Comparison of Side Effects with Comparison of Side Effects with Extended Release Epidural Morphine Extended Release Epidural Morphine

and Other Analgesic Modalitiesand Other Analgesic ModalitiesK. Colfer, M.S.N., R.N.-B.C. , K. Gandhi, M.D., M.P.H., K. Colfer, M.S.N., R.N.-B.C. , K. Gandhi, M.D., M.P.H.,

R. F. Olszewski, Jr., B.S. , D. A. Colli, B.S.N., RN-B.C.,R. F. Olszewski, Jr., B.S. , D. A. Colli, B.S.N., RN-B.C., E. R. Viscusi, M.D. E. R. Viscusi, M.D.

IntroductionIntroduction

Pain Control following total joint arthroplasty Pain Control following total joint arthroplasty remains challenging.remains challenging.

Opioids have side effects that may affect patient Opioids have side effects that may affect patient recoveryrecovery

EREM shown to reduce average supplemental EREM shown to reduce average supplemental opioid usage.opioid usage.

MethodsMethods

206 randomly selected patients receiving total 206 randomly selected patients receiving total hip arthroplasty or total knee arthroplasty hip arthroplasty or total knee arthroplasty between January and July of 2007.between January and July of 2007.

Patients were chosen based on different Patients were chosen based on different postoperative analgesic modalitiespostoperative analgesic modalities

Total Hip ArthroplastyTotal Hip Arthroplasty1.1. EREM 7.5 mgEREM 7.5 mg

2.2. EREM 10.0 mgEREM 10.0 mg

3.3. Combined Intrathecal morphine PF with fentanyl PCACombined Intrathecal morphine PF with fentanyl PCA

4.4. Fentanyl PCAFentanyl PCA

Total Knee ArthroplastyTotal Knee Arthroplasty1.1. EREM 10.0 mgEREM 10.0 mg

2.2. EREM 12.5 mgEREM 12.5 mg

3.3. Indwelling epidural catheter with 0.2% Ropivicaine and fentanyl PCAIndwelling epidural catheter with 0.2% Ropivicaine and fentanyl PCA

4.4. Single injection femoral nerve block and fentanyl PCA.Single injection femoral nerve block and fentanyl PCA.

MethodsMethodsMedical records Medical records

Side effects recorded on post operative day 0, 1, and 2.Side effects recorded on post operative day 0, 1, and 2.

Side effects determined by administration of treatment Side effects determined by administration of treatment medications. With time of spinal, CSE, or EREM set as medications. With time of spinal, CSE, or EREM set as time zero.time zero.

Side effects recorded include:Side effects recorded include: PruritusPruritus Nausea/vomitingNausea/vomiting Respiratory depressionRespiratory depression

ResultsResults THA Side Effect Profile

0

2

4

6

8

10

12

14

Nausea/Vomiting Pruritus

Tim

e to

1st

Dos

e (h

rs) EREM 7.5

EREM 10

Spinal Bupivacaine with ITDuramorphSpinal Bupivacaine

ResultsResults TKA Side Effect Profile

0

2

4

6

8

10

12

Nausea/Vomiting Pruritus

Tim

e to

1st

Dos

e (h

rs)

EREM 10

EREM 12.5

CSE

Femoral Nerve Block

DiscussionDiscussionAll modalities produced peak side effects on day zero, which declined over the next 24 hours.

Intensity not graded, hence the incidence may appear greater than expected.

EREM had a similar side effect profile to IT morphine with PCA.

Opioid related side effects associated with EREM were similar to other analgesic modalities and generally responded to single-dose treatment.

Conclusion

Given the previously demonstrated efficacy of EREM and a side effect profile similar to other modalities, EREM may offer greater patient comfort and reduce utilization of healthcare resources.

Thank youThank you

Thank you to the people whose hard work made Thank you to the people whose hard work made this this project possible: this this project possible: Kathy Colfer, Dr. Kishor Gandhi, Debbie Colli, Kathy Colfer, Dr. Kishor Gandhi, Debbie Colli,

Steve Schaefer, and especially Dr. ViscusiSteve Schaefer, and especially Dr. Viscusi

ReferencesReferences

Gandhi et al. Anesthesiology, 2008; 109 A111Gandhi et al. Anesthesiology, 2008; 109 A111Gambling et al. Anesthesia and Analgesia, 2005. Gambling et al. Anesthesia and Analgesia, 2005. 100(4): p. 1065-74.100(4): p. 1065-74.Hartrick et al. Journal of Bone and Joint Surgery, Hartrick et al. Journal of Bone and Joint Surgery, 2006. 88(2): p. 273-81.2006. 88(2): p. 273-81.Viscusi et al. Anesthesiology, 2005. 102(5).Viscusi et al. Anesthesiology, 2005. 102(5).Carvalho et al. Anesthesia and Analgesia, 2005. Carvalho et al. Anesthesia and Analgesia, 2005. 100(4): p. 1150-8.100(4): p. 1150-8.