ESRA Academy. Cosgrave D. Sep 8, 2016; 138606; 0488 Topic: Analgesia after Major Abdominal Surgery
David Cosgrave
David Cosgrave

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Background and Aims:

Intrathecal morphine(ITM) has been shown to be effective in providing prolonged analgesia after major abdominal surgery.  In our audit, we examined the incidence of side effects in patients receiving 5-15mcg/kg of ITM for major hepato-pancreato-biliary (HPB) surgery. 


We conducted a retrospective audit of patients who received morphine intrathecally for major HPB surgery during the period Jan 2014 to March 2015. All patients were extubated immediately postoperatively and monitored in a high dependency (HDU) setting.


Seventy six patients were analysed. Age, weight and dosage information are contained in table 1. 

Incidence of side effects are shown in table 2. 
Table 2

For the purposes of our audit respiratory depression has been defined as respiratory rate < 10 breaths / min. Our data showed no association with dose of ITM or patient age. 


The rate of respiratory depression is higher than that reported elsewhere although comparisons are difficult as definitions of respiratory depression vary. Our data shows that it is safe to give similar higher doses of ITM as we have demonstrated no serious adverse events. We hypothesise that this was due to patients being cared for in a high dependency setting. We have shown a similar incidence of pruritus and nausea and vomiting as previous publications.

Following this audit, we have recently commenced a randomized controlled trial of low dose naloxone infusion versus placebo, aiming to show a reduction in the rates of respiratory depression and other side effects without compromising analgesic effect. 

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