Analgesic effects of intrathecal morphine and bupivacaine during robotic‐assisted surgery: A prospective randomized controlled study

• Published in: Pain practice 2023-07, Vol.23 (6), p.631-638
• Main Authors: Engström, Anders J. E., Ivarsson, Carina A., Aldergård, Åsa, Henningsson, Ragnar N.
• Format: Article
• Language: English
• Subjects: Adult; analgesics; Analgesics, Opioid - therapeutic use; Analogue Pain Scale; anesthesia and analgesia; Anesthetics, Local - therapeutic use; Bupivacaine; Double-Blind Method; Female; Humans; Injections, Spinal; intrathecal; Morphine - therapeutic use; non‐narcotic; opioid analgesics; Pain Measurement; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Prospective Studies; Robotic Surgical Procedures - adverse effects
• ISSN: 1530-7085; 1533-2500
• DOI: 10.1111/papr.13233

Background Limited data exist concerning the management of postoperative pain after robotic‐assisted surgery. The present study was performed to investigate the efficacy of intrathecal morphine and bupivacaine to treat postoperative pain in adult women undergoing robot‐assisted laparoscopic hysterectomy. Methods The primary outcomes of this study were opioid consumption and pain scores during and after robotic surgery. 96 patients were prospectively enrolled and randomized to a nonspinal group (n = 48) and a spinal group (n = 48). The intrathecal regimen consisted of 100 μg morphine and 15 mg of bupivacaine. The numeric rating scale scores (NRS) were assessed every 15 min in the postoperative care unit (PACU) and pain was treated with iv fentanyl or morphine when NRS was above 5 and orally oxycodone when NRS was 3–5. Cumulative iv opioid‐consumption and NRS scores were compared. Results Intrathecal morphine and bupivacaine resulted in a significantly lower cumulative total iv opioid (morphine equivalents) consumption (9.4 ± 3.9 vs. 22.8 ± 6.1 mg equivalents). Highest recorded NRS scores in the PACU were also significantly lower in the spinal group (2.0 ± 2.6 vs. 5.3 ± 3.2). Conclusion Intrathecal morphine and bupivacaine to treat postoperative pain after robotic‐assisted laparoscopic hysterectomy decrease total opioid consumption and NRS pain scores. This might be of great importance to diminish the rate of other serious disadvantages related to opioids.