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Minerva Obstetrics and Gynecology 2021 Dec 01

DOI: 10.23736/S2724-606X.21.04961-7


language: English

Enhanced recovery after gynecological surgery: comparison between intrathecal and intravenous morphine multimodal analgesia

Alessandro DI FILIPPO 1, Tommaso CAPEZZUOLI 2, Massimiliano FAMBRINI 2, Giuseppe CARITI 3, Gretha ORLANDI 1, Giulia VANNUCCI 1, Tommaso BORRACCI 4, Luciana DI NALLO 1, Marta MAZZELLA 1, Felice PETRAGLIA 2

1 Division of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy; 2 Division of Obstetrics and Gynecology, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy; 3 Division of Oncological Gynecology, Department of Woman and Child Health, Careggi University Hospital, Florence, Italy; 4 Division of Anesthesia for Obstetrical and Gynecological Area, Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy


BACKGROUND: The purpose of the present study was to compare the effectiveness of intrathecal injection of morphine, inserted in the protocols of multimodal analgesia, versus intravenous morphine in the control of postoperative pain and course in women undergoing gynecological surgery.
METHODS: An observational, single-center, retrospective and case-controlled study was performed. Data were collected in a group of women (n=80) who underwent to gynecological surgery. Women were divided into two groups: Group A (40 patients) laparoscopic hysterectomy and Group B (n=40) performing laparotomic myomectomy. In both Groups 20 patients underwent administration of intrathecal morphine (125 mcg in 5 ml) and 20 patients underwent to intravenous morphine (1 mg maximum every 10 minutes). The primary endpoint collected was the mean VAS Score during the first 3 days after surgery, while secondary endpoints were opioid consumed during the same period, nausea, vomitis and pruritus. Among the exploratory objectives, length of hospital stay, canalization and feeding time were collected.
RESULTS: In Group A, patients performing intrathecal morphine presented a significantly lowest VAS on postoperative day 1 and 3 compared to patients performing intravenous morhpine while in Group B mean VAS was statistically significant lower only on the first day. The emergence of pruritus was significantly higher in patients performing intrathecal morphine. The day of complete canalization was different in Group A patients in favor of intratechal morhpine as well as the length of stay.
CONCLUSIONS: Our present study showed that intrathecal morphine allows to achieve important management goals with minimal side effects and complications, in particular in case of laparoscopic hysterectomy.

KEY WORDS: Minimally invasive surgery; Laparotomy; Recovery after surgery; Morphine; Spinal analgesia

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