[Intrathecal opiate-spinal anesthesia. Clinical results of a 1-year study using 0.0375-0.15 mg morphine]

In a prospective study, 184 patients were studied after orthopedic operations with regard to analgesic requirements, analgesic effectiveness, and appearance of postoperative complications. In four groups, 0.0375, 0.075, 0.1 or 0.15 mg morphine was given in combination with 0.5% hyperbaric bupivacaine for perioperative analgesia. The patients' ages ranged between 13 and 90 years (means = 62.97). One hundred sixteen patients did not need any analgesics in the first 24 h. The effect of the spinal opiate was found to be pleasant, especially by patients who received a total hip prosthesis: in this group the average duration of analgesia was more than 24 h in 77.9% and 14.5 h in 22.1% of patients. The need for additional postoperative analgesia was seen earliest in the patients who received a knee prosthesis of the sledge type (P less than 0.05). The overall consumption of the analgesic piritramid was clearly reduced and amounted to 7.7 mg on the day of operation, 8.4 mg on the 1st day, 6.0 mg on the 2nd day, and 3.6 mg on the 3rd day after surgery. The degree of postoperative analgesia was the same in all four groups (P greater than 0.05). Blood gas analyses, respiratory rate, blood pressure, heart rate, oxygen saturation, and laboratory parameters were also examined. The application of small doses of opiate close to the spinal cord produced a good and long-lasting reduction of pain with few opiate side effects. In the spinal anesthetics with larger doses of morphine, side effects were rare and hardly different from those accompanying spinal anesthesia without morphine addition. There were no serious complications noted during the opiate anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)