Letters to the Editor   |    
Evaluation of a Single-Dose, Extended-Release Epidural Morphine Formulation for Pain After Knee Arthroplasty
André P. Boezaart, MBChB, FFA(CMSA), MMed(Anaesth), PhD1
1 Departments of Anesthesia and Orthopaedic Surgery University of Iowa 200 Hawkins Drive Iowa City, IA 52242 andre-boezaart@uiowa.edu
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In support of his research, the author received grants or outside funding from Arrow International and Stryker Instruments. In addition, the author received payments or other benefits or a commitment or agreement to provide such benefits from commercial entities (Arrow International and Stryker Instruments). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the author is affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Nov 01;88(11):2535-2536
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To The Editor:It is with interest and concern that I read the article entitled "Evaluation of a Single-Dose, Extended-Release Epidural Morphine Formulation for Pain After Knee Arthroplasty," (2006;88:273-81), by Hartrick et al.The authors should be commended on this well-executed and well-written study. Although the facts speak for themselves (160 of 162 patients experienced adverse events, highlighted by a 78% rate of nausea, a 43% rate of vomiting, a 36% rate of hypotension, and a 32% rate of hypoxia, with 96% of these mostly elderly patients requiring supplemental oxygen), the authors conclude that "...epidural DepoDur was a safe and effective analgesic alternative...". This is clearly an incorrect conclusion. A more appropriate conclusion should read: "...epidural DepoDur was poorly tolerated and was an unsafe alternative due to severe and frequent respiratory depression..." and "...the drug was more effective than intravenous patient-controlled analgesia for the first twenty-four hours only..."
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