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Randomized Controlled Trial
. 2016 Feb;44(1):42-53.
doi: 10.1177/0300060515595650. Epub 2015 Dec 21.

Efficacy of intrathecal morphine for postoperative pain management following open nephrectomy

Hyun-Chang Kim  1 , Jun-Yeol Bae  2 , Tae Kyong Kim  2 , Yunseok Jeon  2 , Jeong Jin Min  3 , Eui-Kyoung Goo  4 , Deok Man Hong  5
Affiliations
Randomized Controlled Trial

Efficacy of intrathecal morphine for postoperative pain management following open nephrectomy

Hyun-Chang Kim et al. J Int Med Res. 2016 Feb.

Abstract

Objective: To evaluate the efficacy and safety of intrathecal morphine (ITM) for postoperative pain control in patients with renal cell carcinoma undergoing open nephrectomy.

Methods: Forty-five patients scheduled for open nephrectomy were randomised to receive 300 µg ITM and intravenous patient-controlled analgesia (IV-PCA) (n = 22) or IV-PCA alone (n = 23) for postoperative analgesia. The numeric pain score (NPS), postoperative IV-PCA requirements and opioid-related complications including nausea, vomiting, dizziness, headache, and pruritus were compared between groups.

Results: NPS was significantly lower in the ITM group up to 24 h postoperatively. Upon coughing, NPS at 24 h postoperatively was 50 (interquartile range (IQR) 30-60) in the ITM group and 60 (45-70) in the IV-PCA group. Cumulative morphine consumption at 72 h postoperatively was significantly lower in the ITM group compared with the IV-PCA group (20 (9-33) mg vs. 31 (21-49) mg, respectively). Opioid-related complications were similar in both groups with the exception of pruritus (ITM, 77% vs. IV-PCA, 26%).

Conclusions: ITM was associated with greater analgesia without serious complications in patients undergoing open nephrectomy.

Keywords: Injections; morphine; nephrectomy; pain; postoperative; spinal.

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Figures

Figure 1.
Figure 1.
CONSORT diagram showing the flow of participants through the phases of the trial ITM: intrathecal morphine; IV-PCA: intravenous patient-controlled analgesia.
Figure 2.
Figure 2.
Numeric pain scores (0 = no pain, 100 = worst imaginable pain) at (a) rest and (b) on coughing in patients with renal cell carcinoma who underwent open nephrectomy and received intrathecal morphine (ITM) in combination with intravenous patient-controlled analgesia (IV-PCA) or IV-PCA alone for postoperative pain. NPS was significantly lower in the ITM group compared with the IV-PCA group up to 24 h postoperatively. Boxes represent the interquartile range with the bold line across each box indicating the median NPS. *P < 0.05 versus IV-PCA group (Student’s t-test or Mann-Whitney U-test).
Figure 3.
Figure 3.
Cumulative morphine consumption by intravenous patient-controlled analgesia (IV-PCA) in patients with renal cell carcinoma who underwent open nephrectomy and received intrathecal morphine (ITM) in combination with IV-PCA or IV-PCA alone for postoperative pain. Postoperative morphine consumption was significantly lower in the ITM group compared with the IV-PCA group at 6, 12, 24, 48 and 72 h postoperatively. Boxes represent the interquartile range with the bold line across each box indicating the median NPS. *P < 0.05 versus IV-PCA group (Student’s t-test or Mann-Whitney U-test).
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