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ESRA19-0363 Pruritus and postoperative nausea and vomiting after intrathecal morphine in spinal anaesthesia for total knee replacement: prospective cohort study
  1. R Abd Rahim,
  2. G das Punshi,
  3. R Sparks and
  4. V Husarova
  1. Cappah National Orthopaedic Hospital, Anaesthesia, Dublin, Ireland


Background and aims Spinal anaesthesia is a common anaesthetic technique for total knee replacement (TKR). Neuraxial opioids such as intrathecal morphine may cause common adverse effects (pruritus, post-operative nausea and vomiting [PONV]).We investigated the incidence, severity and need for treatment of pruritus and PONV following administration of intrathecal morphine in spinal anaesthesia for TKR in Cappagh National Orthopaedic Hospital, Dublin, Ireland.

Methods We conducted a prospective study involving 100 patients who received intrathecal morphine in spinal anaesthesia for TKR, over 4 months from September 2018 to December 2018 in Cappagh National Orthopaedics Hospital, Dublin, Ireland. Internal Ethics Committee Review Board approval was obtained.

Results Five patients with mild pruritis (9%) required treatment while all ten patients with moderate to severe pruritis required treatment. Eleven patients (11%) had severe PONV (>4 Impact Score). Twenty-two (22%) patients received with mild PONV received single anti-emetics. Eighteen (18%) patients with moderate PONV and six patients with severe PONV received dual anti-emetics therapy. Five patients with severe PONV received triple anti-emetic therapy. The average Overall Benefit of Analgesia Score was 6.8 (SD 3.4, min-max: 0–19). The average (SD) patients‘ satisfaction with pain relief and side effects was 84% (8%).

Abstract ESRA19-0363 Table 1

Baseline characteristics of study participants.

Abstract ESRA19-0363 Figure 1

Incidence of PONV

Abstract ESRA19-0363 Figure 2

Incidence of Pruritis

Conclusions The incidence of PONV is high, with most patients reporting mild nausea. Overall patients reported good postoperative satisfaction with spinal anesthesia and intrathecal morphine. There was a low incidence of pruritus, with most patients reporting mild pruritus. Patients who experienced either pruritis and PONV tend to have a higher (worse) OBAS score and a lower (worse) QoR-15 score.

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