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Reduction in pulmonary embolism after total joint arthroplasty: three years of experience with extended-release epidural morphine.

Author(s): Blackshear RH, Crosson KC

Affiliation(s): Skaggs Regional Medical Center, Department of Surgery and Anesthesiology, Branson, Missouri, USA. rossted@mac.com

Publication date & source: 2010-05, Pain Pract., 10(3):235-44. Epub 2010 Jan 8.

Publication type: Research Support, Non-U.S. Gov't

A retrospective analysis of 659 patients who had undergone a hip or knee arthroplasty was undertaken to determine the incidence of pulmonary embolism (PE) during the 48-hour period following surgery. Data related to pain control, concomitant medications, length of stay, and adverse reactions were also collated. Patients were evenly divided between those receiving extended-release epidural morphine (EREM: n = 327; mean dose 9.7 mg, range 5 mg to 15 mg) or a control group receiving other treatment for postoperative pain (control: n = 332; 44% of controls had an epidural catheter in place). The incidence of PE was significantly higher in the control group than in the EREM group (control: n = 6 or 1.80% vs. EREM: n = 0). Pain control (by a 10-point verbal numerical rating scale) was significantly improved in the EREM group compared with the control group 48 hours after surgery (2.3 +/- 1.8 vs. 4.7 +/- 2.6) and length of stay was significantly reduced (3.9 +/- 1.5 days vs. 4.5 +/- 2.0 days). Adverse event profiles of the EREM and control groups were consistent with prior published studies with EREM. The use of EREM following lower extremity joint arthroplasty may be associated with a significant reduction in the incidence of PE.

Page last updated: 2010-10-05

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