Objective: To study the use of intrathecal morphine plus PCA for reducing morphine consumption, pain scores, and improving patient-satisfaction.
Material and Method: The authors included patients who had received a flank incision for elective kidney surgery. The patients were random into the intrathecal and control groups by block randomization using the sealed envelop technique. The intrathecal group received 0.3 mg of intrathecal morphine before general anesthesia. Patients and providers were not apprised of the treatment. After the operation, both groups received morphine in a PCA pump. Morphine consumption, numeric rating score (NRS, range 0-10) at rest and while coughing, sedation score, nausea vomiting score, and itching score were evaluated at 1, 2, 6, 12, 24, and 48 hr. Patient satisfaction for pain control was recorded.
Results: The authors enrolled 80 patients in the present study. Demographic data was comparable between groups. The intrathecal group had less cumulative morphine consumption (p-value <0.001), less NRS at rest (p-value <0.001) and while coughing (p-value <0.001) than the control group. The intrathecal group had a greater itching score than the control group (p-value <0.001). The sedation score and patient satisfaction for pain control were not significantly different between groups (p-value = 0.55).
Conclusion: Intrathecal morphine plus PCA could reduce morphine consumption and improve the analgesic effect over PCA alone postoperatively. Itching was more common in the intrathecal group. Overall, patient satisfaction for pain control was not improved.

Keywords: Intrathecal analgesia, Morphine, Patient-controlled analgesia, Postoperative, Pain therapy, Urological surgery