Abstract
BackgroundOur 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.MethodsA 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.ResultsOne 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.ConclusionIn 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 registrationRegistered with the Australian New Zealand Clinical Trials Registry (ANZCTR) under ACTRN12620000001998.
Highlights
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
The Enhanced Recovery After Surgery (ERAS) Society guidelines strongly advocate that routine thoracic epidural analgesia cannot be recommended in open liver surgery for ERAS patients and that intrathecal opiates can be good alternatives when combined with multimodal analgesia [5]
For patients undergoing open liver resection using a standardized enhanced recovery after surgery protocol with multimodal analgesia, the addition of ITM resulted in less postoperative opioid use and enhanced postoperative analgesia
Summary
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. The optimal postoperative analgesic technique for patients undergoing open liver resection is controversial. A large international and multicenter landmark randomized controlled trial (RCT) found that most adverse morbid outcomes in high-risk patients undergoing major abdominal surgery are not reduced by the use of epidural analgesia [4]. The Enhanced Recovery After Surgery (ERAS) Society guidelines strongly advocate that routine thoracic epidural analgesia cannot be recommended in open liver surgery for ERAS patients and that intrathecal opiates can be good alternatives when combined with multimodal analgesia [5]
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