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ANALGESIA

A Comparison of Intrathecal Morphine/Fentanyl and Patient-Controlled Analgesia with Patient-Controlled Analgesia Alone for Analgesia After Liver Resection

Jean-Denis Roy, MD, FRCPC^*, Luc Massicotte, MD^*, Marie-Pascale Sassine, C PhD, Robert F. Seal, MD, FRCPC, and André Roy, MD, FRCPC

From the Departments of *Anesthesiology and Epidemiology and Biostatistics, Centre hospitalier de l’Université de Montréal (CHUM), Hôpital St-Luc, Montreal, Quebec, Canada; Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada; and Department of Surgery, Hepatobiliary Service, CHUM-Hôpital St-Luc, Montreal, Quebec, Canada.

Address correspondence and reprint requests to Dr. Luc Massicotte, CHUM-Hôpital St-Luc, 1058 St-Denis, Montreal, QC, Canada H2X 3J4. Address e-mail to luc.massicotte{at}umontreal.ca.

Abstract

Continuous epidural anesthesia and analgesia may be considered in liver resection, but is often avoided because of the potential development of coagulopathies and the risk of epidural hematoma. In this prospective, randomized, double-blind study we compared postoperative morphine consumption via patient-controlled analgesia after liver surgery between two groups of patients: patients receiving a preoperative dose of intrathecal morphine (0.5 mg) and fentanyl (15 µg) (treatment group) and patients receiving a sham intrathecal injection (placebo group). Forty patients scheduled for major liver resection (two segments) were enrolled. The primary outcome measure was patient-controlled analgesia morphine consumption. Secondary outcomes were evaluation of pain at rest and with movement, scored on a visual analog scale with assessment of sedation, nausea, pruritus, and respiratory frequency. Outcome measures were recorded at 6, 12, 18, 24, and 48 h postspinal anesthesia or simulation. Patients in the placebo group consumed approximately three times more morphine during each time interval than patients in the treatment group (at 48 h: 124 ± 30 vs 47 ± 21 mg, P < 0.0001). Pain evaluation on the visual analog scale was lower for the first 18 h in the treatment group. There was no difference in the incidence of side effects in both groups. Intrathecal morphine (0.5 mg) and fentanyl (15 µg) given before liver surgery significantly decreased postoperative morphine consumption compared to placebo without any increase in side effects.

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