# A Randomized Control Study to Assess the Efficacy of Intrathecal Morphine in Patients on Patient-Controlled Analgesia Pump With Morphine for Postoperative Pain Relief After Elective Laparotomy

## TL;DR

This study compares intrathecal morphine with intravenous morphine for postoperative pain after laparotomy, finding that intrathecal morphine reduces total morphine use without increasing side effects.

## Contribution

The study provides evidence that preoperative intrathecal morphine reduces opioid consumption after laparotomy without worsening pain or side effects.

## Key findings

- Patients receiving intrathecal morphine used significantly less morphine (6.6 ± 2.96 mg) compared to those on PCA (24.77 ± 6.79 mg).
- There was no significant difference in pain scores or adverse effects between the two groups.

## Abstract

Introduction

Laparotomy is associated with significant prolonged postoperative pain, which can cause an adverse neuroendocrine stress response. Intrathecal morphine (ITM) retains an important place in pain management after major laparotomy since it is easier to administer and has a relatively lesser possibility of failure and technical difficulty.

Aim

The study aims to compare the effect of the administration of ITM with intravenous (IV) morphine administered by a patient-controlled analgesia (PCA) pump on postoperative analgesia after elective laparotomy. The primary objective was to compare total morphine consumption while secondary objectives were to compare pain assessed by the visual analog scale (VAS) and adverse reactions to opioids.

Methods

Sixty patients who underwent elective laparotomy were enrolled in this study. Thirty patients were enrolled in the study group (ITM+PCA) where ITM (200 mcg) was administered before laparotomy and intravenous morphine was initiated with PCA postoperatively. In the control group, only intravenous morphine was given with PCA postoperatively for pain relief. Parameters in both groups were compared, where estimation of cumulative morphine dose was the primary outcome and pain as assessed by VAS and side effects of opioids were the secondary outcomes.

Results

Patients in the ITM (ITM+PCA) group required less morphine (6.6 ± 2.96 vs. 24.77 ± 6.79 mg of morphine, p < 0.001) compared to patients on PCA. There was no statistically significant difference in VAS score and adverse effects between both groups.

Conclusion

Preoperative ITM can be used as an effective and safe modality for alleviating immediate postoperative pain following laparotomy.