Intrathecal morphine for postoperative analgesia in thoracic surgery: Single center experience

Year 2022, Volume: 47 Issue: 4, 1722 - 1729, 28.12.2022

Mediha Türktan Ersel Güleç

https://doi.org/10.17826/cumj.1188244

Abstract

Purpose: The aim of this study was to present our experiences with intrathecal morphine used for postoperative analgesia in the patients underwent thoracic surgery in our clinic.
Materials and Methods: In this study, a total of 18 adult patients who underwent thoracic surgery and were administered intrathecal morphine for postoperative analgesia between January 2020 and June 2020 were evaluated retrospectively. The patients were divided into two groups: Group 1; 10 mcg/kg intrathecal morphine grup, Group 2; 7 mcg/kg intrathecal morphine group. Demographic data, doses of morphine administered, duration of surgery and anesthesia, intraoperative anesthetic agent consumption, postoperative hemodynamic variables, pain scores, additional analgesic requirement and side effects were recorded.
Results: Twelve of the patients (66.7%) were administered 10 mcg/kg and 6 of them (33.3%) 7 mcg/kg intrathecal morphine according to ideal body weight. Intraoperative anesthetic agent consumption was found to be lower in Group 1 compared to Group 2, but this difference was not statistically significant. Pain scores at rest were statistically lower in Group 1 at 12, 24 and 48 hours postoperatively. Pain scores at effort were also statistically lower in Group 1 at 12, 18, 24 and 48 hours postoperatively.
Conclusion: Intrathecal morphine is a safe postoperative analgesia option for thoracic surgery patients. We believe that intrathecal morphine at a dose of 10 mcg/kg provides more effective analgesia than 7 mcg/kg without increasing the frequency of side effects.

Keywords

Analgesia, anesthesia, intrathecal, morphine, thoracic surgery

Toraks cerrahisinde postoperatif analjezide intratekal morfin: Tek merkez deneyimi

Abstract

Amaç: Bu çalışmada kliniğimizde toraks cerrahisi uygulanan hastalarda postoperatif analjezi amaçlı intratekal morfin kullanımı ile ilgili deneyimlerimizi sunmayı amaçladık.
Gereç ve Yöntem: Bu çalışmada Ocak 2020-Haziran 2020 tarihleri arasında toraks cerrahisi geçiren ve postoperatif analjezi amaçlı intratekal morfin uygulanan toplam 18 erişkin hastanın dosyası ve anestezi formları retrospektif olarak incelendi. Grup 1;10 mcg/kg intratekal morfin, Grup 2; 7 mcg/kg intratekal morfin uygulanan grup olarak ikiye ayrıldı. Hastaların demografik verileri, uygulanan morfin dozları, anestezi ve cerrahi süreleri, intraoperatif anestezik ajan tüketimleri, postoperatif hemodinamik verileri, ağrı düzeyleri, ek analjezik ihtiyaçları ve yan etkiler incelendi.
Bulgular: Hastaların 12’sine (% 66,7) ideal vücut ağırlığına göre 10 mcg/kg, 6’sına (%33,3) 7 mcg/kg intratekal morfin uygulandığı tespit edildi. İntraoperatif anestezik ajan tüketimi Grup 1’de Grup 2’ye kıyasla daha düşük bulundu, ancak aradaki fark istatistiksel olarak anlamlı değildi. Postoperatif 12, 24 ve 48. saatlerde dinlenme sırasında bakılan ağrı düzeyleri Grup 1’de istatistiksel olarak daha düşük. Postoperatif 12, 18, 24 ve 48. saatlerde efor sırasında bakılan ağrı düzeyleri de Grup 1’de istatistiksel olarak daha düşük bulundu.
Sonuç: Toraks cerrahisi hastalarında uygulanan intratekal morfin güvenli bir postoperatif analjezi seçeneğidir. Bu amaçla 10 mcg/kg dozunda uygulanan intratekal morfinin 7 mcg/kg’e göre daha etkin analjezi sağladığı kanaatindeyiz.

Keywords

analjezi, anestezi, intratekal, morfin, toraks cerrahisi, Analgesia, anesthesia, intrathecal, morphine, thoracic surgery

References

• 1. Meylan N, Elia N, Lysakowski C, Tramèr MR. Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery: meta-analysis of randomized trials. Br J Anaesth. 2009;102(2):156-67.
• 2. Alhashemi JA, Sharpe MD, Harris CL, Sherman V, Boyd D. Effect of subarachnoid morphine administration on extubation time after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2000;14(6):639-44.
• 3. Boonmak S, Boonmak P, Bunsaengjaroen P, Srichaipanha S, Thincheelong V. Comparison of intrathecal morphine plus PCA and PCA alone for post-operative analgesia after kidney surgery. Med Assoc Thai. 2007;90(6):1143-9.
• 4. Beaussier M, Weickmans H, Parc Y, Delpierre E, Camus Y, Funck-Brentano C, et al. Postoperative analgesia and recovery course after major colorectal surgery in elderly patients: a randomized comparison between intrathecal morphine and intravenous PCA morphine. Reg Anesth Pain Med. 2006;31(6):531-8.
• 5. Blay M, Orban JC, Rami L, Gindre S, Chambeau R, Batt M, et al. Efficacy of low-dose intrathecal morphine for postoperative analgesia after abdominal aortic surgery: a double-blind randomized study. Reg Anesth Pain Med. 2006;31(2):127-33.
• 6. Boezaart AP, Eksteen JA, Spuy GV, Rossouw P, Knipe M. Intrathecal morphine. Double-blind evaluation of optimal dosage for analgesia after major lumbar spinal surgery. Spine. 1999;24(11):1131-7. 7. Wang JD, Nauss LA, Thomas JE. Pain relief by intrathecally applied morphine in man. Anesthesiology. 1979;50(2):149-51.
• 8. Gray JR, Fromme GA, Nauss LA, Wang JK, Ilstrup DM. Intrathecal morphine for post-thoracotomy pain. Anesth Analg. 1986;65(8):873-6.
• 9. Askar FZ, Kocabas S, Yucel S, Samancilar O, Cetin H, Uyar M. The efficacy of intrathecal morphine in post-thoracotomy pain management. J Int Med Res. 2007;35(3):314-22.
• 10. Mason N, Gondret R, Junca A, Bonnet F. Intrathecal sufentanil and morphine for post-thoracotomy pain relief. Br J Anaesth. 2001;86(2):236-40.
• 11. Neustein SM, Cohen E. Intrathecal morphine during thoracotomy, Part II: Effect on postoperative meperidine requirements and pulmonary function tests. J Cardiothorac Vasc Anesth. 1993;7(2):157-9.
• 12. Liu M, Rock P, Grass JA, Heitmiller RF, Parker SJ, Sakima NT, et al. Double-blind randomized evaluation of intercostal nerve blocks as an adjuvant to subarachnoid administered morphine for post-thoracotomy analgesia. Reg Anesth. 1995;20(5):418-25.
• 13. Sudarshan G, Browne BL, Matthews JN, Conacher ID. Intrathecal fentanyl for post-thoracotomy pain. Br J Anaesth. 1995;75(1):19-22.
• 14. Ummenhofer WC, Arends RH, Shen DD, Bernards CM. Comparative spinal distribution and clearance kinetics of intrathecally administered morphine, fentanyl, alfentanil, and sufentanil. Anesthesiology. 2000;92(3):739-53.
• 15. Neustein SM, Cottone TM. Prolonged respiratory depression after intrathecal morphine. J Cardiothorac Vasc Anesth. 2003;17(2):230-1.
• 16. Suksompong S, Pongpayuha P, Lertpaitoonpan W, Bormann B, Phanchaipetch T, Sanansilp V. Low-dose spinal morphine for post-thoracotomy pain: a prospective randomized study. J Cardiothorac Vasc Anesth. 2013;27(3):417-22.
• 17. Cohen E. Intrathecal morphine: the forgotten child. J Cardiothorac Vasc Anesth 2013;27(3):413-6.
• 18. Yang T, Breen TW, Archer D, Fick G. Comparison of 0.25 mg and 0.1 mg intrathecal morphine for analgesia after Cesarean section. Can J Anaesth. 1999;46(9):856-60.
• 19. 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(9):871-3.
• 20. Gehling M, Tryba M. Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: a meta-analysis. Anaesthesia. 2009;64(6):643-51.
• 21. Liu N, Kuhlman G, Dalibon N, Moutafis M, Levron JC, Fischler M. A randomized, double blinded comparison of intrathecal morphine, sufentanil and their combination versus IV morphine patient-controlled analgesia for postthoracotomy pain. Anesth Analg. 2001;92(1):31-6.
• 22. Gwirtz KH, Young JV, Byers RS, Alley C, Levin K, Walker SG, et al. The safety and efficacy of intrathecal opioid analgesia for acute postoperative pain: seven years experience with 5969 surgical patients at Indiana University Hospital. Anesth Analg. 1999;88(3):599-604.
• 23. Jacobsohn E, Lee TWR, Amadeo RJ, Syslak PH, Debrouwere RG, Bell D, et al. Low-dose intrathecal morphine does not delay early extubation after cardiac surgery. Can J Anaesth. 2005;52(8):848-57.
• 24. Law CJ, Visser EJ. Unconsciousness and severe respiratory depression following intrathecal morphine analgesia for lumbar spinal surgery. Acute Pain. 2007;9(3):163-7.
• 25. Chaney MA, Smith KR, Barclay JC, Slogoff S. Large-dose intrathecal morphine for coronary artery bypass grafting. Anesth Analg. 1996;83(2):215-22.
• 26. Chaney MA, Furry PA, Fluder EM, Slogoff S. Intrathecal morphine for coronary artery bypass grafting and early extubation. Anesth Analg. 1997;84(2):241-8.
• 27. Shroff A, Rooke GA, Bishop MJ. Effects of intrathecal opioid on extubation time, analgesia, and intensive care unit stay following coronary artery bypass grafting. J Clin Anesth. 1997;9(5):415-9.
• 28. Devys JM, Mora A, Plaud B, Jayr C, Laplanche A, Raynard B, et al. Intrathecal + PCA morphine improves analgesia during the first 24 hours after major abdominal surgery compared to PCA alone. Can J Anesth. 2003;50(4):355-61.
• 29. Kim HC, Bae JY, Kim TK, Jeon Y, Min JJ, Goo EK, et al. Efficacy of intrathecal morphine for postoperative pain management following open nephrectomy. J Int Med Res. 2016;44(1):42-53.