Randomised Double-Blind Study of Intrathecal Bupivacaine-Morphine Versus Systemic Morphine Analgesia for Major Abdominal Surgery in a Resource Poor Setting

Abstract

BACKGROUNDFailure of adequate postoperative analgesia, defined as Numerical Rating Scale (NRS) pain score > 3 after major abdominal surgery have been reported to be 30% to 50% in a large number of studies. Effective yet inexpensive technique of anaesthesia and postoperative analgesia for major abdominal surgery seemed to be a hitherto elusive entity. MATERIALS AND METHODSIn this randomised, double-blinded study involving ninety-two participants, we investigated the clinical efficacy and safety of morphine plus bupivacaine administered intrathecally versus systemic morphine for pain control in the first 24h postoperative period after major abdominal surgery under relaxant general anaesthesia in a resource-poor setting. RESULTSOur experimental protocol had significant ARR of 0.3043 (95% CI: 0.1554 to 0.4497) at 12h and ARR of 0.3261 (95% CI: 0.1579 to 0.4764) at 24h in the failure of adequate postoperative analgesia (NRS pain score > 3) with an NNT of 3. There were no significant differences in intraoperative vasopressor consumption, the postoperative OASS scores, first 24h urine output, incidence of postoperative nausea and vomiting and Michigan Awareness Classification Instrument Class. The experimental group experienced higher incidence of mild pruritus. The incidence of serious adverse events was nil. CONCLUSIONIn patients undergoing major abdominal surgery under relaxant general anaesthesia in a simulated resource poor setting, intrathecal analgesia with bupivacaine plus morphine is safe and reduces the incidence of failure of adequate analgesia in the first 24h postoperative period. KEYWORDSIntrathecal Analgesia, Major Abdominal Surgery, Resource Poor Setting. HOW TO CITE THIS ARTICLE:Ray S, Kirtania J. Randomised double-blind study of intrathecal bupivacaine-morphine versus systemic morphine analgesia for major abdominal surgery in a resource poor setting.

Intrathecal hydrophilic opioids for abdominal surgery: a meta-analysis, meta-regression, and trial sequential analysis

“…In addition, a sensitivity analysis was performed including only studies with a patient-blinding procedure in the control group for the outcomes ‘pain scores’, morphine consumption, nausea, and pruritus. 3 , 27 , 28 , 32 , 33 , 34 , 36 , 44 , 46 , 47 , 49 , 53 , 54 , 55 , 56 , 57 , 59 , 60 , 61 , 62 , 63 This analysis showed comparable outcomes to the general comparison.…”

“…0.1 mg kg −1 morphine Paracetamol, diclofenac, PCA morphine SC lidocaine A, C Urinary catheter for one week Levy, 2011 5 Laparoscopic colorectal surgery 31 vs 30 250 μg diamorphine, 12.5 mg bupivacaine I.V. 10 mg morphine Paracetamol, diclofenac, tramadol, or morphine None A, C Urinary catheter removed on POD1 Licina, 1991 55 Mixed abdominal surgery 12 vs 12 15 μg kg −1 morphine No additional medication Unspecified SC saline B, D Unspecified Marion, 2010 56 Abdominal hysterectomy 35 vs 32 200 μg morphine, 10 μg fentanyl, 12.5 mg bupivacaine Intrathecal 10 μg fentanyl, 12.5 mg bupivacaine Paracetamol, diclofenac, and PCA ketobemidone Intrathecal medication A, D Unspecified Motamed, 2000 57 Laparoscopic cholecystectomy 17 vs 17 100 μg morphine, 5 mg bupivacaine No additional medication PCA morphine, paracetamol, and ketoprofen rescue doses SC saline A, C No catheterisation Nuri Deniz, 2013 58 Retropubic radical prostatectomy 28 vs 28 200 μg morphine No additional medication PCA tramadol, paracetamol, and diclofenac rescue doses None B, D Unspecified Ray, 2017 59 Major abdominal surgery 46 vs 46 750 μg morphine, 10 mg bupivacaine I.V. 0.2 mg kg −1 morphine, s.c. 0.1 mg kg −1 morphine Paracetamol, SC morphine Intrathecal saline A Urinary catheter of unspecified duration Roy, 2006 60 Partial hepatic resect...…”