Epidural morphine delays the onset of tourniquet pain during epidural lidocaine anesthesia

Chen Hwan Cherng, Chih Shung Wong, Fang L. Chang, Shung T. Ho, Chian H. Lee

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

We conducted a randomized, double-blinded study to examine the onset time of tourniquet pain during epidural lidocaine anesthesia either with or without morphine in the epidural solution. Forty-five patients undergoing knee surgery with a thigh tourniquet were randomly allocated into 3 groups of 15 patients each: epidural morphine (EM; epidural administration of 17 mL of 2% lidocaine plus 2 mg of morphine, followed by IV injection of 0.2 mL of normal saline), IV morphine (IVM; 17 mL of 2% lidocaine plus 0.2 mL of normal saline, followed by IVM 2 mg IV), and control (17 mL of 2% lidocaine plus 0.2 mL of normal saline, followed by 0.2 mL of normal saline IV). The onset time of tourniquet pain was recorded. The level of sensory block was determined by the pinprick method at the occurrence of tourniquet pain. Hemodynamic changes and side effects of EM were also recorded. The onset time of tourniquet pain from both the epidural injection and the tourniquet inflation were significantly longer in the EM group (103 ± 15 min and 80 ± 15 min, respectively) compared with the IVM group (74 ± 12 min and 50 ± 12 min, respectively; P <0.05) and the Control group (67 ± 9 min and 45 ± 9 min, respectively; P <0.05). The level of sensory block at the onset of tourniquet pain and hemodynamic changes were not different among the three groups. Only two and three patients in the EM group complained of nausea/vomiting and pruritus, respectively. Respiratory depression was not observed in any patient. We conclude that epidural injection of the mixture of 2 mg of morphine and 2% lidocaine solution delayed the onset of tourniquet pain during epidural lidocaine anesthesia without significant morphine-related side effects.

Original languageEnglish
Pages (from-to)1614-1616
Number of pages3
JournalAnesthesia and Analgesia
Volume94
Issue number6
Publication statusPublished - 2002
Externally publishedYes

Fingerprint

Tourniquets
Epidural Anesthesia
Lidocaine
Morphine
Pain
Epidural Injections
Hemodynamics
Economic Inflation
Pruritus
Thigh
Respiratory Insufficiency
Nausea
Vomiting
Knee
Control Groups
Injections

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Epidural morphine delays the onset of tourniquet pain during epidural lidocaine anesthesia. / Cherng, Chen Hwan; Wong, Chih Shung; Chang, Fang L.; Ho, Shung T.; Lee, Chian H.

In: Anesthesia and Analgesia, Vol. 94, No. 6, 2002, p. 1614-1616.

Research output: Contribution to journalArticle

Cherng, Chen Hwan ; Wong, Chih Shung ; Chang, Fang L. ; Ho, Shung T. ; Lee, Chian H. / Epidural morphine delays the onset of tourniquet pain during epidural lidocaine anesthesia. In: Anesthesia and Analgesia. 2002 ; Vol. 94, No. 6. pp. 1614-1616.
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abstract = "We conducted a randomized, double-blinded study to examine the onset time of tourniquet pain during epidural lidocaine anesthesia either with or without morphine in the epidural solution. Forty-five patients undergoing knee surgery with a thigh tourniquet were randomly allocated into 3 groups of 15 patients each: epidural morphine (EM; epidural administration of 17 mL of 2{\%} lidocaine plus 2 mg of morphine, followed by IV injection of 0.2 mL of normal saline), IV morphine (IVM; 17 mL of 2{\%} lidocaine plus 0.2 mL of normal saline, followed by IVM 2 mg IV), and control (17 mL of 2{\%} lidocaine plus 0.2 mL of normal saline, followed by 0.2 mL of normal saline IV). The onset time of tourniquet pain was recorded. The level of sensory block was determined by the pinprick method at the occurrence of tourniquet pain. Hemodynamic changes and side effects of EM were also recorded. The onset time of tourniquet pain from both the epidural injection and the tourniquet inflation were significantly longer in the EM group (103 ± 15 min and 80 ± 15 min, respectively) compared with the IVM group (74 ± 12 min and 50 ± 12 min, respectively; P <0.05) and the Control group (67 ± 9 min and 45 ± 9 min, respectively; P <0.05). The level of sensory block at the onset of tourniquet pain and hemodynamic changes were not different among the three groups. Only two and three patients in the EM group complained of nausea/vomiting and pruritus, respectively. Respiratory depression was not observed in any patient. We conclude that epidural injection of the mixture of 2 mg of morphine and 2{\%} lidocaine solution delayed the onset of tourniquet pain during epidural lidocaine anesthesia without significant morphine-related side effects.",
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