Key result
Epidural methylprednisolone combined with morphine significantly reduced pain scores at 6 hours (NVRS 0.5 vs 1.2) compared to bupivacaine and morphine after knee replacement surgery.
Why the study?
Does epidural methylprednisolone combined with morphine improve postoperative pain relief and attenuate systemic inflammatory response compared to bupivacaine with morphine in patients undergoing knee replacement surgery?
RCT (n=129)
Single-blind
Randomly assigned
No
Does epidural methylprednisolone combined with morphine improve postoperative pain relief and attenuate systemic inflammatory response compared to bupivacaine with morphine in patients undergoing knee replacement surgery?
Absolute Event Rate: 0.5% vs 1.2%
p-value: p=<0.001
Epidural methylprednisolone combined with morphine provides superior postoperative pain relief and attenuates the acute inflammatory response compared to conventional bupivacaine-morphine after major joint replacement surgery.
Supports epidural methylprednisolone-morphine for superior early analgesia after knee replacement; extends evidence for steroid adjuvants in neuraxial techniques.
Effects of Different Epidural Analgesic Compositions on Postoperative Pain Relief and Systemic Response to Surgery Despite many achievements during the last decade, postoperative pain remains the dominant complaint after major surgery and has great potential to be influenced by the anaesthesiologist. Reports suggest that short-term effective anaesthesia and analgesia can have long-lasting beneficial effects on recovery from surgery. The aim of our study is to compare the effect of epidural analgesia, using different compositions, including glucocorticoids (methylprednisolone), and habitual composition of bupivacaine-morphine, in regard to analgesic and anti-inflammatory properties. A total of 129 patients participated in the study in four different treatment groups: patients from Group I received glucocorticoid methylprednisolone succinate and long-acting opioid morphine hydrochloride, Group II received local anaesthetic bupivacaine hydrochloride and morphine hydrochloride, Group III received methylprednisolone succinate and short-acting opioid fentanyl, and Group IV received glucocorticoid methylprednisolone succinate. We obtained good analgesic profiles in all groups. However, significantly better results were achieved using the combination of methylprednisolone and morphine. Epidural methylprednisolone in dose 80 mg/24 h is more effective, compared to the conventional local anaesthetics-opioid composition, when administered as a part of multimodal preventive postoperative analgesia after major joint replacement surgery. Epidural methylprednisolone has a reliable anti-inflammatory and immunomodulatory potential. It attenuates profiles of acute inflammatory response markers as Interleukin-6 and C-reactive protein and stress hormone cortisol. The novelty of this study was application of epidural glucocorticoids for acute postoperative pain relief as part of daily perioperative care. By developing studies on anti-inflammatory and immunomodulatory properties of glucocorticoids, we expect to improve patient rehabilitation in the postoperative period.
No takes yet. Share an insight, caveat, or question.
Golubovska et al. (2008) conducted an RCT in Postoperative pain after knee replacement surgery (n=129). Epidural methylprednisolone and morphine vs. Epidural bupivacaine and morphine, methylprednisolone and fentanyl, or methylprednisolone alone was evaluated on Numeral verbal rating scale (NVRS) for pain at 6 hours post-epidural injection (p=<0.001). Epidural methylprednisolone combined with morphine significantly reduced pain scores at 6 hours (NVRS 0.5 vs 1.2) compared to bupivacaine and morphine after knee replacement surgery.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: