Intratekalni morfij u svrhu analgezije nakon ugradnje totalne endoproteze kuka

professional thesis

• Title (english): Intrathecal morphine for analgesia after total hip arthroplasty
• Author: Anja Mandarić
• Mentor: Zrinka Orešković (mentor)
• Mentor: Željko Čolak (mentor)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2025-01-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Morfij, opioidni analgetik, intratekalnim načinom primjene u širu upotrebu ušao je 1979. godine. Operativni zahvat ugradnje totalne endoproteze kuka je najizvođeniji elektivni kirurški zahvat u razvijenom svijetu. Međutim, često je praćen sa značajnim postoperativnim bolovima koji mogu negativno utjecati na oporavak bolesnika te postoperativnu rehabilitaciju. PROSPECT smjernice za postoperativnu analgeziju kod THA preporučuju upotrebu intratekalnog morfija kao dodatka spinalnoj anesteziji radi postoperativne analgezije. Iako se operativni zahvat ugradnje potpune endoproteze kuka sve više izvodi u sklopu jednodnevne kirurgije ili sa kratkim boravkom u bolnici, anesteziolozi su još uvijek suzdržani oko primjene intratekalnog morfija unatoč njegovom dobrom analgetskom učinku, ponajviše zbog straha od nuspojava u vidu postoperativne mučnine i povraćanja respiratorne depresije. Ove komplikacije mogu rezultirati produljenim bolničkim liječenjem, povećati postoperativni morbiditet i smanjiti zadovoljstvo pacijenta liječenjem, čime učinkovitost i dobrobiti ovog analgetskog modaliteta usmjerenog na pacijenta padaju u drugi plan. Intratekalni morfij pokazao se kao značajna analgetska metoda za liječenje postoperativne boli nakon operacija ugradnje totalne endoproteze kuka. Prema tome, pažljiva primjena uz poslijeoperacijski nadzor bolesnika, te imajući na umu nuspojave koje su uglavnom ovisne o dozi, osigurava intratekalnom morfiju mjesto jednog od važnijih analgetskih modaliteta za kirurške zahvate na donjim ekstremitetima. Međutim, daljnje randomizirane studije vezane za optimalno doziranje IT morfija svakako trebaju biti provedene.

Abstract (english)

Morphine, an opioid analgesic, was widely used by the intrathecal method in 1979. The operative procedure of total hip arthroplasty is the most performed elective surgical procedure in the developed world. However, it is often accompanied by significant postoperative pain that can negatively affect the patient's recovery and postoperative rehabilitation. The PROSPECT guidelines for postoperative analgesia for THA, the use of intrathecal morphine as an adjunct to spinal anesthesia for postoperative analgesia is recommended. Although the total hip arthroplasty is increasingly performed as part of a one-day surgery or with a short hospital stay, anesthesiologists are still reluctant to use intrathecal morphine despite its good analgesic effect, mostly due to the fear of side effects in the form of postoperative nausea and vomiting and respiratory depression. These complications can result in prolonged hospital stay, increase postoperative morbidity, and decrease patient satisfaction, thus compromising the effectiveness and benefit of this patient-centered analgesic modality. Intrathecal morphine has been shown to be a significant analgesic method for the treatment of postoperative pain in total hip arthroplasty. Therefore, careful application with postoperative patient monitoring, and keeping in mind its side effects that are mostly dose-dependent, ensures that intrathecal morphine is one of the most important analgesic modalities for surgical interventions on the lower extremities. But given the many open questions, further randomised studies should be conducted particularly considering the optimal dosing regimen.

• Keywords: Analgetici/opioidi; Morfin; Postoperativna mučnina i povraćanje; Anestezija/spinalna; Artroplastika/zamjena/ kuk; Zadovoljstvo pacijenata; Anesteziolozi; Analgetici
• Keywords (english): Analgesics/ Opioid; Morphine; Postoperative Nausea and Vomiting; Anesthesia/ Spinal; Arthroplasty/ Replacement/ Hip; Patient Satisfaction; Anesthesiologists; Analgesics
• Language: croatian
• URN:NBN: urn:nbn:hr:105:634315
• Study programme: Title: Anesthesiology, reanimatology and intensive care medicine; Study programme type: university; Study level: postgraduate specialist; Academic / professional title: sveučilišni/a magistar/magistra anesteziologije, reanimatologije i intenzivne medicine (sveučilišni/a magistar/magistra anesteziologije, reanimatologije i intenzivne medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2025-02-20 10:15:32