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Intrathecal + PCA morphine improves analgesia during the first 24 hr after major abdominal surgery compared to PCA alone

[La morphine intrathécale + la morphine en AAC, comparée à la morphine en AAC seule, améliore l’analgésie pendant les vingt-quatre premières heures suivant une opération abdominale majeure]

Jean-Michel Devys^*, Anne Mora, Benoît Plaud^*, Christian Jayr, Agnès Laplanche, Bruno Raynard^¶, Philippe Lasser^|| and Bertrand Debaene^**

^* From the Departments of Anaesthesiology and Intensive Care, Adolphe de Rothschild Foundation, Paris;
Anaesthesiology, Henri Duffaux Hospital, Avignon;
Anaesthesiology,
Biostatistics,
^¶ Intensive Care,
^|| and Surgery, Gustave Roussy Institute, Villejuif;
^** Anaesthesiology and Intensive Care, Centre Hospitalier Universitaire La Milétrie, Poitiers, France.

Address correspondence to: Dr. Jean-Michel Devys, Département d’Anesthésiologie-Réanimation-Urgences, Fondation Adolphe de Rothschild, 25-29 Rue Manin, 75019 Paris, France. Phone: 33-1-48-03-67-76; Fax: 33-1-48-03-65-11; E-mail: jmdevys{at}fo-rothschild.fr

Purpose: To compare, over a 48-hr follow-up period, the analgesia and side-effects of patient controlled iv analgesia (PCA) with morphine alone vs combined intrathecal and PCA morphine (IT+PCA) in patients undergoing major abdominal surgery.

Methods: Sixty adult patients undergoing abdominal surgery for cancer were randomly allocated to receive preoperative IT (0.3 or 0.4 mg) plus postoperative PCA morphine or postoperative PCA morphine alone. Postoperative analgesia was tested at rest and while coughing on a visual analogue pain scale and morphine consumption was recorded. Patients’ satisfaction, arterial oxygen saturation, respiratory rate, episodes of nausea, vomiting and pruritus were also noted.

Results: Analgesia at rest and while coughing was significantly better in the IT+PCA morphine group (rest: P = 0.01; coughing: P = 0.005) on the first postoperative day only. IT+PCA morphine constantly provided adequate analgesia during this period. Morphine consumption was lower in the IT+PCA morphine group during this period also (IT+PCA: 9 (17) vs PCA: 40 (26); mg of morphine, mean (SD), P = 0.0001). No difference was found in pain relief and morphine consumption between the groups on the second postoperative day. Nausea and vomiting were more frequent with IT+PCA morphine on the first postoperative day. No respiratory depression occurred in either group. Satisfaction was high in both groups.

Conclusions: IT+PCA morphine improves patient comfort constantly during the first postoperative day after major abdominal surgery. However, after the first postoperative day, IT+PCA morphine provides no additional benefit.

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