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2022-RA-1327-ESGO Intrathecal morphine, a way to achieve opioid-free pain management within an ERAS
  1. Jaroslav Klat,
  2. Sylva Bajsova and
  3. Martina Romanova
  1. Department of Obstetrics and Gynaecology, University hospital Ostrava, Ostrava, Czech Republic


Introduction/Background The main aim of the study was to evaluate whether intrathecal morphine (ITM) can replace systemic opioids in postoperative pain control in patients undergoing radical surgery for gynaecological cancers.

Methodology This is a retrospective, single center study analyzing perioperative data of patients who underwent surgery for a gynaecologic malignancy from January 2019 to December 2021.We reviewed use of systemic opioids in 24 hours after surgery, visual analog scale (VAS, 0–10) assessing pain during the first 24 hours and time from ITM application to the first VAS 3 or more was measured. We analyzed the most frequent side effects of ITM – incidence of pruritus, nausea and vomiting, hypotension and respiratory depression during the first 24 hours after ITM administration.

Results Intrathecal morphine in dose 0.2 – 0.5 mg was used in 170 patients before the surgery for postoperative analgesia. Systemic opioids were administered during the first 24 hours after surgery in 3 cases.65 patients had one or more side effects. 3 patients had pruritus, 46 patients suffered from nausea or vomitus. Postoperative hypotension with vasopressors treatment was reported in 26 cases. There was no case of respiratory depression requiring mechanical ventilation.

Conclusion Our results show that intrathecal morphine is an effective method of postoperative analgesia in patients undergoing radical oncogynecologic surgery. We managed to minimize the use of systemic opioids with a very low frequency of side effects.

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