A Literature Review of Intrathecal Morphine Analgesia in Patients Undergoing Major Open Hepato-Pancreatic-Biliary (HPB) Surgery

Abstract

Context: The optimal analgesic method for patients undergoing major open hepato-pancreatic-biliary surgery remains controversial. Continuous epidural infusion at the thoracic level remains the standard choice, however concerns have been raised due to associated complications. Single shot intrathecal morphine has emerged as a promising alternative offering similar analgesia with an enhanced safety profile. Evidence Acquisition: This review aimed to evaluate the literature comparing intrathecal morphine analgesia to other analgesic modalities following major open hepato-pancreatic-biliary surgery. The primary outcome was pain scores at rest and on movement 24 h after surgery. Secondary outcomes were postoperative opioid consumption within 72 postoperative hours, length of stay (LOS), intra-operative fluid administration and post-operative fluid administration within 72 postoperative hours, and overall systemic complication rate within 30 postoperative days. Results: Eleven trials matching the inclusion criteria were analysed. Intrathecal morphine resulted in equivalent or lower pain scores when contrasted to alternative techniques, but required higher amounts of postoperative opioid. Intrathecal morphine also offered reduced LOS and reduced fluid administration requirements to epidural analgesia, and there was no difference observed in major complication rate between analgesic modalities. Conclusions: In summary the evidence suggests that intrathecal morphine may be a better first-line analgesic modality than epidural analgesia in the context of major open hepato-pancreatic-biliary surgery, but high-quality evidence supporting this is limited.

Intrathecal Morphine Is Associated with Less Delirium Following Hip Fracture Surgery: A Register Study

“…A possible mechanism by which intrathecal morphine reduces postoperative delirium is likely to involve reduced postoperative pain and reduced systemic opioid administration ( 23 ). Both factors are associated with delirium and are reduced by the use of intrathecal morphine ( 5 , 20 ).…”

Comparison of the Impact of Propofol and Sevoflurane on Early Postoperative Recovery in Living Donors After Laparoscopic Donor Nephrectomy: A Prospective Randomized Controlled Study

“…Additionally, the pain threshold tends to be lower in healthy living donors than patients undergoing a similar surgical procedure for health reasons, which could also have affected the results (37). We used ITM as the analgesic in this study, which offers superior analgesia compared with IV opioid, IV-PCA and continuous wound infusion, for example (38). Better pain control, and subsequently reduced IV opioid consumption and PONV incidence, may facilitate ambulation, improve physical capability and prevent severe wound pain, thus resulting in a shorter hospitalization period (39,40).…”

Comparison of the impact of propofol versus sevoflurane on early postoperative recovery in living donors after laparoscopic donor nephrectomy: a prospective randomized controlled study

“…Additionally, pain threshold tends to be lower in healthy living donors than in patients undergoing a similar surgical procedure for health reasons, which could also have affected the results (41). We used ITM as the analgesic in this study, which offers superior analgesia compared with IV opioid, IV-PCA, and continuous wound infusion, for example (42). Better pain control, and subsequently reduced IV opioid consumption and PONV incidence, may facilitate ambulation, improve physical capability, and prevent severe wound pain, thus resulting in a shorter hospitalization period (43,44).…”

“…Speci cally, the global QoR-40K score was 169 (162-179) in the IV propofol group and 142 (131-154) in the IH sevo urane group. Sub-dimension scores in the IV propofol group were 51 (47-54) for physical comfort, 41 (38)(39)(40)(41)(42)(43) for emotional state, 32 (29)(30)(31)(32)(33)(34)(35) for psychological support, 17 (13)(14)(15)(16)(17)(18)(19)(20) for physical independence and 31 (28)(29)(30)(31)(32)(33) for pain while these scores in the IH sevo urane group were 44 (38- The success rate of early ambulation was marginally higher in the IV propofol group (40 [100%] in the IV propofol group vs. 35 [87.5%] in the IH sevo urane group; p=0.055); however, all of the donors could ambulate on POD 1 ( Table 3). The numbers of steps during the early and late postoperative periods, and the total steps on POD 1, were signi cantly higher in the IV propofol group than in the IH sevo urane group.…”