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LOW-DOSE SPINAL MORPHINE FOR POST-THORACOTOMY PAIN AFTER VIDEO-ASSISTED THORACOSCOPIC SURGERY: A PROSPECTIVE RANDOMIZED DOUBLE-BLIND CONTROLLED TRIAL
ESRA Academy. SUKSOMPONG S. Sep 8, 2016; 138207
Topic: PAIN THERAPY (ACUTE - CHRONIC)
Disclosure(s): The authors hereby declare no personal or professional conflicts of interest regarding any aspect of this study.
Assoc. Prof. SIRILAK SUKSOMPONG
Assoc. Prof. SIRILAK SUKSOMPONG

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Abstract
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Background and Aims:

One third of the patients undergoing video-assisted thoracoscopic surgery (VATS) experiences severe pain. Spinal opioids with lumbar approach have been proven to be a simple alternative technique for post-thoracotomy pain. The primary objective of this study was to demonstrate the effectiveness of 0.15 mg spinal morphine compared to control in patients undergoing VATS.


Methods:

After IRB approval, patients scheduled for VATS lobectomy or wedge resection were randomly assigned into two groups. Prior to general anesthesia, Group M received spinal morphine 0.15 mg whereas Group C received only local infiltration. Cumulative 24- and 48-hour intravenous patient-controlled analgesia morphine consumption and numeric rating scale (NRS) score were recorded. Sedation score, itching, nausea and vomiting were assessed during the postoperative period.

Results:

Thirty-six patients were enrolled. Four patients were excluded due to bleeding and protocol violation. Median morphine consumption in group M and group C at 24-hour were 18.0 (6.0, 31.0) and 29.5 (21.0, 45.0) mg, while at 48-hour were 19.5 (7.25, 35.0) and 40.5 (30.5, 60.5) mg which was statistical significant difference. (Figure 1) Patients in Group M had lower NRS score than group C, which was statistically significant at 12 and 48 hours in resting patients. Nearly one-thirds (31.3%) of the patients in group M experienced nausea and vomiting compared to none in group C which was statistically significant difference. However, postoperative peak flow rates at 24 and 48 hours showed no statistically significant differences between the two groups.

Conclusions:

In patients undergoing VATS, spinal morphine 0.15 mg provides better analgesia than control. 

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