pharmacology, toxicology, and clinical use of new long acting local anaesthetics, ropivacaine and levobupivacaine. Acta Biomed 2008; 79: 92-105.
- Vercauteren PM, Hans G, De Decker K, Andriaensen HA. Levobupivacaine Combined with Sufentanil and Epinephrine for Intrathecal Labor Analgesia: A Comparison with Racemic Bupivacaine. Anesth Analg 2001; 93: 996-1000.
- Alley EA, Kopacz DJ, McDonald SB, Liu SS. Hyperbaric spinal levobupivacaine: a comparison to racemic bupivacaine in volunteers. Anesth Analg 2002; 94: 188-93.
- Glaser C, Marhofer P, Zimpfer G, Heinz MT, Sitzwohl C, Kapral S, et al. Levobupivacaine Versus Racemic Bupivacaine for Spinal Anesthesia Anesth Analg 2002; 94: 194-198.
- Sell A, Olkkola KT, Jalonen J, Aantaa R. Minimum effective local anesthetic dose of isobaric levobupivacaine and ropivacaine administered via a spinal catheter for hip replacement surgery. Br J Anaesth 2005; 94: 239-42.
- Lee YY, Muchal K, Chan CK. Levobupivacaine vs. racemic bupivacaine in spinal anaesthesia for urological surgery. Anaesth Intens Care 2003; 31: 637-41.
- Murphy PM, Stack D, Kinirons B, Laffey JG. Optimizing the dose of intrathecal morphine in older patients undergoing hip arthroplasty. Anesth Analg 2003; 97: 1709-15.
- Gupta A, Axelsson K, Thörn SE, Matthiessen P, Larsson LG, Holmström B et al. Low-dose bupivacaine plus fentanyl for spinal anesthesia during ambulatory inguinal herniorrhaphy: a comparison between 6 mg and 7.5 mg of bupivacaine. Acta Anaesthesiol Scand 2003 47: 13-9.
- Goel S, Bhardwai N, Grover VK. Intrathecal fentanyl added to intrathecal bupivacaine for day case surgery: a randomized study. Eur J Anaesthesiol 2003; 20: 294-7.
- Korhonen AM, Valanne JV, Jokela RM, Ravaska P, Korttila K. Intrathecal hyperbaric bupivacaine 3 mg+fentanyl 10 microg for outpatient knee arthroscopy with tourniquet. Acta Anaesthesiol Scand 2003; 47: 342-6.
- Kalso E. Effects of intrathecal morphine, injected with bupivacaine, on pain after orthopaedic surgery. Br J Anaesth 1983; 55: 415-21.
- Abouleish E, Rawal N, Fallon K. Combined intrathecal morphine and bupivacaine for cesarean section. Anesth Analg 1988; 67: 370-74.
- Cole PJ, Craske DA, Wheatley RG. Efficacy and respiratory effects of low-dose spinal morphine for post-operative analgesia following knee arthroplasty. Br J Anaesth 2000; 85: 233-7.
- Fattorini F, Ricii Z, Rocco A, Romano R, Pascarella MA, Pınto G. Levobupivacaine versus racemic bupivacaine for spinal anesthesia in orthopaedic major surgery. Minerva Anestesiol 2006; 72: 637-44.
- Cappelleri G, Aldegheri G, Danelli G, Marchetti C, Nuzzi M, Iannandrea G. Spinal anestesia with hyperbaric levobupivacaine and ropivacaine for outpatient knee arthroscopy: a prospective, randomized. Double-blind study. Anesth Analg 2005; 101: 77-82.
- Cuvas O, Er AE, Ongen E, Basar H. Spinal anesthesia for transurethral resection operations: bupivacaine versus levobupivacaine. Minerva Anestesiol 2008; 74: 697-701.
- Luck JF, Fettes PD, Wildsmith JA Spinal anaesthesia for elective surgery: a comparison of hyperbaric solutions of racemic bupivacaine, levobupivacaine, and ropivacaine. Br J Anaesth 2008; 101(5): 705-10.
- Casati A, Moizo E, Marchetti C, Vinciguerra F. A prospective randomized, double-blind comparison of unilateral spinal anesthesia with hyperbaric bupivacaine, ropivacaine, or levobupivacaine for inguinal herniorrhaphy. Anest Analg 2004; 99: 1387-92.
- Demiraran Y, Yucel I, Akcali GE, Degirmenci E, Sezen G, Iskender A. Adding intrathecal morphine to unilateral spinal anesthesia results in better pain relief following knee arthroscopy. J Anesth 2008; 22: 367-72.
- Girgin NK, Gurbet A, Turker G, Bulut T, Demir S, Kilic N, et al. The combination of low-dose levobupivacaine and fentanyl for spinal anaesthesia in ambulatory inguinal herniorrhaphy. J Int Med Res 2008 ; 36: 1287-92.
- Kuusniemi KS, Pihlajamäki KK, Pitkänen MT, Helenius HY, Kirvelä OA. The use of bupivacaine and fentanyl for spinal anesthesia for urologic surgery. Anesth Analg 2000; 91: 1452-6.
- Goodarzi M, Narasimhan RR. The effect of large-dose intrathecal opioids on the autonomic nervous system. Anesth Analg 2001; 93: 456-9.
- Slappendel R, Weber EWG, Dirksen R, Gielen MJM, van Limbeek J. Optimization of the dose of intrathecal morphine in total hip surgery: A dose-finding study. Anesth Analg 1999; 88: 822-6.
- Rathmell JP, Pino CA, Taylor R, Partin T, Viani BA. Intrathecal morphine for postoperative analgesia: A randomized controlled dose ranging study after hip and knee arthroplasty. Anesth Analg 2003; 97: 1452-7.
- Grattidge P. Nausea and vomiting after major arthroplasty with spinal anaesthesia including morphine: a randomised trial of subhypnotic propofol infusion as prophylaxis. Acta Anaesthesiol Scand 1998; 42: 124-7.
- Auroy Y, Narchi P, Messiah A, Litt L, Rouvier B, Samii K. Serious complications related to regional anesthesia: Results of a prospective survey in France. Anesthesiology 1997;87:479-86.
- Kehlet H, Aasvang E. Groin hernia repair: Anesthesia W J Surg 2005; 29: 1058-61.
- Nordin P, Zetterström H, Gunnarsson U, Nilsson E. Local, regional or general anaesthesia in groin hernia repair: multicentre randomized trial. Lancet 2003; 362: 853-8.
- Pekka Tarkkila. Complications associated with spinal anesthesia. In, Brendan T Finucane (ed), Complications of Regional Anesthesia, 2nd ed., Springer, 2007; 149-166
- van Veen RN, Mahabier C, Dawson I, Hop WC, Kok NF, Lange JF et al. Spinal or local anesthesia in lichtenstein hernia repair: a randomized controlled trial. Ann Surg 2008; 247: 428-33.
- Korhonnen AM. Use of spinal anesthesia in day surgery. Curr Opin Anaesthesiol 2006; 19: 612-16.
- Kallio H, Snäll EV, Suvanto SJ, Tuomas CA, Iivonen MK, Pokki JP et al. Spinal hyperbaric ropivacaine-fentanyl for day-surgery. Reg Anesth Pain Med 2005; 30: 48-54
- Seewal R, Shende D, Kashyap L, Mohan V. Effect of addition of various doses of fentanyl intrathecally to 0.5% hyperbaric bupivacaine on perioperative analgesia and subarachnoid-block characteristics in lower abdominal surgery: a dose-response study. Reg Anaesth Pain Med 2007; 32: 20-6.
