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. 2019 May;13(2):106-111.
doi: 10.1177/2049463718800521. Epub 2018 Sep 19.

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

Thomas G Wojcikiewicz  1 , John Jeans  1 , Anil Karmali  1 , Jackline Nkhoma  1 , Jonathan Cousins  1 , Michael Kynoch  1
Affiliations

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

Thomas G Wojcikiewicz et al. Br J Pain. 2019 May.

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.

Keywords: Intrathecal; bariatric; bariatric surgery; diamorphine; neuroaxial.

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Conflict of interest statement

Conflict of 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.
Average 24-hour oral morphine consumption.
Figure 2.
Figure 2.
Length of stay (hours).
See this image and copyright information in PMC

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