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. 2016 Nov;10(4):209-216.
doi: 10.1177/2049463716668904. Epub 2016 Sep 15.

Effect of adding intrathecal morphine to a multimodal analgesic regimen for postoperative pain management after laparoscopic bariatric surgery: a prospective, double-blind, randomized controlled trial

Fatma Adel El Sherif  1 , Ahmed Hassan Othman  1 , Ahmad Mohammad Abd El-Rahman  1 , Osama Taha  2
Affiliations

Effect of adding intrathecal morphine to a multimodal analgesic regimen for postoperative pain management after laparoscopic bariatric surgery: a prospective, double-blind, randomized controlled trial

Fatma Adel El Sherif et al. Br J Pain. 2016 Nov.

Abstract

Background: Pain control after bariatric surgery is a major challenge. Our objective was to study the efficacy and safety of intrathecal (IT) morphine 0.3 mg added to bupivacaine 0.5% for postoperative pain after laparoscopic bariatric surgery.

Methods: After local ethics committee approval, 100 morbidly obese patients scheduled for laparoscopic bariatric surgery were enrolled in this study. Patients were randomly assigned into two groups: Group I received IT 0.3 mg morphine (0.3 mL) added to 1.2 mL of bupivacaine 0.5%; Group II received IT 0.3 mL saline added to 1.2 mL of bupivacaine 0.5%, immediately before induction of general anaesthesia. For both groups, 60 mg ketorolac and 1000 mg paracetamol were infused 30 minutes before the end of surgery. After wound closure, 20 mL bupivacaine 0.25% was infiltrated at wound edges.

Results: Visual Analogue Scale (VAS) score was significantly lower in group I immediately, 30 minutes and 1 hour postoperatively. Time to first ambulation, return of intestinal sounds and hospital stay were shorter in group I than group II (p < 0.05); total morphine consumption was significantly lower in group I than group II (p < 0.05). Sedation score was significantly higher in group I immediately postoperatively, while at 30 minutes, 1, 2 and 6 hours postoperatively sedation scores were significantly higher in group II. Itching was significantly higher in group I.

Conclusion: The addition of IT morphine to a multimodal analgesic regimen after laparoscopic bariatric surgery was an effective and safe method that markedly reduced postoperative pain, systemic opioid consumption and length of hospital stay.

Keywords: Intrathecal morphine; laparoscopic bariatric surgery; multimodal analgesia; postoperative pain management.

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Conflict of interest statement

Declaration of conflicting interest: The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Figure 1.
Figure 1.
SPO2 (oxygen saturation percentage) of both study groups. GI: group I (intrathecal morphine group); GII: group II (PCA (patient-controlled analgesia) group).
Figure 2.
Figure 2.
Respiratory rate (RR) of both study groups. GI: group I (intrathecal morphine group); GII: group II (PCA (patient-controlled analgesia) group).
Figure 3.
Figure 3.
Visual Analogue Scale (VAS) of both study groups. GI: group I (intrathecal morphine group); GII: group II (PCA (patient-controlled analgesia) group). *Significant p-value.
Figure 4.
Figure 4.
Sedation score (SS) of both study groups. GI: group I (intrathecal morphine group); GII: group II (PCA (patient-controlled analgesia) group). *Significant p-value.
See this image and copyright information in PMC

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