Low-Dose Morphine Intrathecal Analgesia in Elderly Patients with Hip Fracture Undergoing Single Spinal Anesthesia: A Randomized Controlled Trial

Denis Buršík,1– 3 Tereza Romanová,1,2,4,5 Karolína Lečbychová,1,2,4 Markéta Bílená,1,2,4 Michal Burda,6 Pavel Å evčík,1,2,7 Filip Haiduk,1– 3 Michal Frelich,1,2 Marcela Káňová,1,2,5 Jan Máca1,2,5 1Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic; 2Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic; 3Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, Brno, Czech Republic; 4Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic; 5Institute of Physiology and Pathophysiology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic; 6Institute for Research and Applications of Fuzzy Modeling, University of Ostrava, Ostrava, Czech Republic; 7Department of Pain Management, University Hospital Brno, Brno, Czech RepublicCorrespondence: Denis Buršík, Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic, Email [email protected]: Hip fractures (HF) are a serious and increasingly common condition in the geriatric population. Favorable clinical outcomes require early postoperative rehabilitation, which relies on effective pain management. Intrathecal morphine (ITM) is a well-established method of perioperative analgesia, but concerns have been raised about potential adverse effects in the elderly population. This superiority trial was designed to compare the efficacy and safety of low-dose intrathecal morphine, with adverse effect prevention, versus a standard multimodal analgesic regimen in elderly patients undergoing surgery for hip fracture repair.Methods: Patients aged 60– 90 years scheduled for HF surgery under single spinal anesthesia were randomized into two groups: bupivacaine/levobupivacaine with 100 μg ITM, and bupivacaine/levobupivacaine alone. The primary outcome was pain intensity (11-point numeric rating scale; NRS) during the first 24 hours after surgery. Secondary outcomes included postoperative analgesic consumption, time to first analgesic, and incidence and severity of adverse effects.Results: This study enrolled 82 patients; 47 (57.3%) were allocated to the intervention group, 34 (41.5%) to the control group. The median 24-hour postoperative NRS score was 0.39 (IQR 0.00– 0.90) in the intervention group, and 1.70 (IQR 1.23– 1.91) in the control group (p < 0.001). Time to first analgesic was 16.5 hours (IQR 8.75– 24.00) in the intervention group, and 7 hours (IQR 4.62– 9.88) in the control group (p < 0.001). No postoperative analgesics were required for 29.8% of patients in the intervention group, and 2.9% of patients in the control group (p = 0.001). The incidence and severity of adverse effects did not significantly differ between the groups.Conclusion: Compared to standard multimodal analgesia, low-dose ITM significantly reduced postoperative pain and analgesic consumption, and prolonged the time to first analgesic administration, without an increased incidence or severity of adverse effects in elderly patients with HF.Keywords: intrathecal morphine, spinal anesthesia, multimodal analgesia, anesthesia in the elderly, hip fracture