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Comparison of intrathecal morphine and low-dose bupivacaine with intravenous morphine for postoperative analgesia in laparoscopic liver resection: a randomized controlled trial

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Abstract

Background

Laparoscopic liver surgery has undergone substantial advancements over the past few decades, and the key to this improvement has been an improved understanding of liver anatomy, radiologic imaging, and advancements in anesthesia and postoperative care. This study aimed to compare postoperative opioid consumption in patients receiving intrathecal morphine plus low-dose bupivacaine versus those receiving intravenous morphine.

Methods

In this randomized controlled trial, 40 patients were enrolled and randomly assigned to two groups, of which one received 0.2 mg intrathecal morphine plus 0.25% Marcaine in a total volume of 4 mL and the other received intravenous morphine intraoperatively. Pain relief and patient satisfaction were evaluated using the visual analog scale. Intraoperative blood loss was measured at the end of the surgery while morphine consumption was measured by monitoring intravenous patient-controlled morphine at 12, 24, 36, and 48 h postoperatively. Treatment efficacy and complications were documented.

Results

Morphine consumption was significantly different in both groups at all time points, although the pain score did not show any difference. Shoulder pain, a common adverse effect of laparoscopic surgery, was significantly lower in the intrathecal group (25% vs. 75%). Blood loss and patient satisfaction were not different between the groups. However, the intrathecal group showed a significantly higher incidence of intraoperative hypotension.

Conclusion

Intrathecal morphine with bupivacaine can be used effectively for managing acute post-LLR pain.

Thai Clinical trial registry

TCTR20211015004.

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Funding

No funding was received in support of this work.

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Authors and Affiliations

  1. Department of Anesthesia, King Chulalongkorn Memorial Hospital, Thai Red Cross Society Bangkok, Bangkok, Thailand

    Kirada Apisutimaitri, Marvin Thepsoparn, Supichaya Chairat & Ontira Ruanma

  2. Pain Management Research Unit, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand

    Marvin Thepsoparn

  3. Hepatobiliary-Pancreas Surgery and Transplantation Unit, Department of Surgery, Kingchulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand

    Wipusit Taesombat

Authors
  1. Kirada Apisutimaitri
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  2. Marvin Thepsoparn
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  3. Supichaya Chairat
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  4. Ontira Ruanma
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Correspondence to Marvin Thepsoparn.

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Dr. Kirada Apisutimaitri, Dr. Marvin Thepsoparn, Dr. Supichaya Chairat, Dr. Ontira Ruanma, and Dr. Wipusit Taesombat have no conflict or financial ties to disclose.

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Apisutimaitri, K., Thepsoparn, M., Chairat, S. et al. Comparison of intrathecal morphine and low-dose bupivacaine with intravenous morphine for postoperative analgesia in laparoscopic liver resection: a randomized controlled trial. Surg Endosc 37, 2035–2042 (2023). https://doi.org/10.1007/s00464-022-09700-1

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  • DOI: https://doi.org/10.1007/s00464-022-09700-1

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