Intraosseous morphine provided pain relief up to 2 weeks after TKA
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According to published results, an intraosseous infusion of antibiotics combined with morphine offered postoperative pain relief for up to 2 weeks in patients who underwent total knee arthroplasty.
Ava A. Brozovich, MPH, and colleagues from the department of orthopedics and sports medicine at Houston Methodist Hospital performed a double-blinded, randomized, controlled trial on consecutive patients who received an intraosseous (IO) infusion of medication for antibiotic prophylaxis after TKA. A control group of 24 patients received an IO antibiotic (vancomycin) injection – per standard protocol, while the experimental group of 24 patients received an IO antibiotic injection with 10 mg of morphine. According to the study, outcome measures included VAS pain and nausea scores, as well as opioid usage (in morphine milligram equivalents).
Overall, the experimental group had significantly lower VAS pain scores at 1, 2, 3 and 5 hours after surgery compared with the control group. Researchers found the experimental group had a 40% reduction in VAS pain scores after postoperative day 1, a 49% reduction after day 2, a 38% reduction after day 8 and a 33% reduction after day 9. The experimental group also had lower opioid usage compared with the control group during the first 48 hours and second week after surgery.
Brozovich and colleagues noted serum morphine levels in the experimental group were “significantly lower” at 10 hours after injections compared with the control group. The experimental group also showed improvements in Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores at 2 and 8 weeks.
“A decreased serum morphine concentration in the morphine group suggests that IO morphine results in less immediate postoperative narcotic use. Furthermore, no change in nausea over time between the groups indicates similar tolerance between treatments,” the researchers wrote in the study. “These results do suggest that by blunting the initial pain and inflammatory response, IO morphine allows for patients to better manage postoperative pain with less medication and improved recovery trajectories,” they added.
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