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January 23, 2018Journal of Gynecologic Surgery

Safety and Efficacy of Low-Dose Intrathecal Morphine for Laparoscopic Hysterectomy: A Randomized, Controlled Pilot Study

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Key result

Low-dose intrathecal morphine significantly reduced postoperative fentanyl consumption over 24 hours compared to bupivacaine alone and control (175 μg vs 350 μg and 425 μg, respectively; p=0.0001).

Why the study?

Does intrathecal low-dose morphine and bupivacaine improve postoperative analgesia and reduce stress markers in female patients undergoing total laparoscopic hysterectomy?

Population

47 American Society of Anesthesiologists I–II female patients scheduled for elective total laparoscopic…

Comparison

Subarachnoid block with 5 mg of bupivacaine and… vs Subarachnoid block with 5 mg of bupivacaine only…

Design

RCT, Randomized into 3 groups, Double-blind

Follow-up

24 hours

Authors

VSVelmurugan SelvamRSRajeshwari SubramaniamDBDalim Kumar Baidya

Discussion

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Overview

Supports low-dose intrathecal morphine for opioid-sparing analgesia in gynecologic surgery; confirms efficacy in an RCT.

Study Design

Type

RCT (n=47)

Blinding

Double-blind

Randomization

randomized into 3 groups

Structured PICO

Does intrathecal low-dose morphine and bupivacaine improve postoperative analgesia and reduce stress markers in female patients undergoing total laparoscopic hysterectomy?

P
Population
47 ASA I-II female patients scheduled for elective total laparoscopic hysterectomy under general anesthesia.
I
Intervention
Subarachnoid block (SAB) with 5 mg of bupivacaine and 200 μg of morphine (Group M, n=16)
C
Comparator
Subarachnoid block with 5 mg of bupivacaine only (Group B, n=15) or skin infiltration with a local anesthetic alone (Group C, n=16)
O
Outcome
Efficacy as analgesic modalities and effects on perioperative humoral stress markers (plasma cortisol, growth hormone, insulin, and adrenocorticotropic hormone)patient reported

Main Result

Absolute Event Rate: 175% vs 425%

p-value: p=0.0001

Preinduction administration of low-dose intrathecal morphine provides better postoperative analgesia up to 24 hours, reducing parenteral opioid consumption and surgical stress in patients undergoing laparoscopic hysterectomy.

Cite This Study

Selvam et al. (2018) conducted an RCT in Total laparoscopic hysterectomy (n=47). Low-dose intrathecal morphine vs. Bupivacaine alone (5 mg) or skin infiltration with local anesthetic alone was evaluated on Total postoperative fentanyl consumption during 24 hours of observation (p=0.0001). Low-dose intrathecal morphine significantly reduced postoperative fentanyl consumption over 24 hours compared to bupivacaine alone and control (175 μg vs 350 μg and 425 μg, respectively; p=0.0001).

synapsesocial.com/papers/6a8adfde0ca85c7e33dec943https://doi.org/10.1089/gyn.2017.0096
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Also Consider

Synapse has enriched 3 closely related papers on similar clinical questions. Consider them for comparative context:

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