الفهرس 
Anatomy of spinal cord and vertebral columnOnly 14 pages are availabe for public view
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Abstract
Spinal anesthesia is the most common performed method in prolonged lower limb surgeries. Bupivacaine is routinely used with the addition of number of adjuvants to increase its duration and potency of analgesia such as opioids.
Intrathecal opioids administration is an attractive analgesic technique since the opioids is injected directly into the cerebrospinal fluid, close to the structures of the central nervous system where the opioids acts. Neuraxial opioids provide excellent analgesia intra-operatively and postoperatively, Single dose intrathecal morphine (in doses of 100 to 200 mcg) can provide safe and effective postoperative analgesia for up to 24 hours.
The most common adverse effects after intrathecal morphine are postoperative nausea, vomiting and pruritus.
Anticholinergic agents are thought to act via inhibition of muscarinic receptors in several regions of the medulla oblongata, which are implicated with nausea and vomiting generation; in addition to the chemoreceptor trigger zone.
This study aimed to evaluate the effect of intrathecal 100 mcg preservative-free atropine sulphate on prevention of postoperative nausea and vomiting in patients receiving intrathecal 15mg of 0.5% hyperbaric bupivacaine and 200 mcg preservative-free morphine sulphate in lower limb surgeries and on its effect on duration of postoperative analgesia.
Eighty patients scheduled for elective lower limb surgery under spinal anesthesia were enrolled in this study. Patients were randomly allocated into two equal groups by computer generated numbers and closed envelope.
Patients of group BM (control group) received spinal anesthesia with 15 mg of 0.5% hyperbaric bupivacaine (3ml) + 200 mcg of preservative-free morphine sulphate (0.2ml) + Normal saline (0.1ml) while patients of group BMA received spinal anesthesia with 15 mg of 0.5% hyperbaric bupivacaine (3ml) + 200 mcg of preservative-free morphine sulphate (0.2ml) + 100 mcg preservative-free atropine sulphate (0.1ml).
The two groups were compared regarding their demographic data (age, sex and ASA classification), the duration and type of surgery, sensory level and degree of motor block at 15 min, time of two segments regression and total duration of motor block. Hemodynamics were monitored through the operation.
Postoperative nausea and vomiting episodes, time to request first antiemetic and time to request first analgesic were recorded. Data were collected for each patient and statistical analysis was done.
The present study showed that addition of intrathecal 100 mcg preservative-free atropine sulphate to intrathecal 15 mg of 0.5% hyperbaric bupivacaine and 200 mcg preservative-free morphine sulphate in lower limb surgeries significantly decreased the incidence of postoperative nausea and vomiting. It also prolonged the time needed for first anti emetic, while no significant effect on postoperative analgesia was found.