Effect of intrathecal morphine before and after laminectomy on intraoperative surgical stress response and post-operative pain: A prospective randomized study

Amany Faheem Abd El Salam Omara, MD; Asmaa Fawzy Amer, MD

doi:10.5055/jom.2020.0546

Authors

Amany Faheem Abd El Salam Omara, MD
Asmaa Fawzy Amer, MD

DOI:

https://doi.org/10.5055/jom.2020.0546

Keywords:

laminectomy, morphine, cortisol, intrathecal

Abstract

Study objective: Intrathecal administration of morphine.

Design: A prospective, randomized, controlled study.

Setting: Operating room.

Patients: Ninety patients of American Society of Anesthesiologists physical statuses I and II undergoing lumbar laminectomy.

Interventions: Pre-emptive versus post-operative intrathecal morphine injection, compared to a control group.

Main outcome: The visual analog score at the time of discharge and 2, 4, 6, 8, 10, 12, 18, and 24 h later, serum cortisol level, the number of patients needing post-operative rescue analgesia, its duration, and the total amount required.

Main results: Morphine sulfate consumption as rescue analgesia over 24-h postoperatively was significantly higher in general anesthesia group (Group I) than in pre-emptive intrathecal morphine groups (Group II) [p = 0.001] and then postoperative intrathecal morphine group (Group III) [p = 0.001], and it was higher in Group III than Group II [p = 0.001]. There was a greater need for post-operative rescue morphine in general anesthesia group (Group I) than in the other two groups, and it was greater in post-operative intrathecal morphine group (Group III) than in pre-emptive intrathecal morphine group (Group II). At 30 min after surgical incisions and at 1 and 24 h after surgery, serum cortisol levels were significantly higher in general anesthesia group (Group I) [p = 0.001] and in post-operative intrathecal morphine group (Group III) [p = 0.001] than in pre-emptive intrathecal morphine groups (Group II), with no significant difference between general anesthesia group (Group I) and post-operative intrathecal morphine group (Group III) [p = 0.704, 0.263, and 0.943, respectively].

Conclusion: Pre-emptive intrathecal morphine analgesia is an effective technique for controlling surgical stress response and post-lumbar laminectomy pain.

Author Biographies

Amany Faheem Abd El Salam Omara, MD

Department of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt

Asmaa Fawzy Amer, MD

Department of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt

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