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LOW-DOSE INTRATHECAL DIAMORPHINE FOR ABDOMINAL HYSTERECTOMY

Department of Anesthesia, Dryburn Hospital, North Road, Durham, DH1 5TW, England.

INTRODUCTION

Total Abdominal Hysterectomy (TAH) is a frequently performed operation with moderate to severe postoperative pain. The aim of our study was to investigate whether the combination of low-dose (0.3 mg) intrathecal (IT) diamorphine with patient-controlled intravenous (i.v) morphine, provided more effective postoperative analgesia than patient-controlled i.v morphine alone in patients undergoing TAH.

METHODS

Following Local Research Ethics Committee approval and informed patient consent, we studied 48 ASA I and II patients undergoing TAH, in a prospective, randomized, double-blind study. Patients received either IT diamorphine 0.3 mg (diamorphine group) or saline 0.3 ml (control group) with 3 ml of 0.25% isobaric bupivacaine. Further anesthetic management was standardized. Postoperative analgesia was provided with an i.v patient controlled analgesic (PCA) device. Pain on movement (0-10 visual analogue scale), morphine usage, sedation, nausea and vomiting (N+V), pruritis and respiratory rate were recorded at 4, 8 and 24 hr postoperatively. Statistical analysis was achieved using Student=s t-test for patient characteristics and the Mann-Whitney test for non-parametric data.

RESULTS

Groups were well matched demographically.

Boxplot of PCA morphine consumption in the first 24 hr postoperatively Boxes represent interquartile range, horizontal lines in boxes the median values, error bars 5th and 95th centiles. Open circles represent outlying values. There is a significant reduction in morphine consumption in the diamorphine group in 24 hr (p=0.0002).

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DISCUSSION

IT diamorphine (0.3 mg) significantly reduces i.v morphine requirements following TAH. Pain scores suggest that this effect is maximal up to 8 hr, with patients receiving diamorphine experiencing mild pain in contrast to moderate pain (control group). IT diamorphine was not associated with an increase in major side-effects, although there was a significant increase in the number of patients requiring treatment for pruritis.

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Danjoux, G. Articles by Thomas, D. Search for Related Content PubMed Articles by Danjoux, G. Articles by Thomas, D.