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. 2025 Apr 15;61(4):732.
doi: 10.3390/medicina61040732.

A Retrospective Cohort Study on the Side Effects of Intrathecal Morphine Administration Combined with General Anaesthesia Versus General Anaesthesia Alone in Prostatectomy Patients

Timon Marvin Schnabel  1 , Katharina Fetz  2   3 , Hanaa Baagil  1 , Kim Kutun  1 , Claus Eisenberger  4 , Mark Ulrich Gerbershagen  1
Affiliations

A Retrospective Cohort Study on the Side Effects of Intrathecal Morphine Administration Combined with General Anaesthesia Versus General Anaesthesia Alone in Prostatectomy Patients

Timon Marvin Schnabel et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Prostatectomy is a common surgical procedure for prostate cancer, the most frequently diagnosed cancer in the male population. The choice of anaesthetic technique has a significant impact on postoperative pain management. The changes in recommendations between 2015 and 2021 prompted this study to evaluate the impact of intrathecal morphine administration in combination with general anaesthesia compared to general anaesthesia alone on postoperative analgesic consumption and the associated side effects. Material and Methods: A single-centre retrospective cohort study was conducted, analysing data from 202 patients who underwent a prostatectomy between 2015 and 2021. Patients were divided into two groups: 147 patients received intrathecal morphine combined with general anaesthesia, while 49 patients received general anaesthesia alone. Key postoperative parameters, including numerical rating scale (NRS) scores, analgesic consumption, and side effects (e.g., nausea, pruritus, hypotension, and respiratory depression) were evaluated. Statistical analyses were performed using Mann-Whitney U-tests and multiple regression models. Results: The group receiving intrathecal morphine showed a significant decrease in NRS pain scores at rest and during movement in the recovery room (p < 0.001). The need for postoperative analgesics, especially opioids such as piritramide, was reduced in this group. No significant increase in serious side effects such as respiratory depression was observed. Conclusions: The present study investigates the potential of intrathecal morphine combined with general anaesthesia as a promising approach to improve pain management in prostatectomy patients. By reducing pain intensity, this method shows significant clinical benefits. In addition, the absence of a significant increase in serious adverse events reinforces the safety of this approach. However, further studies are warranted to assess the long-term outcomes and explore optimal dosing strategies. The reintroduction of this anaesthetic technique has great potential to improve patient recovery and satisfaction following major surgery.

Keywords: analgesic consumption; general anaesthesia; intrathecal morphine; numerical rating scale (NRS); pain management; postoperative pain; prostatectomy; retrospective cohort study; side effects; spinal anaesthesia.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Boxplot of NRS at rest and movement in the recovery room (RR). (a) Average NRS at movement in the recovery room by ITM; (b) average NRS at rest in the recovery room by ITM.
Figure 2
Figure 2
Boxplot of (a) intravenous piritramide dose (mg) administered in the recovery room (RR) by intrathecal morphine (ITM) administration status; (b) number of analgesics administered in the recovery room (RR) by intrathecal morphine (ITM) administration status.
Figure 3
Figure 3
Line chart of mean oxygen saturation over time for patients with and without ITM administration. Measurements were taken at baseline, during ITM administration, and at intervals of 15 min, 30 min, 6 h, 12 h, and 24 h post-intervention.
Figure 4
Figure 4
Bar chart of the distribution of side effects reported in the discharge summaries grouped by intrathecal morphine (ITM) administration.
See this image and copyright information in PMC

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