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Title: Intrathecal Morphine in Postoperative Analgesia for Colorectal Cancer Surgery: A Retrospective Study
Authors: Young, J
Macpherson, A
Thakerar, A
Alexander, M
Keywords: Morphine
Medical oncology
Retrospective studies
Post-operative analgesia
Abstract: Background: Colorectal cancer surgery is commonly performed with adequate analgesia essential for patient recovery. This study assessed the effectiveness of intrathecal morphine and patient-controlled analgesia (ITM + PCA) vs patient-controlled analgesia alone (PCA) for postoperative pain management in colorectal cancer surgery. Methods: This retrospective study extracted and analyzed data covering a 4-year period (2014-2018) from a clinical database with 24- and 48-hour postsurgery follow-up. Primary outcomes included pain scores, median opioid consumption (oral morphine equivalence dose), sedation, nausea and vomiting, and length of admission. Outcomes were analyzed for ITM + PCA vs PCA alone, overall and stratified by laparotomy or laparoscopy procedures. Results: In total, 283 patients were included: ITM + PCA (163) and PCA alone (120). Median opioid consumption in the first 24 hours for ITM + PCA vs PCA alone was lower for laparotomy (-32.7 mg, P<0.001) and laparoscopy (-14.3 mg, P<0.001). Median pain score (worst pain) within the first 24 hours for ITM + PCA vs PCA alone was similar for laparotomy (P>0.05) and lower for laparoscopy (-1 unit, P=0.031). Sedation occurred less frequently for ITM + PCA vs PCA at 24 hours (3.5% vs 11.4%, P=0.031), with nonsignificant reduction at 48 hours (4.8% vs 18.8%, P=0.090) for laparotomy, but with no difference for laparoscopy (P>0.05). Incidence of nausea and vomiting and length of admission were similar for ITM + PCA vs PCA alone for laparotomy or laparoscopy (P>0.05). Conclusion: This retrospective study demonstrated that ITM + PCA can achieve similar analgesic effects after laparotomy and laparoscopy colorectal cancer surgery compared with PCA alone while resulting in a reduction of oral opioid consumption and lower incidence of sedation. Keywords: Colorectal; Intrathecal; Morphine; Oncology; Pain; Surgery.
DOI: 10.1093/pm/pnaa319
ORCID: 0000-0002-7142-8288
PubMed URL:
ISSN: 1526-2375
Journal Title: Pain Medicine
Type: Journal Article
Affiliates: Department of Anaesthesia and Pain, Peter MacCallum Cancer Centre, Melbourne, Australia
Centre for Integrated Critical Care, University of Melbourne, Melbourne, Australia
Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Australia
Department of Oncology, University of Melbourne, Parkville, Australia
Study/Trial: Study
Appears in Collections:Scholarly and Clinical

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