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Comparison of the relative analgesic efficacies of epidural or intramuscular diamorphine following total knee arthroplasty

Published online by Cambridge University Press:  01 November 2007

R. J. Green ,
J. Chambers ,
P. W. Thomas ,
L. Monnery ,
G. Titley  and
T. Doyle
R. J. Green*
Affiliation:
Royal Perth Hospital, Perth, UK
J. Chambers
Affiliation:
Salisbury District Hospital, Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK
P. W. Thomas
Affiliation:
Dorset Research and Development Support Unit, Poole Hospital NHS Trust, Poole, Dorset, UK
L. Monnery
Affiliation:
Southampton University Hospital NHS Trust, Shackleton Department of Anaesthesia, Southampton, UK
G. Titley
Affiliation:
Poole Hospital NHS Trust, Ronald Fisher Anaesthetic Department, Poole, Dorset, UK
T. Doyle
Affiliation:
WestDorset General Hospital, Anaesthetic Department, Dorchester, UK
*
Correspondence to: Richard James Green, Royal Perth Hospital, Wellington Street, Perth WA 6000, UK. E-mail: rjgreen@doctors.org.uk; Tel: +44 61 8 9224 2244; Fax: +44 61 8 9224 1111
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Summary

Background and objectives

Debate has proliferated as to the true site of action of opioids when placed in the epidural space. The aim of this study was to compare the analgesic effects of a bolus of diamorphine given by the epidural or intramuscular route.

Methods

Sixty patients having elective primary total knee replacements were recruited and randomized to receive epidural or intramuscular diamorphine. A lumbar epidural catheter was sited and 10 mL of bupivacaine 0.5% wt vol−1 was injected. Patients subsequently received diamorphine 5 mg into the epidural space or as an intramuscular injection. Patient-controlled analgesia with intravenous morphine was used for postoperative analgesia. The primary outcome measures included time to first patient-controlled analgesia use and total morphine consumption in 24 h. Secondary end-points considered possible treatment complications.

Results

All primary end-points showed significant differences in favour of epidural diamorphine. Medians for times to first patient-controlled analgesia use and total 24 h morphine requirements were significantly different (P < 0.001) at 418 vs. 198 min and 11 vs. 39 mg, respectively. There were no significant differences in secondary end-points.

Conclusions

This study has shown the superior analgesic efficacy of epidural diamorphine when compared to intramuscular injection.

Keywords

POSTOPERATIVE NAUSEA AND VOMITINGANAESTHETIC RECOVERY PERIODANALGESIA, postoperativeOPIOIDS, diamorphineANALGESIA EPIDURAL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 11 , November 2007 , pp. 951 - 957
Copyright
Copyright © European Society of Anaesthesiology 2007

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