Intrathecal Morphine in Major Abdominal and Thoracic Surgery: Observational Study.

Area of Science:

• Anesthesiology and Pain Management
• Surgical Recovery
• Regional Anesthesia Techniques

Background:

• Effective postoperative pain management is crucial for patient recovery, reducing hospital stays, and healthcare costs.
• Intrathecal morphine offers prolonged analgesia, making it suitable for various major surgical procedures.
• Assessing the safety and efficacy of intrathecal morphine in major abdominal and thoracic surgery is essential.

Purpose of the Study:

• To evaluate the safety of intrathecal morphine for acute postoperative pain control in major surgery.
• To determine the incidence of respiratory depression, atelectasis, and need for respiratory support.
• To assess secondary outcomes including rescue analgesic use, postoperative nausea and vomiting (PONV), and late complications.

Main Methods:

• Retrospective observational study of 484 patients receiving intrathecal morphine after major abdominal or thoracic surgery (2018-2021).
• Primary safety endpoints included respiratory depression, atelectasis, and respiratory support requirements.
• Secondary endpoints included rescue IV morphine consumption, PONV, pneumonia, readmissions, reoperations, hospital stay, and mortality.

Main Results:

• No instances of respiratory depression were reported.
• Atelectasis occurred in 2.07% of patients; 1.86% required respiratory support (NIMV/HFOT).
• 51% required rescue IV morphine; PONV incidence was 30.37%. Thoracic and general surgery groups had higher rescue morphine needs than urological surgery.

Conclusions:

• Intrathecal morphine is a safe technique for managing acute postoperative pain in major abdominal and thoracic surgery.
• It integrates well into multimodal pain management strategies.
• While generally safe, careful consideration of patient factors and surgical type is warranted for optimal outcomes.