• Masaaki Machino, Yasutsugu Yukawa, Tetsuro Hida, Yoshiharu Oka, Teruo Terashima, Susumu Kinoshita, and Fumihiko Kato.
• Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labour Health and Welfare Organization, 1-10-6 Koumei, Minato-ku, Nagoya 455-8530, Japan. masaaki_machino_5445_2@yahoo.co.jp
• Nagoya J Med Sci. 2010 Aug 1;72(3-4):145-50.

AbstractSystemic opioids are known to be effective for controlling postoperative pain. Intrathecal morphine administration can be performed in a simple manner concurrently with spinal anesthesia. The purpose of this study was to investigate the efficacy of intrathecal morphine administration for the postoperative analgesia of lower extremity fractures. A prospective randomized study for postoperative pain relief was conducted. Fifty consecutive patients with a lower extremity fracture who underwent osteosynthesis under spinal anesthesia were enrolled. The patients were divided into two groups for comparative results. No baseline variable differences between the groups were observed. Twenty-two patients were assigned to a morphine group and were administered intrathecal bupivacaine combined with a single intrathecal injection of morphine. The other 28 patients were assigned to a control group and administered intrathecal bupivacaine alone. Pain intensity was assessed using the Visual Analog Scale (VAS). The use of supplemental analgesics, time of first request for supplemental analgesics, and side effects were investigated. During the initial 12 h after surgery, the VAS score was significantly lower in the morphine group (p < 0.05). The use of supplemental analgesic drugs was significantly less in the morphine group (p < 0.05). The time of first request of the control group was shorter than that of the morphine group (p < 0.001). Side effects were seen more frequently in the morphine group though there was no significant difference. Although the use of morphine requires appropriate postoperative care, an intrathecal morphine injection can be an attractive analgesic for the postoperative pain of lower extremity fractures.

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