Orthostatic Intolerance and Hypotension After Administration of Morphine in Patients Prior to Hip or Knee Arthroplasty
- Conditions
- Orthostatic HypotensionOrthostatic Intolerance
- Interventions
- Registration Number
- NCT04902222
- Lead Sponsor
- Copenhagen University Hospital, Hvidovre
- Brief Summary
Incidence of orthostatic intolerance and orthostatic hypotension after intravenous administration of morphine in patients prior to hip or knee arthroplasty.
- Detailed Description
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.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 26
- Patients undergoing primary unilateral total hip arthroplasty (THA), total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA)
- Patients > 18
- Patients that understand and speak Danish
- Patients that have provided written informed consent
- Alcohol or substance abuse
- Habitual use of opioids
- Habitual use of anxiolytic, antidepressant and/or antipsychotic drugs
- History of previous orthostatic intolerance or hypotension
- Cognitive dysfunction
- Glomerular filtration rate (GFR) < 30 ml/min
- Cardiac arrhythmia
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Patients undergoing primary hip or knee arthroplasty Morphine Patients undergoing primary hip or knee arthroplasty
- Primary Outcome Measures
Name Time Method Incidence of orthostatic hypotension 30 minutes after morphine administration Orthostatic hypotension is defined as a fall in systolic pressure \> 20 mmHg and/or diastolic pressure \> 10 mmHg during mobilization
- Secondary Outcome Measures
Name Time Method Changes in cardiac output (CO) during mobilization Before and 30 minutes after morphine administration Measured in L/min by non-invasive LiDCO
Changes in mean arterial pressure (MAP) during mobilization Before and 30 minutes after morphine administration Measured in mmHg by non-invasive LiDCO
Changes in systemic vascular resistance (SVR) during mobilization Before and 30 minutes after morphine administration Measured in dynes s cm-5 by non-invasive LiDCO
Changes in cerebral perfusion (ScO2) during mobilization Before and 30 minutes after morphine administration Measured in % by Root Masimo
Changes in heart rate variability (HRV) during Valsalva manoeuvre Before and 30 minutes after morphine administration Measured in ms
Changes in systolic arterial pressure (SAP) during mobilization Before and 30 minutes after morphine administration Measured in mmHg by non-invasive Lithium Dilution Cardiac Output (LiDCO) measurement
Changes in peripheral perfusion index (PPI) during mobilization Before and 30 minutes after morphine administration Measured in % by Root Masimo
Changes in baroreflex sensitivity - vagal (BRSv) during Valsalva manoeuvre Before and 30 minutes after morphine administration Measured in ms
Changes in heart rate (HR) during mobilization Before and 30 minutes after morphine administration Measured in beats min-1 by non-invasive LiDCO
Changes in diastolic arterial pressure (DAP) during mobilization Before and 30 minutes after morphine administration Measured in mmHg by non-invasive LiDCO
Changes in stroke volume (SV) during mobilization Before and 30 minutes after morphine administration Measured in mL by non-invasive LiDCO
Changes in muscular perfusion (SmO2) during mobilization Before and 30 minutes after morphine administration Measured in % by Root Masimo
Trial Locations
- Locations (1)
Hvidovre University Hospital
🇩🇰Hvidovre, Denmark