Incidence of orthostatic intolerance and orthostatic hypotension after intravenous administration of morphine in patients prior to hip or knee arthroplasty.
Early postoperative mobilization is crucial for recovery of patients undergoing surgery in the multimodal fast-track approach to perioperative care, since physical immobilization is highly associated with increased risk of postoperative complications and prolonged hospital length of stay. Postoperative mobilization is often delayed due to patients experiencing orthostatic hypotension (OH), defined as a drop in systolic blood pressure \> 20 mmHg or diastolic blood pressure \> 10 mmHg, or orthostatic intolerance (OI), characterized by dizziness, blurred vision, nausea, vomiting, sensation of heat or syncope. Previous studies have found a high incidence of postoperative OI (\> 40 %) among patients undergoing total hip arthroplasty. A possible causative factor to the high occurrence of OH and OI after surgery could be postoperative pain management by administration of morphine. Morphine is known to have many side-effects including nausea, vomiting, dizziness and orthostatic hypotension. The object of this study is to isolate and estimate the effect of intravenous morphine on the incidence of OH and OI.
Study Type
OBSERVATIONAL
Enrollment
26
Administration of 0.1 mg/kg (IBW) intravenous morphine
Hvidovre University Hospital
Hvidovre, Denmark
RECRUITINGIncidence of orthostatic hypotension
Orthostatic hypotension is defined as a fall in systolic pressure \> 20 mmHg and/or diastolic pressure \> 10 mmHg during mobilization
Time frame: 30 minutes after morphine administration
Changes in systolic arterial pressure (SAP) during mobilization
Measured in mmHg by non-invasive Lithium Dilution Cardiac Output (LiDCO) measurement
Time frame: Before and 30 minutes after morphine administration
Changes in diastolic arterial pressure (DAP) during mobilization
Measured in mmHg by non-invasive LiDCO
Time frame: Before and 30 minutes after morphine administration
Changes in mean arterial pressure (MAP) during mobilization
Measured in mmHg by non-invasive LiDCO
Time frame: Before and 30 minutes after morphine administration
Changes in heart rate (HR) during mobilization
Measured in beats min-1 by non-invasive LiDCO
Time frame: Before and 30 minutes after morphine administration
Changes in stroke volume (SV) during mobilization
Measured in mL by non-invasive LiDCO
Time frame: Before and 30 minutes after morphine administration
Changes in cardiac output (CO) during mobilization
Measured in L/min by non-invasive LiDCO
Time frame: Before and 30 minutes after morphine administration
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Changes in systemic vascular resistance (SVR) during mobilization
Measured in dynes s cm-5 by non-invasive LiDCO
Time frame: Before and 30 minutes after morphine administration
Changes in peripheral perfusion index (PPI) during mobilization
Measured in % by Root Masimo
Time frame: Before and 30 minutes after morphine administration
Changes in cerebral perfusion (ScO2) during mobilization
Measured in % by Root Masimo
Time frame: Before and 30 minutes after morphine administration
Changes in muscular perfusion (SmO2) during mobilization
Measured in % by Root Masimo
Time frame: Before and 30 minutes after morphine administration
Changes in baroreflex sensitivity - vagal (BRSv) during Valsalva manoeuvre
Measured in ms
Time frame: Before and 30 minutes after morphine administration
Changes in heart rate variability (HRV) during Valsalva manoeuvre
Measured in ms
Time frame: Before and 30 minutes after morphine administration