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Randomized Controlled Trial
. 2023 Aug;37(8):e14996.
doi: 10.1111/ctr.14996. Epub 2023 Apr 19.

Comparison of two doses of intrathecal morphine in laparoscopic donor hepatectomy: A randomized double-blinded non-inferiority trial

Seungwon Lee  1 , RyungA Kang  1 , Gyu-Seong Choi  2 , Jong Man Kim  2 , Mi Sook Gwak  1 , Sangmin Maria Lee  1 , Gaab Soo Kim  1 , Ah Hyun Kim  1 , Justin Sangwook Ko  1
Affiliations
Randomized Controlled Trial

Comparison of two doses of intrathecal morphine in laparoscopic donor hepatectomy: A randomized double-blinded non-inferiority trial

Seungwon Lee et al. Clin Transplant. 2023 Aug.

Abstract

Background: Intrathecal morphine (ITM) injection is an effective postoperative analgesic strategy in open or laparoscopic donor hepatectomy; however, the optimal dose has not been determined. In this trial, we compared the post-operative analgesic effects of two doses (300 vs. 400 μg) of ITM injections.

Methods: In this prospective randomized non-inferiority trial, 56 donors were divided into either the 300 μg or 400 μg ITM group (n = 28, each). The primary outcome was the resting pain score at 24 h postoperatively. Pain scores, cumulative opioid consumption, and side effects (postoperative nausea and vomiting [PONV]) were compared up to 48 h postoperatively.

Results: Fifty-five donors participated in the entire study. The mean resting pain scores at 24 h after surgery were 1.7 ± 1.6 and 1.7 ± 1.1 in the ITM 300 and ITM 400 groups, respectively (mean difference, 0 [95% CI, -.8 to .7], p = .978). The upper limit of the 95% CI was lower than the prespecified non-inferiority margin (δ = 1), indicating that non-inferiority had been established. The incidence of PONV was lower in the ITM 300 group than in the ITM 400 group at 18 (p = .035) and 24 h postoperatively (p = .015). There were no significant differences in the resting and coughing pain scores and cumulative opioid consumption at any time point.

Conclusion: For laparoscopic donor hepatectomy, preoperative ITM 300 μg exhibited non-inferior postoperative analgesic effects compared to ITM 400 μg, with a lower incidence of PONV.

Keywords: intrathecal morphine; laparoscopic hepatectomy; liver donor; liver transplantation; postoperative analgesia.

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References

REFERENCES

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