Clinically Evaluate The Analgesic Efficacy Of Intrathecal Administered Morphine In Thoracic Surgeries

Background. The intensity of pain in thoracic surgery, associated with nociceptive stimulation caused by skin incision, muscle trauma, rib retraction and pleural dissection, contributes to central sensitization and the formation of severe pain, especially in the early postoperative period. Intrathecal morphine is an alternative opioid-sparing method within the concept of a multimodal approach to the treatment of acute pain.

Objective this study was to clinically evaluate the analgesic efficacy of intrathecal administered morphine in thoracic surgeries.

Methods. 255 patients who underwent lobectomies using thoracoscopic access were examined. The patients were divided into three groups: in the 1st group (n=85) — intrathecal administration of morphine was used, in the 2nd group (n=85) — opioid analgesics, in the 3rd group (n=85) — intercostal blockade with ropivacaine. We assessed the intensity of pain 2 hours and 24 hours after surgery, the need for promedol and tramadol, the incidence of postoperative nausea and vomiting, skin itching, urinary retention requiring bladder catheterization, and delayed respiratory depression.

Results. The level of pain 2 hours after surgery was the lowest in the intercostal blockade group 4[3-4] points, slightly higher in the intrathecal morphine group 4[4-5] points, which were significantly superior in their analgesic effectiveness to the systemic opioid analgesia group — 6 [5-6] points, (p <0.001). 24 hours after surgery, the level of pain in group 1 decreased to 3[2-3] points; in group 2, pain increased to 6[5-6] points, reaching the pain syndrome of patients in group 3 6 [5-6] points (p <0.001). The consumption of promedol was significantly less in group 1 (p <0.001). In relation to tramadol, there was a reduction in the need for administration of the drug, as well as the frequency of its use (p <0.001). The highest risk of developing postoperative nausea and vomiting was in group 2 (p <0.001). Skin itching and urinary retention in absolute numbers were more common in group 1; there were no significant differences according to the χ2 criterion. In no case was delayed respiratory depression observed.

Conclusion. Intrathecal administration of morphine significantly reduced the severity of pain syndrome, significantly reduced the opiate consumption and was accompanied by a low incidence of skin itching on the first day after surgery. The incidence of postoperative nausea and vomiting was lower compared with the use of opioids and intercostal nerve blockade. The need for bladder catheterization did not differ between groups. Delayed respiratory depression was not observed in any case.