The effect of adding morphine to intratecal bupivacaine on postoperative analgesia in patients with perianal surgery

Abstract

ABSTRACT Aim: Pain is the major problem early postoperative period after perianal operations. In this study, we aimed to evaluate the effect of adding 50 μg or 100 μg of morphine on intrathecal 5 mg hyperbaric bupivacaine on postoperative analgesia before anal surgery. Material and Method: A total of 60 patients divided into 3 groups, including 20 patients in each group, were included for the study; Group 1: 5 mg 0.5% heavy bupivacaine (HB), Group 2: 5 mg 0.5% HB and 50 μg Morphine, Group 3: 5 mg 0.5% HB and 100 μg Morphine was intrathecally administered. Intraoperative and postoperative hemodynamics, time to urination and first analgesia requirement, perioperative and postoperative side effects were recorded Results: The time to first analgesic need in Group 1 (305.40 ± 143.86) was statistically significantly lower than Group 2 (435.50 ± 171.70) and Group 3 (435.50 ± 156.08) was determined (p=0.015). No significant difference was found between urinary retention (p>0.05). It was determined that the postoperative nausea and vomiting percentages (25.0%) in Group 3 were statistically significantly higher than Group 2 (5.0%) and Group 1 (0.0%) (p<0.05). Conclusions: The use of 50 μg of intrathecal morphine in patients undergoing perianal surgery in saddle block anesthesia has the expected effect on postoperative analgesia and it is considered appropriate to be preferred in perianal surgery because it causes minimal adverse side effects.

Keywords

• Perianal surgery
• Pain
• Bupivacaine
• Intratechal
• Morphine

References

1. Sommer M, de Rijke JM, van Kleef M, et al. The prevalence of postoperative pain in a sample of 1490 surgical in patients. Eur J Anaesthesiol 2008; 25: 267-74.
2. Kushwaha R, Hutchings W, Davies C, Rao NG. Randomized clinical trial comparing day-care open haemorrhoidectomy under local versus general anaesthesia. Br J Surg 2008; 95: 555–63.
3. Shon YJ, Huh J, Kang SS, Bae SK, Kang RA, Kim DK. Comparison of saddle, lumbar epidural and caudal blocks on anal sphincter tone: A prospective, randomized study. J Int Med Res 2016; 44: 1061-71.
4. Gehling M, Tryba M: Risks and side-effects of inrathecal morphine combined with spinal anaesthesia: A meta-analysis. Anaesthesia 2008; 64: 643-51.
5. Pöpping DM, Elia N, Marret E, Wenk M, Tramèr MR. Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-analysis of randomized trials. Pain 2012; 153: 784–93.
6. Karaman S, Günüsen I, Uyar M, Biricik E, Fırat V. The effects of morphine and fentanyl alone or in combination added to intrathecal bupivacaine in spinal anesthesia for cesarean section. Agrı 2011; 23: 57-63.
7. Meylan N, Elia N, Lysakowski C, Tramer MR. Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing mojor surgery: Meta-analysis of randomized trials. Br J Anaesth 2009; 102: 156-67.
8. Jayaraman S, Colquhoun PHD, Malthaner RA. Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum 2007; 50: 1297–305.

9. Hancock B. Lord’s procedure for haemorrhoids: a prospective anal pressure study. Br J Surg 1981; 68: 72930.
10. Fueglistaler P, Guenin MO, Montali I, et al. Long-term results after stapled hemorrhoidopexy: high patient satisfaction despite frequent postoperative symptoms. Dis Colon Rectum 2007; 50: 204–12.
11. Rathmell JP, Lair TR, Nauman B: The role of intrathecal drugs in the treatment of acute pain. Anesth Analg 2005; 101: 30-43.
12. Uchiyama A, Nakano S, Ueyama H, Nishimura M, Tashiro C. Low dose intrathecal morphine and pain relief following caesarean section. Int J Obstet Anesth 1994; 3: 87-91.
13. Milner AR, Bogod DG, Harwood RJ. Intrathecal administration of morphine for elective Caesarean section. A comparison between 0.1 mg and 0.2 mg. Anaesthesia 1996; 51: 871-3.
14. Ozbek H, Deniz MN, Erakgun A, Erhan E. Comparison of 75 and 150 μg doses of intrathecal morphine for postoperative analgesia after transurethral resection of the prostate under spinal anesthesia. J Opioid Manag 2013; 9: 415-20.
15. Duman A, Apiliogullari S, Balasar M, Gürbüz R, Karcioglu M. Comparison of 50 g and 25 g doses of intrathecal morphine on postoperative analgesic requirements in patients undergoing transurethral resection of the prostate with intrathecal anesthesia. J ClinAnesth 2010; 22: 329-33.
16. Baytas V. Sezaryen için spinal anestezide, kullanılan lokal anesteziğe eklenen iki farklı morfin dozunun kontrol grubu ile karşılaştırılarak değerlendirilmesi. Ankara University Medical School, Department of Anesthesiology and Reanimation, 2010. (Thesis , in Turkish)
17. Karaman S, Kocabas S, Uyar M, Zincircioglu C, Firat V. Intrathecal morphine: effects on perioperative hemodynamics, postoperative analgesia, and stress response for total abdominal hysterectomy. Adv Ther 2006; 23: 295-306.
18. Kirson LE, Goldman JM, Slover RB. Low-dose intrathecal morphine for postoperative pain control in patients undergoing transurethral resection of the prostate. Anesthesiology 1989; 71: 192-5.
19. Incesu A, Deniz MN, Elvan E, Ugur G. The Efficacy of Intrathecal Morphine With Bupivacaine For Postoperative Analgesia After TUR-B. CBU-SBED 2020; 7: 65-9.
20. Sakai T, Use T, Shimamoto H, Use T, Shimamoto H, Fukano T, Sumikawa K. Mini-dose (0.05mg) intrathecal morphine provides effective analgesia after transurethral resection of the prostate. Can J Anaesth 2003; 50: 1027-30.
21. Moreira M, Moreira JP, Isaac RR, et al. Morphine spinal block anesthesia in patients who undergo an open hemorrhoidectomy: a prospective analysis of pain control and postoperative complications. Ann Coloproctol 2014; 30: 135-40.
22. Toyonaga T1, Sogawa MN, Jiang SF, et al. Postoperative urinary retention after surgery for benign anorectal disease: potential risk factors and strategy for prevention. Int J Colorectal Dis 2006; 21: 676-82.
23. Darrah DM, Griebling TL, Silverstein JH. Postoperative urinary retention. Anesthesiol Clin 2009; 27: 465-84.
24. Prasad ML, Abcarian H. Urinary retention following operations for benign anorectal diseases. Dis Colon Rectum 1978; 21: 490-2.