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Open Access 01-12-2020 | Liver Resection | Research article

Intrathecal morphine is associated with reduction in postoperative opioid requirements and improvement in postoperative analgesia in patients undergoing open liver resection

Authors: Jefferson Tang, Leonid Churilov, Chong Oon Tan, Raymond Hu, Brett Pearce, Luka Cosic, Christopher Christophi, Laurence Weinberg

Published in: BMC Anesthesiology | Issue 1/2020

Abstract

Background

Our study aimed to test the hypothesis that the addition of intrathecal morphine (ITM) results in reduced postoperative opioid use and enhanced postoperative analgesia in patients undergoing open liver resection using a standardized enhanced recovery after surgery (ERAS) protocol with multimodal analgesia.

Methods

A retrospective analysis of 216 adult patients undergoing open liver resection between June 2010 and July 2017 at a university teaching hospital was conducted. The primary outcome was the cumulative oral morphine equivalent daily dose (oMEDD) on postoperative day (POD) 1. Secondary outcomes included postoperative pain scores, opioid related complications, and length of hospital stay. We also performed a cost analysis evaluating the economic benefits of ITM.

Results

One hundred twenty-five patients received ITM (ITM group) and 91 patients received usual care (UC group). Patient characteristics were similar between the groups. The primary outcome - cumulative oMEDD on POD1 - was significantly reduced in the ITM group. Postoperative pain scores up to 24 h post-surgery were significantly reduced in the ITM group. There was no statistically significant difference in complications or hospital stay between the two study groups. Total hospital costs were significantly higher in the ITM group.

Conclusion

In patients undergoing open liver resection, ITM in addition to conventional multimodal analgesic strategies reduced postoperative opioid requirements and improved analgesia for 24 h after surgery, without any statistically significant differences in opioid-related complications, and length of hospital stay. Hospital costs were significantly higher in patients receiving ITM, reflective of a longer mandatory stay in intensive care.

Trial registration

Registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) under ACTRN12620000001998.

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Title: Intrathecal morphine is associated with reduction in postoperative opioid requirements and improvement in postoperative analgesia in patients undergoing open liver resection
Authors: Jefferson Tang
Leonid Churilov
Chong Oon Tan
Raymond Hu
Brett Pearce
Luka Cosic
Christopher Christophi
Laurence Weinberg
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Liver Resection
Opioids
Liver Resection
Opioids
Analgesics in Dentistry
Morphine
Ketamine
Published in: BMC Anesthesiology / Issue 1/2020
Electronic ISSN: 1471-2253
DOI: https://doi.org/10.1186/s12871-020-01113-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intrathecal morphine is associated with reduction in postoperative opioid requirements and improvement in postoperative analgesia in patients undergoing open liver resection

Abstract

Background

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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