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Updated: Oct 11, 2025

An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Enhanced recovery after gynecological surgery: comparison between intrathecal and intravenous morphine multimodal
Alessandro DI Filippo1, Tommaso Capezzuoli2, Massimiliano Fambrini2
1Division of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy.
Background:
The purpose of the present study was to compare the effectiveness of intrathecal injection of morphine, inserted in the protocols of multimodal analgesia, versus intravenous morphine in the control of postoperative pain and course in women undergoing gynecological surgery.
Methods:
An observational, single-center, retrospective and case-controlled study was performed. Data were collected in a group of women (N.=80) who underwent to gynecological surgery. Women were divided into two groups: group A (40 patients) laparoscopic hysterectomy and group B (N.=40) performing laparotomic myomectomy. In both groups 20 patients underwent administration of intrathecal morphine (125 mcg in 5 mL) and 20 patients underwent to intravenous morphine (1 mg maximum every 10 minutes). The primary endpoint collected was the mean VAS Score during the first 3 days after surgery, while secondary endpoints were opioid consumed during the same period, nausea, vomitus and pruritus. Among the exploratory objectives, length of hospital stay, canalization and feeding time were collected.
Results:
In group A, patients performing intrathecal morphine presented a significantly lowest VAS on postoperative day 1 and 3 compared to patients performing intravenous morphine while in group B mean VAS was statistically significant lower only on the first day. The emergence of pruritus was significantly higher in patients performing intrathecal morphine. The day of complete canalization was different in Group A patients in favor of intrathecal morphine as well as the length of stay.
Conclusions:
The present study showed that intrathecal morphine allows to achieve important management goals with minimal side effects and complications, in particular in case of laparoscopic hysterectomy.
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