{"paper_id":"26e15ffa-e1cf-41af-8a9e-05ae4a212fc1","body_text":"Effect of Intravenous Dexamethasone Added to Intrathecal Morphine on Postoperative Analgesia and Nausea/Vomiting in Geriatric Hip Fractures: A Retrospective Clinical Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Intravenous Dexamethasone Added to Intrathecal Morphine on Postoperative Analgesia and Nausea/Vomiting in Geriatric Hip Fractures: A Retrospective Clinical Trial Kadir ARSLAN, Ayca SULTAN SAHIN This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7256255/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Hip fractures are associated with high morbidity and mortality in the geriatric population, and adequate postoperative analgesia is crucial for improving outcomes. Intrathecal morphine provides adequate analgesia in geriatric patients with hip fractures, but it can also cause adverse effects such as postoperative nausea and vomiting (PONV) and respiratory depression. Dexamethasone, with its antiemetic and analgesic effects, has the potential to reduce these side effects. This study investigated the effects of intravenous dexamethasone added to intrathecal morphine on postoperative analgesia and PONV. Methods: This retrospective observational study included geriatric patients (≥65 years) who underwent hip fracture surgery under spinal anesthesia using 0.1 mg intrathecal morphine between January 2024 and August 2024. Patients were classified into two groups: those receiving 8 mg of intravenous dexamethasone before the procedure (Group D) and those receiving a placebo (Group P). Postoperative pain scores (VAS: Visual analog scale), opioid (contramal) consumption, PONV, respiratory depression, and pruritus were compared between the groups during the first 24 hours. Results: A total of 80 patients, 40 in Group D and 40 in Group P, were included in the study. Demographic data, comorbidities, anesthesia, and operation times were similar between the groups. Postoperative VAS scores of patients in Group D were significantly lower than those in Group P at the 2nd (1.2± 0.6 vs. 1.5± 0.6, p=0.027), 6th (2.0± 0.7 vs. 3.1± 0.6, p<0.001), 12th (2.7± 0.8 vs. 4.3± 0.7, p<0.001) and 24th hours (3.2± 0.7 vs. 4.8± 0.4, p<0.001). Contramal consumption in the first 24 hours (70±61 mg vs. 135±58 mg, p<0.001) and PONV rate (7.5% vs. 16.3%, p=0.034) were also significantly lower in Group D. There were no significant differences between the groups in terms of respiratory depression and pruritus. Conclusions: Prophylactic administration of dexamethasone before intrathecal morphine in geriatric hip fracture patients reduces postoperative pain scores, opioid consumption, and PONV rates in the first 24 hours. However, it did not affect adverse events such as respiratory depression and pruritus. Trial registration: ClinicalTrials.gov Identifier: NCT07037745 Spinal morphine Neuraxial opioids Hip fracture Dexametasone Postoperative nausea and vomiting Pruritis Postoperative pain Figures Figure 1 Figure 2 Background Hip fractures (proximal femur fractures) are a global public health problem with high morbidity and mortality rates, particularly in the geriatric population aged 65 and older. Hip fractures, a significant consequence of osteoporosis, occur as a result of low-energy trauma with advancing age. They are associated with increased mortality rates, increased risk of postoperative complications, the need for intensive care unit (ICU), prolonged hospital stays, and decreased quality of life [1-3]. Multimodal analgesia strategies in geriatric hip fracture patients aim to provide adequate pain control while limiting systemic opioid use. Spinal anesthesia, a type of neuraxial anesthesia, is frequently used in this patient group and is important for avoiding complications associated with general anesthesia [4]. The addition of intrathecal morphine (ITM) to minimal-dose local anesthetics used in spinal anesthesia has been reported to be effective in postoperative pain control. In major orthopedic surgeries such as total hip arthroplasty, the use of ITM in doses ranging from 0.1–0.2 mg has been reported to reduce systemic opioid use and reduce early pain scores [5]. This opioid-sparing effect is particularly significant in patients undergoing geriatric hip fracture surgery, where the use of opioids can be challenging (5). Depending on the dose of ITM used, side effects such as postoperative nausea and vomiting (PONV), respiratory depression, and pruritus may occur [6,7]. Prophylactic intravenous dexamethasone administration has been reported to be beneficial in postoperative analgesia and nausea and vomiting in both patients undergoing peripheral and fascial plane blocks and those undergoing ITM [8,9]. Dexamethasone is frequently used in patients undergoing general anesthesia, as well as in patients undergoing neuraxial anesthesia, due to its antiemetic properties. Furthermore, the role of intravenous dexamethasone in effectively controlling side effects such as PONV, respiratory depression, and pruritus that may occur due to ITM is a current and critical area of research. The aim of this study, conducted in a tertiary center, was to investigate the effects of intravenous 8 mg dexamethasone on postoperative pain scores, opioid consumption, PONV, respiratory depression, and pruritus in geriatric hip fractures operated under spinal anesthesia using 0.1 mg ITM. Methods Ethics This single-center retrospective observational study was approved by the Institutional Review Board at University of Health Sciences, Istanbul Kanuni Sultan Süleyman Training and Research Hospital (approval number: KAEK/2024.09.185, September 11, 2024) and the need for written informed consent was waived. This study was registered with ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT07037745). The study was conducted following the principles of the Declaration of Helsinki. Consent for spinal anesthesia was obtained from the patients before the operation. Study population and study protocol Patients who underwent hip fracture surgery under spinal anesthesia with 0.1 mg ITM at the University of Health Sciences, Istanbul Kanuni Sultan Süleyman Training and Research Hospital, between January 2024 and August 2024 were included in the study. Patient data were retrospectively evaluated through the hospital information system and patient files. Inclusion criteria: (1) age 65 and older; (2) spinal anesthesia using 0.1 mg ITM; (3) patients undergoing surgery for hip fractures. Exclusion criteria: (1) need for surgery in addition to hip fractures; (2) trauma at another site; (3) use of general anesthesia for any reason following spinal anesthesia; (4) cardiovascular or respiratory failure requiring perioperative intervention; (5) systemic steroid therapy; (6) uncontrolled diabetes; (7) cognitive dysfunction; (8) delirium (a state of consciousness that would preclude assessment of pain scores and PONV with the Visual Analog Scale); (9) missing data. Patients with hip fractures who were 65 years or older were studied between January and August 2024. Patients were classified as receiving 8 mg intravenous dexamethasone before spinal anesthesia using ITM (Group D) and not receiving dexamethasone before spinal anesthesia using ITM (Group P, Placebo group). Demographic data, comorbidities, American Society of Anesthesiologist (ASA) and Glasgow Coma Scale (GCS) scores, anesthesia and operative time, preoperative and postoperative hemoglobin levels, ICU and hospital stays, VAS scores at 2, 6, 12, and 24 hours postoperatively, and opioid (contramal) consumption were recorded. Additionally, conditions such as PONV, respiratory depression, and pruritus, which may be observed due to ITM, were analyzed. The presence and severity of PONV were assessed using an ordinal scale (0: no nausea; 1: mild; 2: moderate; 3: severe; 4: vomiting). The presence and severity of pruritus were also assessed using an ordinal scale (0: no pruritus; 1: mild; 2: moderate; 3: severe). Respiratory depression was defined as a pulse oximetry SpO2 < 90 on room air and the need for oxygen therapy. The presence of PONV and pruritus was considered significant, and their severity was not assessed. Anaesthesia and postoperative analgesia protocol Our hospital, a tertiary healthcare institution in Istanbul, frequently admits trauma patients and performs surgeries. Neuraxial anesthesia and peripheral nerve blocks are performed in geriatric patients with hip fractures at our clinic. In patients undergoing spinal anesthesia, 0.1 mg intrathecal morphine is used in conjunction with heavy bupivacaine to prolong intraoperative anesthesia and contribute to postoperative analgesia. Patients with hip fractures are admitted to the operating room, and a 20-22 gauge intravascular access is established, and fluid resuscitation is initiated with crystalloid solution or 0.9% NaCI. Midazolam (Dilemy 5 mg/5 mL, Saba Pharma, Turkey) (1-2 mg) is used for premedication. Following routine ASA monitoring (electrocardiography, pulse oximetry, non-invasive and, if necessary, invasive blood pressure monitoring), spinal anesthesia is performed in the sitting position at the L3-L4 or L4-L5 interval using a 22 or 25-gauge spinal needle with 0.1 mg morphine (0.1 mL) and 10-12.5 mg heavy bupivacaine. Dexamethasone (Gadexon 8 mg / 2 mL, Haver Pharma, Turkey) 8 mg intravenously (IV) can be administered before spinal anesthesia to patients undergoing intrathecal morphine spinal anesthesia to both potentiate the analgesic effect and reduce the rate of PONV. Some patients do not receive prophylactic dexamethasone. Patients who undergo intrathecal morphine spinal anesthesia but do not receive dexamethasone beforehand do not receive any other prophylactic antiemetic treatment. In our hospital, postoperative patients receive 1 g of IV paracetamol (Rastamol 10 mg/mL, Haver Farma, Turkey) every 8 hours as analgesics, and Diclofenac sodium (Dichloron 75 mg/3 mL, Deva Farma, Turkey) is infused every 12 hours. Patients experiencing pain despite paracetamol and NSAIDs are given a slow infusion of 100 mg of contramal hydrochloride (Tradolex 100 mg/2mL, Menta Pharma, Turkey) in saline. Primary outcome measure The primary outcome is the VAS measurements at rest in the first 24 hours postoperatively (2nd, 6th, 12th, and 24th hours). Secondary outcome measure Secondary outcomes are the opioid dose consumed, PONV, respiratory depression, and pruritus rate in the first 24 postoperative hours. Sample size The required sample size for this study was determined using G*Power 3.1 software (Heinrich Heine University Düsseldorf, Germany). A power analysis was performed based on a one-way analysis of variance (ANOVA) to compare VAS pain scores measured within the first 24 hours between two groups. In the analysis, a significance level of α = 0.05, a statistical power of 80% (1–β = 0.80), and a medium effect size were assumed. It was calculated that at least 34 patients per group, totaling a minimum of 68 patients, would be required for adequate statistical power. This sample size was achieved in our study. Statistical analysis SPSS 26.0 (SPSS Inc., Chicago, USA) program was used to analyze the data. Descriptive data are expressed as number of patients, percentage, mean and standard deviation, and median (interquartil range=Q1-Q3). The conformity of the variables to the normal distribution was evaluated analytically (Shapiro-Wilks test) and visually (histogram). An Independent sample t-test was used to analyze data with normal group distribution. The Mann-Whitney U test was used to analyze data that did not show normal distribution. In the analysis of VAS scores within and between groups, repeated measures ANOVA test with Bonferroni post hoc comparisons was used. The Chi-square and Fisher's exact tests were used to evaluate qualitative data. The significance level for all results was accepted as p <0.05. Results A total of 80 patients aged 65 and older who underwent hip fracture surgery under spinal anesthesia using intrathecal morphine between January 2024 and August 2024 were included in the study (Fig. 1). The mean age of the patients undergoing hip fracture surgery was 76.7 ± 9.2 years, and 66.3% (n=80) were female. Of the hip fracture patients, 61.3% (n=49) had ASA III status, and 56.3% (n=45) were followed in the ICU postoperatively. Age, gender, ASA status, BMI, and GCS were similar between the groups ( p =0.485, p =0.478, p =0.491, p =0.714, and p =0.554, respectively). The mean hemoglobin of the entire population undergoing surgery for hip fractures was 12.2±1.2 g/dL, and the operative hemoglobin change (ΔHb) was 1.2±0.6 g/dL. The mean operative time was 113.6±20 minutes. The operative time and ΔHb values were also similar between the groups (p=0.549 and p=0.824, respectively). The mean ICU stay was 0.9±1.0 days, and the mean hospital stay was 13.4±3.8 days. There was no significant difference between the groups in terms of ICU requirement, ICU and hospital stay (p=0.822, p=0.935, and p=0.392, respectively) (Table 1). The most common comorbidities in patients with hip fractures were hypertension (58.8%), coronary vascular disease-heart failure (48.8%), and diabetes (33.8%). The groups were also similar in terms of comorbidities (Table 2). In Group D, the mean VAS scores at the postoperative 2nd (1.2 ± 0.6 vs. 1.5± 0.6, p =0.027), 6th (2.0 ± 0.7 vs. 3.1± 0.6, p <0.001), 12th (2.7± 0.8 vs. 4.3± 0.7, p <0.001) and 24th (3.2± 0.7 vs. 4.8± 0.4, p <0.001) hours were found to be significantly lower (Table 3) (Fig. 2). The mean opioid (contramal hydrochloride) dose consumed in the first 24 hours postoperatively was also significantly lower in Group D (70±61 mg vs. 135±58 mg, p<0.001). The rate of PONV observed in the first 24 hours postoperatively was significantly lower in Group D (7.5% vs. 16.3%, p=0.034). Puritis due to ITM use was not observed in Group D, while it was detected in only one patient (1.3%) in Group P. Respiratory depression rates due to ITM did not differ significantly between the groups (2.5% vs. 7.5%, p=0.615) (Table 4). Discussion This study, conducted in geriatric hip fracture patients at a tertiary hospital, found that intravenous administration of 8 mg dexamethasone prior to spinal anesthesia using 0.1 mg ITM resulted in a significant reduction in pain scores and opioid consumption in the first 24 hours postoperatively. Prophylactic dexamethasone administration also significantly reduced PONV, a potential adverse effect of ITM. However, dexamethasone administration did not affect pruritus or respiratory depression. Procedure-Specific Postoperative Pain Management (PROSPECT) guidelines recommend 0.1 mg ITM in total hip arthroplasty, as in various types of surgery (Grade D). However, the PROSPECT guidelines reported that adverse effects such as PONV and pruritus are associated with ITM. The guidelines noted that while the incidence of these adverse effects may be relatively lower with intrathecal 0.1 mg morphine, it may negatively impact patient satisfaction because it may delay ambulation and oral intake [ 5 ]. The Enhanced Recovery After Surgery® (ERAS) Guidelines, however, do not recommend spinal opioids for routine use regardless of the surgery due to adverse effects such as respiratory depression, PONV, and pruritus [ 10 ]. Vitola et al . compared 0.1 and 0.2 mg ITM doses in total hip arthroplasty. They reported that 0.2 mg ITM provided superior analgesia compared to both 0.1 mg ITM and the control group [ 11 ]. Murphy et al . reported that 100 µg (0.1 mg) ITM provided postoperative analgesia as adequate as 200 mcg ITM and was well tolerated and safe, with fewer adverse effects in elderly patients undergoing total hip arthroplasty. The authors also reported that 50 mcg ITM did not provide adequate analgesia compared to placebo [ 12 ]. Other studies investigating the ITM dose in geriatric hip arthroplasty have also emphasized that 0.1 mg may be the optimal dose [ 13 – 14 ]. The analgesic effects of ITM in cesarean delivery, in addition to hip arthroplasty procedures, have also been investigated. Milner et al. reported that 0.1 mg ITM provided analgesia of similar quality to 0.2 mg ITM in patients undergoing elective cesarean delivery [ 15 ]. A dose of 0.1 mg ITM may be the optimal dose in this regard. The PROSPECT guidelines also recommend a single intravenous (IV) dose of 8–10 mg dexamethasone intraoperatively due to its analgesic and antiemetic effects (Grade A) [ 5 ]. Dexamethasone suppresses the secretion of inflammatory cytokines (IL-1, IL-2, IL-6, TNF-α, etc.) by acting transcriptionally on the glucocorticoid receptor. It also reduces prostaglandin and leukotriene production by blocking the cyclooxygenase and lipogenase pathways through phospholipase A₂ inhibition. Reduced levels of algogenic mediators such as bradykinin have also been reported to play a role in the analgesia mechanism [ 16 ]. In patients receiving perioperative dexamethasone, opioid consumption is reduced, and the first analgesic requirement occurs later. The timing of dexamethasone administration is also important. Preoperative administration has been reported to be the most effective method, resulting in greater reductions in pain scores [ 17 ]. In a study investigating the effects of 8 mg IV dexamethasone before 0.2 mg intravenous sedation on PONV in cesarean sections, it was reported that dexamethasone did not significantly reduce pain scores or 48-hour opioid (oxycodone) consumption [ 18 ]. To our knowledge, the effects of IV 8 mg dexamethasone before 0.1 mg ITM on pain scores, opioid consumption, and adverse events such as PONV, pruritus, and respiratory depression have not been investigated in geriatric hip fractures. In our study, 0.1 mg ITM and heavy bupivacaine were used in spinal anesthesia for both groups of patients, as recommended in the literature. We found that pain scores and opioid consumption in the first 24 hours were significantly reduced in the patient group receiving 8 mg IV dexamethasone before spinal anesthesia. We believe that the current study is valuable in this respect and that IV dexamethasone may be beneficial in patients without contraindications. One of the most significant concerns regarding the use of ITM is PONV [ 19 ]. It has been reported that PONV, which can occur after ITM is added to spinal anesthesia, can be challenging to control and may impair patient comfort. This has been attributed to decreased gastric emptying [ 20 ]. In a study investigating the effects of 0.1 and 0.2 mg ITM in hip arthroplasty surgeries, the incidence of PONV was found to be 23% in the 0.1 mg ITM group. It was noted that no significant difference in PONV was observed between the placebo group and the patients treated with 0.1 and 0.2 mg ITM [ 11 ]. Another study reported that PONV occurred within the first 24 hours in 80% of patients undergoing hip and knee surgeries under spinal anesthesia using ITM (0.12 mg), bupivacaine (15–20 mg), and clonidine (30 mcg) [ 21 ]. A study investigating the effect of 8 mg dexamethasone on PONV in cesarean deliveries performed under spinal anesthesia using 0.2 mg ITM reported no difference between the placebo and dexamethasone groups [ 18 ]. Another study reported that 0.1 mg ITM caused less PONV than 0.2 mg ITM in patients undergoing elective cesarean delivery [ 15 ]. The PROSPECT guideline states that intrathecal morphine (0.1 mg) and intravenous dexamethasone (8–10 mg) contribute to postoperative analgesia. However, there is no consensus on whether adding prophylactic dexamethasone to ITM reduces PONV in patients undergoing geriatric hip surgery. It has also been reported that administering dexamethasone before or after ITM may also affect PONV, but there are differing opinions on this issue [ 18 , 22 ]. In our study, dexamethasone was administered before ITM and spinal anesthesia. PONV was found to be significantly reduced in the IV dexamethasone group. The PROSPECT and ERAS guidelines emphasize pruritus as another concern regarding ITM [ 5 , 10 ]. Pruritus, a significant side effect of intrathecal morphine, negatively impacts patient comfort. Pruritus has been suggested to be centrally mediated by opioid receptors [ 23 ]. Murphy et al. reported that pruritus was significantly increased in patients undergoing geriatric hip surgery who received 0.2 mg ITM compared to placebo and those who received lower doses [ 12 ]. Vitola et al . found that the incidence of pruritus (23.3%) in patients receiving 0.2 mg ITM during hip arthroplasty surgery was significantly higher than in both the 0.1 mg ITM and the control group [ 11 ]. In our study, unlike these studies, the dose of ITM was fixed, and 8 mg of IV dexamethasone was administered beforehand. Pruritus was detected in only one patient (1.3%) in the entire population. No significant difference was observed between the groups. Pruritus will not pose a significant problem in the geriatric population when 0.1 mg ITM is used. One of the serious side effects associated with ITM administration is respiratory depression. Respiratory depression can occur late in the course of the disease, particularly in the geriatric population [ 5 ]. Respiratory depression caused by ITM can occur within 6–18 hours (especially at high doses of ≥ 0.2–0.3 mg). However, the risk of late respiratory depression has been reported to be acceptable with doses as low as 0.1 mg [ 24 ]. In our study, respiratory depression, responsive to 2–4 L/min oxygen supplementation in the recovery room during the early postoperative period, was observed in 5% of the entire population (n = 4). We believe that 8 mg IV dexamethasone prophylaxis before 0.1 mg ITM administration did not make a difference in terms of respiratory depression. The study has several limitations. First, it is retrospective and single-center, and the sample size is small. Second, the study included both patients with and without respiratory diseases (asthma and chronic obstructive pulmonary disease). It is important to note that the groups were similar in terms of comorbidities, which helps to maintain the study's internal validity. However, secondary outcomes such as respiratory depression may have been affected. Third, the study data cover the first 24 hours postoperatively. The longer-term effects of IV dexamethasone administered before ITM were not investigated. Fourth, spinal anesthesia used 10–15 mg heavy bupivacaine plus 0.1 mg ITM, depending on the patient's height. The lack of a fixed bupivacaine dose may have influenced the results. Fifth, antiemetic doses in the first 24 hours postoperatively were not evaluated. Finally, postoperative opioid consumption was based on contraceptive consumption in the first 24 hours. Patient-controlled analgesia was not used, and the time to first analgesic request was not recorded. In conclusion, providing adequate postoperative analgesia for hip fractures in the geriatric population is crucial for preventing complications and reducing morbidity and mortality. IV dexamethasone added to intrathecal morphine is effective in reducing postoperative pain scores and PONV in geriatric hip fracture patients. We believe that the literature is insufficient on this topic and that prospective randomized trials are needed. Abbreviations ASA: American Society of Anesthesiologist; BMI: Body Mass Index; ERAS: Enhanced Recovery After Surgery®; GCS: Glasgow Coma Scale; ΔHb: Difference between preoperative and postoperative hemoglobin; ICU: Intensive care unit; IV: Intravenous; ITM: Intrathecal morphine; PROSPECT: Procedure-Specific Postoperative Pain Management; PONV: Postoperative nausea and vomiting; VAS: Visual analog scale Declarations Ethics approval and consent to participate This single-center retrospective observational study was approved by the Institutional Review Board at University of Health Sciences, Istanbul Kanuni Sultan Süleyman Training and Research Hospital (approval number: KAEK/2024.09.185, September 11, 2024) and the need for written informed consent was waived. This study was registered with ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT07037745). The study was conducted following the principles of the Declaration of Helsinki. Consent for spinal anesthesia was obtained from the patients before the operation. Funding Declaration Not Applicable Consent for publication Not Applicable Availability of Data and Materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare no conflicts of interest. Authors’ contributions KA and ASS helped to design and conduct the study. KA analysed the data and approved the final manuscript. KA and ASS helped to design and conduct the study. KA and ASS and handed in the final manuscript. The authors read and approved the final manuscript Acknowledgements Not Applicable References Global Burden Disease Fracture Collaborators. Global, regional, andnational burden of bone fractures in 204 countries and territories,1990-2019: a systematic analysis from the global burden of disease study 2019. Lancet Healthy Longev. 2021;2(9):e580–e92. Arslan K, Altunbay RA, Sahin AS. 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The effect of intravenous dexamethasone on postoperative nausea and vomiting after Cesarean delivery with intrathecal morphine: a randomized-controlled trial. Can J Anaesth. 2020;67(7):817-26. Hess SR, Lahaye LA, Waligora AC, Sima AP, Jiranek WA, Golladay GJ. Safety and side-effect profile of intrathecal morphine in a diverse patient population undergoing total knee and hip arthroplasty. Eur J Orthop Surg Traumatol. 2019;29(1):125–9. Lydon AM, Cooke T, Duggan F, Shorten GD. Delayed postoperative gastric emptying following intrathecal morphine and intrathecal bupivacaine. Can J Anaesth. 1999;46:544-9. Moraitis A, Hultin M, Walldén J. Risk of postoperative nausea and vomiting in hip and knee arthroplasty: a prospective cohort study after spinal anaesthesia including intrathecal morphine. BMC Anesthesiol. 2020;20(1):242. Allen TK, Jones CA, Habib AS. Dexamethasone for the prophylaxis of postoperative nausea and vomiting associated with neuraxial morphine administration: a systematic review and meta-analysis. Anesth Analg. 2012;114(4): 813-22. Tohda C, Yamaguchi T, Kuraishi Y. Intracisternal injection of opioids induces itch-associated response through mu-opioid receptors in mice. Jpn J Pharmacol. 1997;74:77–82. DeSousa KA, Chandran R. Intrathecal morphine for postoperative analgesia: Current trends. World J Anesthesiol. 2014;3(3):191-202. Tables Tables 1 to 4 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.docx Table2.docx Table3.docx Table4.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-7256255\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":501914718,\"identity\":\"471a65b1-ddfd-47c7-bb0d-df26c1681c0b\",\"order_by\":0,\"name\":\"Kadir ARSLAN\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYBACCQYGgwNgFjsQf2AAsw2I1MLMwMA4A64lAb8WBpgWZh5itEi2H954uILBLl++mfnZY5s/dxIb2Ju3STD+uIdTizRPWsHBMwzJlhsOs5kb57Y9S2zgOVYmwZBQjFOLHEOOwcEGBmYDA2YGM+nchsOJDRI5ZkAtuF0mx/8GpKXeQL6Z/Zu0xR+gFvk3+LVIS4BtOWzAcJjHTJqBDWQLD34tkjOeFRxsMDhuYHCYp0yyt+2ZcRtPWrFFQhpuLRLnkzd/bKioNpBvb98m8ePPHdl+9sMbb3ywwa0FApCjmw1EENIwCkbBKBgFowA/AAD0kE85u9XnawAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Kadir\",\"middleName\":\"\",\"lastName\":\"ARSLAN\",\"suffix\":\"\"},{\"id\":501914719,\"identity\":\"52caabdd-0ac2-48a0-8242-5c5256081526\",\"order_by\":1,\"name\":\"Ayca SULTAN SAHIN\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Ayca\",\"middleName\":\"SULTAN\",\"lastName\":\"SAHIN\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-07-30 20:38:20\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-7256255/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-7256255/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":89541242,\"identity\":\"5ae237ef-ba83-4413-855b-4a74234b02d2\",\"added_by\":\"auto\",\"created_at\":\"2025-08-21 06:35:14\",\"extension\":\"jpg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":133088,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eFlow chart of the study\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig.1.Flowchartofthestudy.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7256255/v1/ba4842a7c0e18520c60d44f2.jpg\"},{\"id\":89542220,\"identity\":\"6bb2b3a7-5fad-4cc4-afd6-a4be6ed4f385\",\"added_by\":\"auto\",\"created_at\":\"2025-08-21 06:43:14\",\"extension\":\"jpg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":131035,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eThe mean VAS scores of the groups in the first 24 hours\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig.2.VASscoresofthegroupsinthefirst24hours.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7256255/v1/837dbc21321faa190d747cc8.jpg\"},{\"id\":90335132,\"identity\":\"1e1eaacf-2165-42dd-8bc6-10c1c212ff45\",\"added_by\":\"auto\",\"created_at\":\"2025-09-01 14:02:10\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":799031,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7256255/v1/850377ec-b20b-4f97-b1f1-7f1e6e10ee42.pdf\"},{\"id\":89541239,\"identity\":\"e80bf848-95cd-49d1-8667-ac371121f859\",\"added_by\":\"auto\",\"created_at\":\"2025-08-21 06:35:14\",\"extension\":\"docx\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":23388,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Table1.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7256255/v1/9c1dab910589d43c67b94f51.docx\"},{\"id\":89541247,\"identity\":\"58149d60-3e9e-45a9-b576-06667590d562\",\"added_by\":\"auto\",\"created_at\":\"2025-08-21 06:35:14\",\"extension\":\"docx\",\"order_by\":2,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":14756,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Table2.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7256255/v1/bcda3cffed327a97596400aa.docx\"},{\"id\":89541240,\"identity\":\"4981feaf-46bb-465f-b83e-8a4f9409b9ca\",\"added_by\":\"auto\",\"created_at\":\"2025-08-21 06:35:14\",\"extension\":\"docx\",\"order_by\":3,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":16996,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Table3.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7256255/v1/f5b3e3f1b0700a1ea895a8b1.docx\"},{\"id\":89542911,\"identity\":\"1035398d-525e-4eb1-939e-3f4476a78ef6\",\"added_by\":\"auto\",\"created_at\":\"2025-08-21 06:51:14\",\"extension\":\"docx\",\"order_by\":4,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":18778,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Table4.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7256255/v1/7af7f2e8bec87105f010ba75.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Effect of Intravenous Dexamethasone Added to Intrathecal Morphine on Postoperative Analgesia and Nausea/Vomiting in Geriatric Hip Fractures: A Retrospective Clinical Trial\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eHip fractures (proximal femur fractures) are a global public health problem with high morbidity and mortality rates, particularly in the geriatric population aged 65 and older. Hip fractures, a significant consequence of osteoporosis, occur as a result of low-energy trauma with advancing age. They are associated with increased mortality rates, increased risk of postoperative complications, the need for intensive care unit (ICU), prolonged hospital stays, and decreased quality of life [1-3]. Multimodal analgesia strategies in geriatric hip fracture patients aim to provide adequate pain control while limiting systemic opioid use. Spinal anesthesia, a type of neuraxial anesthesia, is frequently used in this patient group and is important for avoiding complications associated with general anesthesia [4]. The addition of intrathecal morphine (ITM) to minimal-dose local anesthetics used in spinal anesthesia has been reported to be effective in postoperative pain control.\\u003c/p\\u003e\\n\\u003cp\\u003eIn major orthopedic surgeries such as total hip arthroplasty, the use of ITM in doses ranging from 0.1\\u0026ndash;0.2 mg has been reported to reduce systemic opioid use and reduce early pain scores [5]. This opioid-sparing effect is particularly significant in patients undergoing geriatric hip fracture surgery, where the use of opioids can be challenging (5). Depending on the dose of ITM used, side effects such as postoperative nausea and vomiting (PONV), respiratory depression, and pruritus may occur [6,7]. Prophylactic intravenous dexamethasone administration has been reported to be beneficial in postoperative analgesia and nausea and vomiting in both patients undergoing peripheral and fascial plane blocks and those undergoing ITM [8,9]. Dexamethasone is frequently used in patients undergoing general anesthesia, as well as in patients undergoing neuraxial anesthesia, due to its antiemetic properties. Furthermore, the role of intravenous dexamethasone in effectively controlling side effects such as PONV, respiratory depression, and pruritus that may occur due to ITM is a current and critical area of research.\\u003c/p\\u003e\\n\\u003cp\\u003eThe aim of this study, conducted in a tertiary center, was to investigate the effects of intravenous 8 mg dexamethasone on postoperative pain scores, opioid consumption, PONV, respiratory depression, and pruritus in geriatric hip fractures operated under spinal anesthesia using 0.1 mg ITM.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis single-center retrospective observational study was approved by the Institutional Review Board at University of Health Sciences, Istanbul Kanuni Sultan S\\u0026uuml;leyman Training and Research Hospital (approval number: KAEK/2024.09.185, September 11, 2024) and the need for written informed consent was waived. This study was registered with ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT07037745). The study was conducted following the principles of the Declaration of Helsinki. Consent for spinal anesthesia was obtained from the patients before the operation.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStudy population and study protocol\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePatients who underwent hip fracture surgery under spinal anesthesia with 0.1 mg ITM at the University of Health Sciences, Istanbul Kanuni Sultan S\\u0026uuml;leyman Training and Research Hospital, between January 2024 and August 2024 were included in the study. Patient data were retrospectively evaluated through the hospital information system and patient files.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eInclusion criteria: (1) age 65 and older; (2) spinal anesthesia using 0.1 mg ITM; (3) patients undergoing surgery for hip fractures. Exclusion criteria: (1) need for surgery in addition to hip fractures; (2) trauma at another site; (3) use of general anesthesia for any reason following spinal anesthesia; (4) cardiovascular or respiratory failure requiring perioperative intervention; (5) systemic steroid therapy; (6) uncontrolled diabetes; (7) cognitive dysfunction; (8) delirium (a state of consciousness that would preclude assessment of pain scores and PONV with the Visual Analog Scale); (9) missing data.\\u003c/p\\u003e\\n\\u003cp\\u003ePatients with hip fractures who were 65 years or older were studied between January and August 2024. Patients were classified as receiving 8 mg intravenous dexamethasone before spinal anesthesia using ITM (Group D) and not receiving dexamethasone before spinal anesthesia using ITM (Group P, Placebo group).\\u003c/p\\u003e\\n\\u003cp\\u003eDemographic data, comorbidities,\\u0026nbsp;American Society of Anesthesiologist (ASA) and Glasgow Coma Scale (GCS) scores, anesthesia and operative time, preoperative and postoperative hemoglobin levels, ICU and hospital stays, VAS scores at 2, 6, 12, and 24 hours postoperatively, and opioid (contramal) consumption were recorded. Additionally, conditions such as PONV, respiratory depression, and pruritus, which may be observed due to ITM, were analyzed. The presence and severity of PONV were assessed using an ordinal scale (0: no nausea; 1: mild; 2: moderate; 3: severe; 4: vomiting). The presence and severity of pruritus were also assessed using an ordinal scale (0: no pruritus; 1: mild; 2: moderate; 3: severe). Respiratory depression was defined as a pulse oximetry SpO2 \\u0026lt; 90 on room air and the need for oxygen therapy. The presence of PONV and pruritus was considered significant, and their severity was not assessed.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAnaesthesia and postoperative analgesia protocol\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOur hospital, a tertiary healthcare institution in Istanbul, frequently admits trauma patients and performs surgeries. Neuraxial anesthesia and peripheral nerve blocks are performed in geriatric patients with hip fractures at our clinic. In patients undergoing spinal anesthesia, 0.1 mg intrathecal morphine is used in conjunction with heavy bupivacaine to prolong intraoperative anesthesia and contribute to postoperative analgesia. Patients with hip fractures are admitted to the operating room, and a 20-22 gauge intravascular access is established, and fluid resuscitation is initiated with crystalloid solution or 0.9% NaCI. Midazolam (Dilemy 5 mg/5 mL, Saba Pharma, Turkey) (1-2 mg) is used for premedication. Following routine ASA monitoring (electrocardiography, pulse oximetry, non-invasive and, if necessary, invasive blood pressure monitoring), spinal anesthesia is performed in the sitting position at the L3-L4 or L4-L5 interval using a 22 or 25-gauge spinal needle with 0.1 mg morphine (0.1 mL) and 10-12.5 mg heavy bupivacaine. Dexamethasone (Gadexon 8 mg / 2 mL, Haver Pharma, Turkey) 8 mg intravenously (IV) can be administered before spinal anesthesia to patients undergoing intrathecal morphine spinal anesthesia to both potentiate the analgesic effect and reduce the rate of PONV. Some patients do not receive prophylactic dexamethasone. Patients who undergo intrathecal morphine spinal anesthesia but do not receive dexamethasone beforehand do not receive any other prophylactic antiemetic treatment.\\u003c/p\\u003e\\n\\u003cp\\u003eIn our hospital, postoperative patients receive 1 g of IV paracetamol (Rastamol 10 mg/mL, Haver Farma, Turkey) every 8 hours as analgesics, and Diclofenac sodium (Dichloron 75 mg/3 mL, Deva Farma, Turkey) is infused every 12 hours. Patients experiencing pain despite paracetamol and NSAIDs are given a slow infusion of 100 mg of contramal hydrochloride (Tradolex 100 mg/2mL, Menta Pharma, Turkey) in saline.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003ePrimary outcome measure\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe primary outcome is the VAS measurements at rest in the first 24 hours postoperatively (2nd, 6th, 12th, and 24th hours).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSecondary outcome measure\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSecondary outcomes are the opioid dose consumed, PONV, respiratory depression, and pruritus rate in the first 24 postoperative hours.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSample size\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe required sample size for this study was determined using\\u0026nbsp;G*Power 3.1 software (Heinrich Heine University D\\u0026uuml;sseldorf, Germany). A power analysis was performed based on a\\u0026nbsp;one-way analysis of variance (ANOVA)\\u0026nbsp;to compare VAS pain scores measured within the first 24 hours between two groups. In the analysis, a significance level of\\u0026nbsp;\\u0026alpha; = 0.05, a statistical power of\\u0026nbsp;80% (1\\u0026ndash;\\u0026beta; = 0.80), and a medium effect size were assumed. It was calculated that\\u0026nbsp;at least 34 patients per group, totaling\\u0026nbsp;a minimum of 68 patients, would be required for adequate statistical power. This sample size was achieved in our study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStatistical analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSPSS 26.0 (SPSS Inc., Chicago, USA) program was used to analyze the data. Descriptive data are expressed as number of patients, percentage, mean and standard deviation, and median (interquartil range=Q1-Q3). The conformity of the variables to the normal distribution was evaluated analytically (Shapiro-Wilks test) and visually (histogram). An Independent sample t-test was used to analyze data with normal group distribution. The Mann-Whitney U test was used to analyze data that did not show normal distribution. In the analysis of VAS scores within and between groups, repeated measures ANOVA test with Bonferroni post hoc comparisons was used. The Chi-square and Fisher\\u0026apos;s exact tests were used to evaluate qualitative data. The significance level for all results was accepted as p \\u0026lt;0.05.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eA total of 80 patients aged 65 and older who underwent hip fracture surgery under spinal anesthesia using intrathecal morphine between January 2024 and August 2024 were included in the study (Fig. 1). The mean age of the patients undergoing hip fracture surgery was 76.7 \\u0026plusmn; 9.2 years, and 66.3% (n=80) were female. Of the hip fracture patients, 61.3% (n=49) had ASA III status, and 56.3% (n=45) were followed in the ICU postoperatively.\\u003c/p\\u003e\\n\\u003cp\\u003eAge, gender, ASA status, BMI, and GCS were similar between the groups (\\u003cem\\u003ep\\u003c/em\\u003e=0.485, \\u003cem\\u003ep\\u003c/em\\u003e=0.478, \\u003cem\\u003ep\\u003c/em\\u003e=0.491, \\u003cem\\u003ep\\u003c/em\\u003e=0.714, and \\u003cem\\u003ep\\u003c/em\\u003e=0.554, respectively). The mean hemoglobin of the entire population undergoing surgery for hip fractures was 12.2\\u0026plusmn;1.2 g/dL, and the operative hemoglobin change (\\u0026Delta;Hb) was 1.2\\u0026plusmn;0.6 g/dL. The mean operative time was 113.6\\u0026plusmn;20 minutes. The operative time and \\u0026Delta;Hb values were also similar between the groups (p=0.549 and p=0.824, respectively). The mean ICU stay was 0.9\\u0026plusmn;1.0 days, and the mean hospital stay was 13.4\\u0026plusmn;3.8 days. There was no significant difference between the groups in terms of ICU requirement, ICU and hospital stay (p=0.822, p=0.935, and p=0.392, respectively) (Table 1).\\u003c/p\\u003e\\n\\u003cp\\u003eThe most common comorbidities in patients with hip fractures were hypertension (58.8%), coronary vascular disease-heart failure (48.8%), and diabetes (33.8%). The groups were also similar in terms of comorbidities (Table 2).\\u003c/p\\u003e\\n\\u003cp\\u003eIn Group D, the mean VAS scores at the postoperative 2nd (1.2 \\u0026plusmn; 0.6 vs. 1.5\\u0026plusmn; 0.6, \\u003cem\\u003ep\\u003c/em\\u003e=0.027), 6th (2.0 \\u0026plusmn; 0.7 vs. 3.1\\u0026plusmn; 0.6, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026lt;0.001), 12th (2.7\\u0026plusmn; 0.8 vs. 4.3\\u0026plusmn; 0.7, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026lt;0.001) and 24th (3.2\\u0026plusmn; 0.7 vs. 4.8\\u0026plusmn; 0.4, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026lt;0.001) hours were found to be significantly lower (Table 3) (Fig. 2).\\u003c/p\\u003e\\n\\u003cp\\u003eThe mean opioid (contramal hydrochloride) dose consumed in the first 24 hours postoperatively was also significantly lower in Group D (70\\u0026plusmn;61 mg vs. 135\\u0026plusmn;58 mg, p\\u0026lt;0.001). The rate of PONV observed in the first 24 hours postoperatively was significantly lower in Group D (7.5% vs. 16.3%, p=0.034). Puritis due to ITM use was not observed in Group D, while it was detected in only one patient (1.3%) in Group P. Respiratory depression rates due to ITM did not differ significantly between the groups (2.5% vs. 7.5%, p=0.615) (Table 4).\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThis study, conducted in geriatric hip fracture patients at a tertiary hospital, found that intravenous administration of 8 mg dexamethasone prior to spinal anesthesia using 0.1 mg ITM resulted in a significant reduction in pain scores and opioid consumption in the first 24 hours postoperatively. Prophylactic dexamethasone administration also significantly reduced PONV, a potential adverse effect of ITM. However, dexamethasone administration did not affect pruritus or respiratory depression.\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003eProcedure-Specific Postoperative Pain Management (PROSPECT)\\u003c/em\\u003e guidelines recommend 0.1 mg ITM in total hip arthroplasty, as in various types of surgery (Grade D). However, the \\u003cem\\u003ePROSPECT\\u003c/em\\u003e guidelines reported that adverse effects such as PONV and pruritus are associated with ITM. The guidelines noted that while the incidence of these adverse effects may be relatively lower with intrathecal 0.1 mg morphine, it may negatively impact patient satisfaction because it may delay ambulation and oral intake [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. The \\u003cem\\u003eEnhanced Recovery After Surgery\\u0026reg; (ERAS)\\u003c/em\\u003e Guidelines, however, do not recommend spinal opioids for routine use regardless of the surgery due to adverse effects such as respiratory depression, PONV, and pruritus [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. \\u003cem\\u003eVitola et al\\u003c/em\\u003e. compared 0.1 and 0.2 mg ITM doses in total hip arthroplasty. They reported that 0.2 mg ITM provided superior analgesia compared to both 0.1 mg ITM and the control group [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. \\u003cem\\u003eMurphy et al\\u003c/em\\u003e. reported that 100 \\u0026micro;g (0.1 mg) ITM provided postoperative analgesia as adequate as 200 mcg ITM and was well tolerated and safe, with fewer adverse effects in elderly patients undergoing total hip arthroplasty. The authors also reported that 50 mcg ITM did not provide adequate analgesia compared to placebo [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. Other studies investigating the ITM dose in geriatric hip arthroplasty have also emphasized that 0.1 mg may be the optimal dose [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. The analgesic effects of ITM in cesarean delivery, in addition to hip arthroplasty procedures, have also been investigated.\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003eMilner et al.\\u003c/em\\u003e reported that 0.1 mg ITM provided analgesia of similar quality to 0.2 mg ITM in patients undergoing elective cesarean delivery [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. A dose of 0.1 mg ITM may be the optimal dose in this regard. The \\u003cem\\u003ePROSPECT\\u003c/em\\u003e guidelines also recommend a single intravenous (IV) dose of 8\\u0026ndash;10 mg dexamethasone intraoperatively due to its analgesic and antiemetic effects (Grade A) [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. Dexamethasone suppresses the secretion of inflammatory cytokines (IL-1, IL-2, IL-6, TNF-α, etc.) by acting transcriptionally on the glucocorticoid receptor. It also reduces prostaglandin and leukotriene production by blocking the cyclooxygenase and lipogenase pathways through phospholipase A₂ inhibition. Reduced levels of algogenic mediators such as bradykinin have also been reported to play a role in the analgesia mechanism [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. In patients receiving perioperative dexamethasone, opioid consumption is reduced, and the first analgesic requirement occurs later. The timing of dexamethasone administration is also important. Preoperative administration has been reported to be the most effective method, resulting in greater reductions in pain scores [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. In a study investigating the effects of 8 mg IV dexamethasone before 0.2 mg intravenous sedation on PONV in cesarean sections, it was reported that dexamethasone did not significantly reduce pain scores or 48-hour opioid (oxycodone) consumption [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. To our knowledge, the effects of IV 8 mg dexamethasone before 0.1 mg ITM on pain scores, opioid consumption, and adverse events such as PONV, pruritus, and respiratory depression have not been investigated in geriatric hip fractures. In our study, 0.1 mg ITM and heavy bupivacaine were used in spinal anesthesia for both groups of patients, as recommended in the literature. We found that pain scores and opioid consumption in the first 24 hours were significantly reduced in the patient group receiving 8 mg IV dexamethasone before spinal anesthesia. We believe that the current study is valuable in this respect and that IV dexamethasone may be beneficial in patients without contraindications.\\u003c/p\\u003e\\u003cp\\u003eOne of the most significant concerns regarding the use of ITM is PONV [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]. It has been reported that PONV, which can occur after ITM is added to spinal anesthesia, can be challenging to control and may impair patient comfort. This has been attributed to decreased gastric emptying [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]. In a study investigating the effects of 0.1 and 0.2 mg ITM in hip arthroplasty surgeries, the incidence of PONV was found to be 23% in the 0.1 mg ITM group. It was noted that no significant difference in PONV was observed between the placebo group and the patients treated with 0.1 and 0.2 mg ITM [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. Another study reported that PONV occurred within the first 24 hours in 80% of patients undergoing hip and knee surgeries under spinal anesthesia using ITM (0.12 mg), bupivacaine (15\\u0026ndash;20 mg), and clonidine (30 mcg) [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]. A study investigating the effect of 8 mg dexamethasone on PONV in cesarean deliveries performed under spinal anesthesia using 0.2 mg ITM reported no difference between the placebo and dexamethasone groups [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. Another study reported that 0.1 mg ITM caused less PONV than 0.2 mg ITM in patients undergoing elective cesarean delivery [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. The \\u003cem\\u003ePROSPECT\\u003c/em\\u003e guideline states that intrathecal morphine (0.1 mg) and intravenous dexamethasone (8\\u0026ndash;10 mg) contribute to postoperative analgesia. However, there is no consensus on whether adding prophylactic dexamethasone to ITM reduces PONV in patients undergoing geriatric hip surgery. It has also been reported that administering dexamethasone before or after ITM may also affect PONV, but there are differing opinions on this issue [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]. In our study, dexamethasone was administered before ITM and spinal anesthesia. PONV was found to be significantly reduced in the IV dexamethasone group.\\u003c/p\\u003e\\u003cp\\u003eThe \\u003cem\\u003ePROSPECT\\u003c/em\\u003e and \\u003cem\\u003eERAS\\u003c/em\\u003e guidelines emphasize pruritus as another concern regarding ITM [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. Pruritus, a significant side effect of intrathecal morphine, negatively impacts patient comfort. Pruritus has been suggested to be centrally mediated by opioid receptors [\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. \\u003cem\\u003eMurphy et al.\\u003c/em\\u003e reported that pruritus was significantly increased in patients undergoing geriatric hip surgery who received 0.2 mg ITM compared to placebo and those who received lower doses [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. \\u003cem\\u003eVitola et al\\u003c/em\\u003e. found that the incidence of pruritus (23.3%) in patients receiving 0.2 mg ITM during hip arthroplasty surgery was significantly higher than in both the 0.1 mg ITM and the control group [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. In our study, unlike these studies, the dose of ITM was fixed, and 8 mg of IV dexamethasone was administered beforehand. Pruritus was detected in only one patient (1.3%) in the entire population. No significant difference was observed between the groups. Pruritus will not pose a significant problem in the geriatric population when 0.1 mg ITM is used.\\u003c/p\\u003e\\u003cp\\u003eOne of the serious side effects associated with ITM administration is respiratory depression. Respiratory depression can occur late in the course of the disease, particularly in the geriatric population [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. Respiratory depression caused by ITM can occur within 6\\u0026ndash;18 hours (especially at high doses of \\u0026ge;\\u0026thinsp;0.2\\u0026ndash;0.3 mg). However, the risk of late respiratory depression has been reported to be acceptable with doses as low as 0.1 mg [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]. In our study, respiratory depression, responsive to 2\\u0026ndash;4 L/min oxygen supplementation in the recovery room during the early postoperative period, was observed in 5% of the entire population (n\\u0026thinsp;=\\u0026thinsp;4). We believe that 8 mg IV dexamethasone prophylaxis before 0.1 mg ITM administration did not make a difference in terms of respiratory depression.\\u003c/p\\u003e\\u003cp\\u003eThe study has several limitations. First, it is retrospective and single-center, and the sample size is small. Second, the study included both patients with and without respiratory diseases (asthma and chronic obstructive pulmonary disease). It is important to note that the groups were similar in terms of comorbidities, which helps to maintain the study's internal validity. However, secondary outcomes such as respiratory depression may have been affected. Third, the study data cover the first 24 hours postoperatively. The longer-term effects of IV dexamethasone administered before ITM were not investigated. Fourth, spinal anesthesia used 10\\u0026ndash;15 mg heavy bupivacaine plus 0.1 mg ITM, depending on the patient's height. The lack of a fixed bupivacaine dose may have influenced the results. Fifth, antiemetic doses in the first 24 hours postoperatively were not evaluated. Finally, postoperative opioid consumption was based on contraceptive consumption in the first 24 hours. Patient-controlled analgesia was not used, and the time to first analgesic request was not recorded.\\u003c/p\\u003e\\u003cp\\u003eIn conclusion, providing adequate postoperative analgesia for hip fractures in the geriatric population is crucial for preventing complications and reducing morbidity and mortality. IV dexamethasone added to intrathecal morphine is effective in reducing postoperative pain scores and PONV in geriatric hip fracture patients. We believe that the literature is insufficient on this topic and that prospective randomized trials are needed.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eASA:\\u0026nbsp;American Society of Anesthesiologist;\\u0026nbsp;BMI:\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003eBody Mass Index; ERAS: Enhanced Recovery After Surgery\\u0026reg;; GCS: Glasgow Coma Scale; \\u0026Delta;Hb: Difference between preoperative and postoperative hemoglobin; ICU: Intensive care unit; IV: Intravenous; ITM: Intrathecal morphine; PROSPECT: Procedure-Specific Postoperative Pain Management; PONV: Postoperative nausea and vomiting; VAS: Visual analog scale\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis single-center retrospective observational study was approved by the Institutional Review Board at University of Health Sciences, Istanbul Kanuni Sultan S\\u0026uuml;leyman Training and Research Hospital (approval number: KAEK/2024.09.185, September 11, 2024) and the need for written informed consent was waived. This study was registered with ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT07037745). The study was conducted following the principles of the Declaration of Helsinki. Consent for spinal anesthesia was obtained from the patients before the operation.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding Declaration\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot Applicable\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot Applicable\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of Data and Materials\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no conflicts of interest.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026rsquo; contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eKA and ASS helped to design and conduct the study. KA analysed the data and approved the final manuscript. KA and ASS helped to design and conduct the study. KA and ASS and handed in the final manuscript. The authors read and approved the final manuscript\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot Applicable\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eGlobal Burden Disease Fracture Collaborators. Global, regional, andnational burden of bone fractures in 204 countries and territories,1990-2019: a systematic analysis from the global burden of disease study 2019. Lancet Healthy Longev. 2021;2(9):e580\\u0026ndash;e92.\\u003c/li\\u003e\\n\\u003cli\\u003eArslan K, Altunbay RA, Sahin AS. Predictors and Influential Factors of Prolonged Stay in the Postoperative Surgical Intensive Care Unit. CM. 2024;16(4):244-51.\\u003c/li\\u003e\\n\\u003cli\\u003eKatsoulis M, Benetou V, Karapetyan T, Feskanich D, Grodstein F, Pettersson-Kymmer U, et al. Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project. J Intern Med. 2017;281(3):300\\u0026ndash;10.\\u003c/li\\u003e\\n\\u003cli\\u003eArslan K, Sahin AS. Should the Paramedian Approach be the First Choice in Spinal Anesthesia of Geriatric Patients? Prospective Randomized Clinical Trial. Bagcılar Med Bull. 2022;7(3):240-6.\\u003c/li\\u003e\\n\\u003cli\\u003eAnger M, Valovska T, Beloeil H, Lirk P, Joshi GP, Van de Velde M, et al. PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2021;76(8):1082-97.\\u003c/li\\u003e\\n\\u003cli\\u003eArslan K, Cetin Arslan H, Yıldız ME, Sahin AS. Effects of Ultrasonography-Guided Transversus Abdominis Plane Block on Postoperative Analgesia, Gastrointestinal Motility, and Mobilization in Patients Delivering Cesarean Delivery Under Spinal Anesthesia: A Retrospective Study. Duzce Med J. 2023;25(2):167-72. \\u003c/li\\u003e\\n\\u003cli\\u003eGrape S, Usmanova I, Kirkham KR, Albrecht E. Intravenous dexamethasone for prophylaxis of postoperative nausea and vomiting after administration of long-acting neuraxial opioids: a systematic review and meta-analysis. Anaesthesia. 2018;73(4):480-9. \\u003c/li\\u003e\\n\\u003cli\\u003eKücüksarac G, Arslan K, Sahin A. Effect of Dexamethasone on Postoperative Analgesia Following the Transversus Abdominis Plane Block in Gynecological Laparotomies. Cureus. 2025;16(11): e73814.\\u003c/li\\u003e\\n\\u003cli\\u003eLucero CM, Garc\\u0026iacute;a-Mansilla A, Zanotti G, Comba F, Slullitel PA, Buttaro MA. A Repeat Dose of Perioperative Dexamethasone Can Effectively Reduce Pain, Opioid Requirement, Time to Ambulation, and In-Hospital Stay After Total Hip Arthroplasty: A Prospective Randomized Controlled Trial. J Arthroplasty. 202;36(12):3938-44. \\u003c/li\\u003e\\n\\u003cli\\u003eWainwright TW, Gill M, McDonald DA, Middleton RG, Reed M, Sahota O, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS((R))) Society recommendations. Acta Orthop. 2020;91(1):3-19.\\u003c/li\\u003e\\n\\u003cli\\u003eVitola E, Buraka N, Erts R, Golubovska I, Miscuks A. Effect of different low doses of intrathecal morphine (0.1 and 0.2 mg) on pain and vital functions in patients undergoing total hip arthroplasty: a randomised controlled study. BMC Anesthesiol. 2022;22(1):377.\\u003c/li\\u003e\\n\\u003cli\\u003eMurphy PM, Stack D, Kinirons B, Laffey JG. Optimizing the dose of intrathecal morphine in older patients undergoing hip arthroplasty. Anesth Analg. 2003;97(6):1709-15. \\u003c/li\\u003e\\n\\u003cli\\u003eSlappendel R, Weber EW, Dirksen R, Gielen MJ, van Limbeek J. Optimization of the dose of intrathecal morphine in total hip surgery: a dose-finding study. Anesth Analg. 1999;88:822-6.\\u003c/li\\u003e\\n\\u003cli\\u003eMendieta Sanchez JM, Fernandez-Liesa JI, Marco G, Panadero A, S\\u0026aacute;nchez-Ledesma MJ, Mac\\u0026iacute;as A. Efficacy of 0.1 mg of subarachnoid morphine combined with bupivacaine on postoperative analgesia in total hip arthroplasty [in Spanish]. Rev Esp Anestesiol Reanim. 1999;46(10):433\\u0026ndash;7. \\u003c/li\\u003e\\n\\u003cli\\u003eMilner AR, Bogod DG, Harwood RJ. Intrathecal administration of morphine for elective caesarean section: a comparison between 0.1 and 0.2 mg. Anaesthesia. 1996;51(9):871\\u0026ndash;3.\\u003c/li\\u003e\\n\\u003cli\\u003eBansal T, Singhal S, Taxak S, Bajwa SJS. Dexamethasone in anesthesia practice: A narrative review. J Anaesthesiol Clin Pharmacol. 2024;40(1):3-8.\\u003c/li\\u003e\\n\\u003cli\\u003eMitchell C, Cheuk SJ, O\\u0026apos;Donnell CM, Bampoe S, Walker D. What is the impact of dexamethasone on postoperative pain in adults undergoing general anaesthesia for elective abdominal surgery: a systematic review and meta-analysis. Perioper Med (Lond). 2022;11(1):13.\\u003c/li\\u003e\\n\\u003cli\\u003eSelzer A, Pryor KO, Tangel V, O\\u0026apos;Connell K, Kjaer K. The effect of intravenous dexamethasone on postoperative nausea and vomiting after Cesarean delivery with intrathecal morphine: a randomized-controlled trial. Can J Anaesth. 2020;67(7):817-26.\\u003c/li\\u003e\\n\\u003cli\\u003eHess SR, Lahaye LA, Waligora AC, Sima AP, Jiranek WA, Golladay GJ. Safety and side-effect profile of intrathecal morphine in a diverse patient population undergoing total knee and hip arthroplasty. Eur J Orthop Surg Traumatol. 2019;29(1):125\\u0026ndash;9.\\u003c/li\\u003e\\n\\u003cli\\u003eLydon AM, Cooke T, Duggan F, Shorten GD. Delayed postoperative gastric emptying following intrathecal morphine and intrathecal bupivacaine. Can J Anaesth. 1999;46:544-9.\\u003c/li\\u003e\\n\\u003cli\\u003eMoraitis A, Hultin M, Walld\\u0026eacute;n J. Risk of postoperative nausea and vomiting in hip and knee arthroplasty: a prospective cohort study after spinal anaesthesia including intrathecal morphine. BMC Anesthesiol. 2020;20(1):242.\\u003c/li\\u003e\\n\\u003cli\\u003eAllen TK, Jones CA, Habib AS. Dexamethasone for the prophylaxis of postoperative nausea and vomiting associated with neuraxial morphine administration: a systematic review and meta-analysis. Anesth Analg. 2012;114(4): 813-22.\\u003c/li\\u003e\\n\\u003cli\\u003eTohda C, Yamaguchi T, Kuraishi Y. Intracisternal injection of opioids induces itch-associated response through mu-opioid receptors in mice. Jpn J Pharmacol. 1997;74:77\\u0026ndash;82.\\u003c/li\\u003e\\n\\u003cli\\u003eDeSousa KA, Chandran R. Intrathecal morphine for postoperative analgesia: Current trends. World J Anesthesiol. 2014;3(3):191-202.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003eTables 1 to 4 are available in the Supplementary Files section.\\u003c/p\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Spinal morphine, Neuraxial opioids, Hip fracture, Dexametasone, Postoperative nausea and vomiting, Pruritis, Postoperative pain\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7256255/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7256255/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground: \\u003c/strong\\u003eHip fractures are associated with high morbidity and mortality in the geriatric population, and adequate postoperative analgesia is crucial for improving outcomes. Intrathecal morphine provides adequate analgesia in geriatric patients with hip fractures, but it can also cause adverse effects such as postoperative nausea and vomiting (PONV) and respiratory depression. Dexamethasone, with its antiemetic and analgesic effects, has the potential to reduce these side effects. This study investigated the effects of intravenous dexamethasone added to intrathecal morphine on postoperative analgesia and PONV.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods: \\u003c/strong\\u003eThis retrospective observational study included geriatric patients (≥65 years) who underwent hip fracture surgery under spinal anesthesia using 0.1 mg intrathecal morphine between January 2024 and August 2024. Patients were classified into two groups: those receiving 8 mg of intravenous dexamethasone before the procedure (Group D) and those receiving a placebo (Group P). Postoperative pain scores (VAS: Visual analog scale), opioid (contramal) consumption, PONV, respiratory depression, and pruritus were compared between the groups during the first 24 hours.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults: \\u003c/strong\\u003eA total of 80 patients, 40 in Group D and 40 in Group P, were included in the study. Demographic data, comorbidities, anesthesia, and operation times were similar between the groups. Postoperative VAS scores of patients in Group D were significantly lower than those in Group P at the 2nd (1.2± 0.6 vs. 1.5± 0.6, p=0.027), 6th (2.0± 0.7 vs. 3.1± 0.6, p\\u0026lt;0.001), 12th (2.7± 0.8 vs. 4.3± 0.7, p\\u0026lt;0.001) and 24th hours (3.2± 0.7 vs. 4.8± 0.4, p\\u0026lt;0.001). Contramal consumption in the first 24 hours (70±61 mg vs. 135±58 mg, p\\u0026lt;0.001) and PONV rate (7.5% vs. 16.3%, p=0.034) were also significantly lower in Group D. There were no significant differences between the groups in terms of respiratory depression and pruritus.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusions: \\u003c/strong\\u003eProphylactic administration of dexamethasone before intrathecal morphine in geriatric hip fracture patients reduces postoperative pain scores, opioid consumption, and PONV rates in the first 24 hours. However, it did not affect adverse events such as respiratory depression and pruritus.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTrial registration: \\u003c/strong\\u003eClinicalTrials.gov Identifier: NCT07037745\\u003c/p\\u003e\",\"manuscriptTitle\":\"Effect of Intravenous Dexamethasone Added to Intrathecal Morphine on Postoperative Analgesia and Nausea/Vomiting in Geriatric Hip Fractures: A Retrospective Clinical Trial\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-08-21 06:35:10\",\"doi\":\"10.21203/rs.3.rs-7256255/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"be38c194-7d06-447f-b887-9f28b3d5dc0b\",\"owner\":[],\"postedDate\":\"August 21st, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-09-01T13:54:02+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-08-21 06:35:10\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7256255\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7256255\",\"identity\":\"rs-7256255\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}