A Comparative Study Between Single Shot Intrathecal Morphine with Multimodal Analgesia Versus Currently Ongoing Multimodal Analgesia alone For Postoperative Pain Management in Hepatobiliary and Pancreatic Surgery

Open Access

Abstract

Background: Major hepatobiliary and pancreatic surgeries cause significant postoperative pain. Single-shot intrathecal morphine may improve pain control and reduce rescue analgesic requirements when added to multimodal analgesia. This study compared intrathecal morphine plus multimodal analgesia with multimodal analgesia alone for postoperative pain, rescue analgesic use, and adverse effects. Methods & Materials: This prospective comparative study included 60 patients undergoing elective major hepatobiliary and pancreatic surgery. Patients were equally assigned to single-shot intrathecal morphine plus multimodal analgesia or multimodal analgesia alone. Postoperative pain, rescue analgesic requirement, adverse effects, and patient satisfaction were assessed. Data were analyzed using Statistical Package for the Social Sciences version 25, with p<0.05 considered statistically significant. Results: Sixty patients were included, with 30 in each group. Baseline characteristics and surgical procedures were comparable (p>0.05). Postoperative VAS scores were significantly lower in Group A at 2-48 hours (p≤0.001). Group A had a longer time to first rescue analgesia (14.8 ± 5.1 vs. 7.6 ± 3.4 hours, p<0.001) and fewer rescue doses (1.30 ± 0.79 vs. 2.23 ± 0.90, p<0.001). Pruritus was more frequent in Group A (23.3% vs. 3.3%, p=0.023), with no respiratory depression. Patient satisfaction was higher in Group A (8.3 ± 1.1 vs. 6.9 ± 1.4, p<0.001). Conclusion: Single-shot intrathecal morphine improved postoperative pain control, prolonged the time to rescue analgesia, reduced analgesic requirements, and increased patient satisfaction, with pruritus as the main adverse effect and no clinically significant respiratory depression. It may therefore be considered an effective adjunct to multimodal analgesia for hepatobiliary and pancreatic surgery.