2026, Number 4
Prevalence of postoperative pain after the use of intrathecal opioids in subarachnoid block in patients undergoing hip fracture surgery
Full text
10.35366/123496
Language: Spanish
References: 16
Page: 373-378
PDF size: 630.23 Kb.
ABSTRACT
Introduction: inflammatory pain arises as a response to harmful stimuli, such as an incision in the skin, and is characterized by signs such as pain, heat, erythema, and swelling. After surgery, this pain can be localized, especially in the skin and deep tissues, due to the activation of A-beta nociceptive fibers. To measure pain, unidimensional scales such as the visual analog scale (VAS) are used, which is preferred by anesthesiologists for quickly and effectively assessing postoperative pain. Hip fractures in elderly patients present a high risk of mortality, with 25% of patients being operated on within 48 hours. Recovery after surgery is crucial, as it improves mobility and quality of life by 67%. Optimal analgesic techniques have been developed, such as intrathecal morphine, which provides pain relief for 12 hours postoperatively. This study aims to assess postoperative pain in patients receiving or not receiving this analgesic technique, in order to recommend its use in this population. Objective: to identify the prevalence of postoperative pain after the use of intrathecal opioids in subarachnoid block in patients undergoing hip fracture surgery. Material and methods: we conducted a case-control study with 100 patients aged 18 to 85 years, ASA I, II and III, scheduled for hip arthroplasty surgery (first time). Patients were assigned to group A (n = 50) who received intrathecal opioids such as morphine, or to group B who did not receive intrathecal opioids (n = 50). Postoperative pain was assessed using the visual analogue scale at 0, 30, 60, 90 and 120 minutes postoperatively. Results: at 120 minutes, 8% of the group without opioids presented severe pain, and 2% in the group with opioids (p = 0.434). The prevalence and severity of postoperative pain were significantly lower in the opioid group at all time points. Conclusions: intrathecal morphine reduces immediate postoperative pain but has a higher prevalence of side effects.REFERENCES
Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S,Brennan T et al. Management of postoperative pain: a clinical practiceguideline from the American Pain Society, the American Society ofRegional Anesthesia and Pain Medicine, and the American Societyof Anesthesiologists’ Committee on Regional Anesthesia, ExecutiveCommittee, and Administrative Council. J Pain. 2016; 17 (2): 131-157. doi: 10.1016/j.jpain.2015.12.008.
Teunissen AJW, Koning MV, Liefers WJ, Stap DVD, Roukema G, deBruijn B et al. A double-blind, randomised, placebo-controlled trialcomparing intrathecal bupivacaine with bupivacaine plus morphineto reduce delirium in patients with hip fractures-Salmon-Mind trialstudy protocol. BJA Open. 2023; 7: 100216.