COMPARISON OF INTRATHECAL MORPHINE AND CONTINUOUS FEMORAL 3-IN-1 BLOCK FOR PAIN AFTER MAJOR KNEE SURGERY UNDER SPINAL-ANESTHESIA

Major knee surgery is associated with moderate or severe post-operativ e pain. Intrathecal morphine and continuous femoral 3-in-1 block were compared prospectively in 40 patients for pain after major knee surger y under spinal anaesthesia, with 4 mL isobaric 0.5% bupivacaine. In a random order, 20 patients received preservative free morphine 0.3 mg m ixed with spinal bupivacaine. In 20 patients, following spinal anaesth esia with only bupivacaine, femoral 3-in-1 block was performed post-op eratively with 0.5% bupivacaine 2 mg kg(-1). The block was continued v ia a catheter with 0.25% bupivacaine 0.1 mL h(-1) kg(-1) until the nex t morning (24 h after induction of spinal anaesthesia). Intramuscular oxycodone was given as a rescue analgesic in all patients. Two patient s from the femoral group were excluded due to technical failure. Three patients in the morphine group and one patient in the femoral group d id not need any additional oxycodone. In the morphine group on average 2.8 (range 0-7) and in the femoral group 3.2 (0-5) additional doses o f oxycodone were needed during the 24 h observation period. The mean p ain scores were significantly lower in the morphine group at 9 and 12 h into the 24-h trial. Itching was seen only in the morphine group (40 % of the patients). Other side effects were similar in the two groups. All patients were satisfied with their pain therapy. Both intrathecal morphine and femoral 3-in-1 block alone were insufficient for the tre atment of severe pain after major knee surgery.