Comparison between intrathecal morphine and intravenous patient control analgesia for pain control after video-assisted thoracoscopic surgery: A pilot randomized controlled study

Abstract

Background Video-assisted thoracoscopic surgery (VATS) is a minimally invasive procedure, but patients may still experience intense pain, especially during the early postoperative period. Intrathecal morphine (ITM) is an effective pain control method that involves a simple maneuver and has a low risk of complications. This study aimed to study the effectiveness of ITM for pain control in patients who undergo VATS. Materials and methods A randomized controlled study was conducted who were in ASA classes 1–3, aged over 18 years, and scheduled for elective VATS. Patients were randomized into two groups: the ITM group (n = 19) received a single shot of 0.2 mg ITM before general anesthesia; and the control group (n = 19) received general anesthesia only. For 48 hours after surgery, other than intravenous patient-controlled analgesia (IVPCA) morphine, patients received no sedatives or opioid medications except for 500 mg acetaminophen four times daily orally. Postoperative pain scores and IVPCA morphine used, side effects, sedation at specific time-points, i.e., 1, 6, 12, 24, and 48-hours and overall treatment satisfaction scores were assessed. Results Postoperative pain scores (median [IQR]) in ITM group were significantly lower than control group (repeated-measure ANOVA, p = 0.006) and differed at the first (7 [2, 7] vs 8 [6, 9], p = 0.007) and sixth hours (3 [2, 5] vs 5 [5, 7], p = 0.002). The cumulative dose of post-operative morphine (median [IQR]) in ITM group was also lower (6 [3, 20] vs 19 [14, 28], p = 0.006). The incidence of pruritus was significantly higher in ITM group (68.42% vs. 26.32%, p = 0.009). No significant differences in nausea and vomiting, sedation scores, and satisfaction scores were observed between the two groups. Conclusion ITM could reduce pain scores and opioid consumption after VATS compared to IVPCA-opioids. However, pain scores and opioid consumption still remained high. No difference in patient satisfaction was detected.

Analgesic Efficacy and Safety of Intrathecal Morphine or Intercostal Levobupivacaine in Lung Cancer Patients after Major Lung Resection Surgery by Videothoracoscopy: A Prospective Randomized Controlled Trial

“…We also observed no significant differences in the total amount of IV rescue morphine used. The total amount of rescue IV morphine utilized in the ITM group was comparable to that reported by Vijitpavan et al after the application of ITM in VATS [29]. However, contrary to our findings, these authors reported poorer pain management in the control group, which did not involve a locoregional anesthetic technique.…”

“…However, contrary to our findings, these authors reported poorer pain management in the control group, which did not involve a locoregional anesthetic technique. The divergence in pain management for the control group between our study and that of Vijitpavan et al may imply that the utilization of intercostal block after VATS is a more suitable anesthetic technique than the absence of locoregional blockade, as previously suggested [29].…”

“…This is crucial because profound and prolonged respiratory depressions have been reported after high doses of ITM, making postoperative vigilance at PACU for 24 h advisable [30,31]. Clinical practices could potentially change if positive results from studies, such as that of Vijitpavan et al, are confirmed, where they reported no respiratory depressions after the use of 200 µg of ITM in VATS [29]. In our study, excessive sedation was identified in two patients who did not require artificial ventilation or intubation immediately after admission to the PACU.…”

Effect of dexmedetomidine on postoperative nausea and vomiting in female patients undergoing radical thoracoscopic lung cancer resection

“…With the development of minimally invasive technology, thoracoscopic surgery, which has the advantages of less trauma and fast recovery, has now become the most common surgical method in thoracic surgery. However, the incidence of PONV after thoracoscopic surgery remains high ( Zha et al, 2021 ; Sertcakacilar et al, 2022 ; Vijitpavan et al, 2022 ). Vijitpavan’s study showed that the incidence of PONV within 48 h after thoracoscopy was 68.42%–73.68%, and 57.89% of patients needed drug intervention treatment ( Vijitpavan et al, 2022 ).…”

“…However, the incidence of PONV after thoracoscopic surgery remains high ( Zha et al, 2021 ; Sertcakacilar et al, 2022 ; Vijitpavan et al, 2022 ). Vijitpavan’s study showed that the incidence of PONV within 48 h after thoracoscopy was 68.42%–73.68%, and 57.89% of patients needed drug intervention treatment ( Vijitpavan et al, 2022 ).…”