Effect of intrathecal morphine and epidural analgesia on post operative recovery after radical cholecystectomy for carcinoma gall bladder – An open label observational study
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 7, Pages 2962-2964
Abstract
Background: This observational study aims to compare the efficacy and safety of intrathecal morphine versus epidural analgesia in postoperative recovery following radical cholecystectomy.Methods: 40 patients posted for radical cholecystectomy were divided into two groups of 20 patients each, epidural analgesia group (EDA) and intrathecal morphine group (ITM). The EDA group received continuous epidural infusion of 0.2% Ropivicaine with inj. Fentanyl 2 mcg/ml at 5-6 ml/hr in the postoperative period while the ITM group received 150-200 mcg of morphine intrathecally before general anaesthesia was administered. VAS will be assessed for 72 hours postoperatively, rescue analgesic consumption in the first 24 hours as well as total analgesic consumption in the next 48 hours will be recorded, time for first rescue analgesic use, time for ambulation, duration of stay in ICU, total duration of stay in hospital will be assessed. Side effects if any will be recorded.
Results: There was statistically significant difference in favour of ITM in respect to VAS score for most part of our study, there is less rescue analgesic consumption in the first 24 hours as well as less analgesic consumption in the next 48 hours in the ITM group and it was statistically significant, time for rescue analgesic requirement was more in the ITM group although it was not statistically significant. Time for ambulation and total duration of stay in ICU was less in the ITM group and it was statistically significant. Side effects and total duration of stay in hospital was comparable in both groups.
Conclusion: From our study we can conclude that low dose of intrathecal morphine (150 -200 mcg) is comparable to epidural analgesia by continuous infusion of local anaesthetic with an opioid through an epidural catheter in terms of duration of stay in hospital while low dose intrathecal morphine has better safety profile with a better pain score as assessed by VAS along with a lesser consumption of rescue analgesic in the first 24 hours also a decrease in total analgesic consumption and a reduction in the length of stay in the ICU as compared to the continuous epidural infusion
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