Comparison of Intrathecal Morphine plus PCA and PCA alone for Post-Operative Analgesia after Kidney Surgery
Suhattaya Boonmak MD*, Polpun Boonmak MD*, Piyaporn Bunsaengjaroen MD*, Somyong Srichaipanha BSc*, Viriya Thincheelong BSc*
Affiliation : * Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen
Objective : To study the use of intrathecal morphine plus PCA for reducing morphine consumption, pain
scores, and improving patient-satisfaction.
Materials and Methods : 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, Uro- logical surgery
