Orthostatic Hypotension, Orthostatic Intolerance
Conditions
Keywords
Orthostatic Hypotension, Orthostatic Intolerance, Morphine, Autonomic Dysfunction
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.
Interventions
DRUGMorphine
Administration of 0.1 mg/kg (IBW) intravenous morphine
Sponsors
Kehlet, Henrik, M.D., Ph.D.
Copenhagen University Hospital, Hvidovre
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Inclusion criteria
* 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
Exclusion criteria
* 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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 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
| Measure | Time frame | Description |
|---|---|---|
| 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 diastolic arterial pressure (DAP) during mobilization | Before and 30 minutes after morphine administration | Measured in mmHg 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 heart rate (HR) during mobilization | Before and 30 minutes after morphine administration | Measured in beats min-1 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 cardiac output (CO) during mobilization | Before and 30 minutes after morphine administration | Measured in L/min by non-invasive LiDCO |
| Changes in baroreflex sensitivity - vagal (BRSv) during Valsalva manoeuvre | Before and 30 minutes after morphine administration | Measured in ms |
| Changes in heart rate variability (HRV) during Valsalva manoeuvre | Before and 30 minutes after morphine administration | Measured in ms |
| 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 peripheral perfusion index (PPI) during mobilization | Before and 30 minutes after morphine administration | Measured in % by Root Masimo |
| Changes in cerebral perfusion (ScO2) during mobilization | Before and 30 minutes after morphine administration | Measured in % by Root Masimo |
| Changes in muscular perfusion (SmO2) during mobilization | Before and 30 minutes after morphine administration | Measured in % by Root Masimo |
Other
| Measure | Time frame | Description |
|---|---|---|
| Pain score during mobilisation | Before and 30 minutes after morphine administration | Measured by verbal rating scale (VRS) from 0 to 10 (0 = no pain, 10 = worse pain imaginable) |
| Occurence of side-effects to morphine administration | 30 minutes after morphine administration | Occurrence of following side-effects to morphine administration: nausea, vomiting, pruritus, headache or dizziness |
Countries
Denmark
Contacts
Primary ContactBodil Uldall-Hansen, BA Medicine
Backup ContactAna-Marija Hristovska, Resident
Outcome results
None listed