Single-shot intrathecal morphine in bilateral lung transplantation: Early experience and feasibility

Bilateral lung transplantation via clamshell thoracotomy is associated with intense postoperative pain. Thoracic epidural analgesia (TEA) is the institutional standard at our center but carries haemodynamic, catheter-related, and anticoagulation constraints in the early post-transplant period. We describe a case series of 5 bilateral lung transplant recipients in whom single-shot intrathecal morphine (ITM) was used as the primary analgesic technique; the first reported experience of ITM in this setting. Across all cases, effective analgesia was achieved, no patient required TEA rescue, numeric rating scale (NRS) pain scores did not exceed 2 up to 48 hours postoperatively, patient-reported satisfaction was good, and no adverse events attributable to ITM were observed. These findings contribute early safety and efficacy data for ITM in a setting where it has not previously been described.