The use of high-dose intrathecal diamorphine in laparoscopic bariatric surgery: a single-centre retrospective cohort study

Abstract

Introduction: The use of intrathecal diamorphine is not commonplace in laparoscopic bariatric surgery. At our institution, a major UK bariatric centre, high-dose intrathecal diamorphine is routinely utilised. Methods: Data were analysed retrospectively. Fifty-three patients who had a spinal anaesthetic were matched against age, sex, body mass index and surgical procedure type to generate controls. Pain scores were recorded in the post-anaesthetic care unit on arrival, after 1 hour and on discharge to the ward. Post-operative nausea and vomiting; post-operative hypertension; pruritus; 24-hour morphine consumption and length of stay were measured. Results: Pain scores were better in the spinal anaesthetic group in all measured categories (p = 0.033, p < 0.01, p < 0.01); post-operative nausea and vomiting was less common in the spinal anaesthetic group (p < 0.01); post-operative hypertension was less common in the spinal anaesthetic group (p = 0.25); pruritus was more common in the spinal anaesthetic group (p < 0.01); morphine consumption was less common in the spinal anaesthetic group (p = 0.037). Length of hospital stay was reduced by 12.4 hours (p = 0.025). Conclusion: We propose that this is a practical and safe technique to adopt. A randomised-control trial will need to be conducted in order to find the most efficacious volume of local anaesthetic and dose of diamorphine

Single-shot spinal diamorphine for laparoscopic nephrectomy: A retrospective study

“…The results suggest that the precise judgement of our anaesthetists ensured that all patients received the appropriate volume of diamorphine to experience the desired effect. There is some debate as to whether the use of high-dose spinal diamorphine (≥1000 μg) is suitable and safe; Fares et al and Wojcikiewicz et al state that superior analgesic effects are seen with the higher dose of 1000 μg 13,18 The present study may help to suggest that high dose is safe, as one third of our spinal patients received ≥1000 μg and experienced no adverse effects. However, to properly assess this, a prospective trial set out to compare high and low dose volumes would be required.…”

“…Nonetheless, the scoring system that was used in the present study is in-line with similar studies. 10,13 However, we would recommend a more rigorous assessment of pain and nausea with future studies.…”

“…12 These results were reinforced by a study investigating spinal diamorphine's use in laparoscopic bariatric surgery which also demonstrated lower levels of pain intensity. 13 The evidence base for the use of spinal diamorphine is clearly growing; however, substantiation of its efficacy in urological surgery is severely lacking. A recent topical review highlighted the need for surgery-based procedural protocols when using spinal opioids to assure its efficacy.…”

Intrathecal diamorphine for perioperative analgesia during colorectal surgery: a cross-sectional survey of current UK practice

“…Virlos et al 27 used doses between 1000 µg and 1500 µg for their study comparing intrathecal analgesia vs epidural analgesia for laparoscopic colorectal surgery 27. In a major bariatric centre, doses of intrathecal diamorphine between 600 µg and 1500 µg were used for patients 28. Similarly, our survey showed a large variability in respondents’ usual administered diamorphine doses for major laparoscopic colorectal surgery (range 200–2000 µg), with most anaesthetists using 300, 500 or 1000 µg.…”

“…27 In a major bariatric centre, doses of intrathecal diamorphine between 600 µg and 1500 µg were used for patients. 28 Similarly, our survey showed a large variability in respondents' usual administered diamorphine doses for major laparoscopic colorectal surgery (range 200-2000 µg), with most anaesthetists using 300, 500 or 1000 µg. We found a weak positive correlation between the number of patients anaesthetised for laparoscopic colorectal resections per month by each anaesthetist and the doses of intrathecal diamorphine they administer.…”