Intrathecal morphine versus intravenous opioid administration to impact postoperative analgesia in hepato-pancreatic surgery: a randomized controlled trial

Dichtwald, Sara; Ben-Haim, Menahem; Papismedov, L.; Hazan, Shoshana; Cattan, Anat; Matot, Idit

doi:10.1007/s00540-016-2286-y

Cited by 33 publications

(39 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ten studies were included in the review (26,(29)(30)(31)(32)(33)(34)(35)(36)(37) as shown in the PRISMA diagram ( Figure 1). Six of the studies were RCTs (29-31, 33, 35, 37), two studies were retrospective observational studies (26,34), and two studies were prospective observational studies (32,36).…”

Section: Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

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

Tang

Weinberg

2019

Anesth Pain Med

View full text Add to dashboard Cite

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.

show abstract

Section: Study Characteristicsmentioning

confidence: 99%

“…Eight studies (29)(30)(31)(32)(33)(35)(36)(37) assessed postoperative analgesia as measured by pain scores. Measured against placebo, CWI and PCA, patients treated with intrathecal morphine demonstrated significantly improved pain scores for up to the first 24 hours post-operation.…”

Section: Post-operative Analgesiamentioning

confidence: 99%

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

Tang

Weinberg

2019

Anesth Pain Med

View full text Add to dashboard Cite

show abstract

“…These findings contradict previously published results. In previous studies proving the superiority of preoperative intrathecal morphine in patients undergoing hepatobiliary operations, pain severity was apparently higher both in patients with and without intrathecal morphine administration [9][10][11]. These three studies included a similar number of patients who received similar doses of the intrathecal regimen comprising 0.5 mg of morphine, 15 lg of fentanyl, 0.4 mg of morphine, and 4 lg/kg of morphine.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Intrathecal and Intravenous Morphine for Analgesia After Hepatectomy: A Randomized Controlled Trial

et al. 2020

View full text Add to dashboard Cite

Background Effective analgesia is essential for patient recovery after liver resection. This study aimed to evaluate the effects of the addition of preoperative intrathecal morphine to multimodal intravenous analgesia in patients undergoing liver resection. Methods In this single-blind randomized controlled trial, patients undergoing liver resection were randomly assigned to the patient-controlled analgesia with (ITM-IV) or without (IV) preoperative intrathecal morphine groups. All patients received acetaminophen and dexketoprofen. The primary outcome was pain severity at rest over three postoperative days, assessed using the numerical rating scale (NRS). Results The study included 36 patients (18 in each group). The mean maximum daily NRS scores over the first three postoperative days in the ITM-IV and IV groups were 1.3, 1.1, and 0.3 and 1.6, 1.1, and 0.7, respectively (p = 0.580). No differences were observed in pain severity while coughing, with corresponding scores of 2.8, 2.1, and 1.1, respectively, in the ITM-IV group and 2.3, 2.2, and 1.5, respectively, in the IV group (p = 0.963). Proportions of patients reporting clinically significant pain at rest and while coughing were 11.1% and 44.4%, respectively, in the ITM-IV group, and 16.7% and 44.4%, respectively, in the IV group (both p [ 0.999). Cumulative morphine doses in the ITM-IV and IV groups were 26 mg and 17 mg, respectively (p = 0.257). Both groups also showed similar time to mobilization (p = 0.791) and solid food intake (p = 0.743), sedation grade (p = 0.584), and morbidity (p = 0.402). Conclusions Preoperative intrathecal morphine administration provides no benefits to multimodal analgesia in patients undergoing liver resection. Trial registration number Clinicaltrial.gov Identifier: NCT03620916

show abstract

“…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).…”

Section: Discussionmentioning

confidence: 99%

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

Han

Park

Hong

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Enhancing postoperative recovery of the donor is important to encourage living kidney donation. We investigated the effects of anesthetic agents (intravenous [IV] propofol versus inhaled [IH] sevoflurane) on the quality of early recovery of healthy living kidney donors after hand-assisted laparoscopic nephrectomy (HALN) under analgesic intrathecal morphine injection. Methods: This single-center, prospective randomized controlled study enrolled 80 living donors undergoing HALN from October 2019 to June 2020 at Seoul St. Mary’s hospital. Donors were randomly assigned to the IV propofol group or IH sevoflurane group. To measure the quality of recovery, we used the Korean version of the Quality of Recovery-40 questionnaire (QoR-40K) on postoperative day (POD) 1, and ambulation (success rate, number of footsteps) 6–12 hours after surgery and on POD 1. The pain score for the wound site, IV opioid requirement, postoperative complications including incidence of nausea/vomiting, length of in-hospital stay were also assessed.Results: The global QoR-40K score and all subscale scores (physical comfort, emotional state, physical independence, psychological support, and pain) were significantly higher in the IV propofol group than in the IH sevoflurane group. The numbers of footsteps at all timepoints were also higher in the IV propofol group. The donors in the IV propofol group had a lower incidence of nausea/vomiting, and a shorter hospitalization period.Conclusions: Total IV anesthesia with propofol led to better early postoperative recovery than that associated with IH sevoflurane.Trial registration: Clinical Research Information Service, Republic of Korea (approval number: KCT0004351) on October 18, 2019.https://cris.nih.go.kr/cris/search/search_result_st01_kren.jsp?seq=15768&sLeft=2&ltype=my&rtype=my

show abstract

Intrathecal morphine versus intravenous opioid administration to impact postoperative analgesia in hepato-pancreatic surgery: a randomized controlled trial

Cited by 33 publications

References 19 publications

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

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

A Comparison of Intrathecal and Intravenous Morphine for Analgesia After Hepatectomy: A Randomized Controlled Trial

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

Contact Info

Product

Resources

About