No clinically relevant advantage of intrathecal morphine in total hip arthroplasty?

Adding morphine to intrathecal bupivacaine provides sound analgesia, but is associated with side effects. The purpose of this study is to investigate if the contribution of intrathecal morphine to postoperative analgesia for total hip replacement outweighs its side effects in a modern multimodal setting. From November 2012 till January 2013 patients undergoing total hip arthroplasty (THA) under spinal anesthesia received either plain bupivacaine (group B) or bupivacaine + 0.1 mg morphine (group M). VAS pain scores, PCA morphine consumption and side effects (nausea, vomiting, pruritus) were registered. 60 patients in group B were compared to 36 patients in group M. Overall morphine consumption and pain scores were low, although they were slightly but significantly lower in group M. Intrathecal morphine was associated with significantly more pruritus. In this study, PCA morphine consumption and pain scores were low in THA with multimodal pain treatment, and the added analgesic value of intrathecal morphine did not outweigh the increased incidence of pruritus.