Enhanced recovery after gynecological surgery: comparison between intrathecal and intravenous morphine multimodal analgesia

Background: The purpose of the present study was to compare the effectiveness of intrathecal injection of morphine, inserted in the protocols of multimodal analgesia, versus intravenous morphine in the control of postoperative pain and course in women undergoing gynecological surgery. Methods: An observational, single-center, retrospective and case-controlled study was performed. Data were collected in a group of women (n=80) who underwent to gynecological surgery. Women were divided into two groups: Group A (40 patients) laparoscopic hysterectomy and Group B (n=40) performing laparotomic myomectomy. In both Groups 20 patients underwent administration of intrathecal morphine (125 mcg in 5 ml) and 20 patients underwent to intravenous morphine (1 mg maximum every 10 minutes). The primary endpoint collected was the mean VAS Score during the first 3 days after surgery, while secondary endpoints were opioid consumed during the same period, nausea, vomitis and pruritus. Among the exploratory objectives, length of hospital stay, canalization and feeding time were collected. Results: In Group A, patients performing intrathecal morphine presented a significantly lowest VAS on postoperative day 1 and 3 compared to patients performing intravenous morhpine while in Group B mean VAS was statistically significant lower only on the first day. The emergence of pruritus was significantly higher in patients performing intrathecal morphine. The day of complete canalization was different in Group A patients in favor of intratechal morhpine as well as the length of stay. Conclusions: Our present study showed that intrathecal morphine allows to achieve important management goals with minimal side effects and complications, in particular in case of laparoscopic hysterectomy.