Unveiling the superior analgesic: Thoracic epidural versus intrathecal morphine in open live donor hepatectomy – A randomized controlled trial
Background and Aims: Postoperative pain management in open live donor hepatectomy is vital. This study aimed to compare postoperative analgesia provided by intrathecal morphine (ITM) and epidural in open live donor hepatectomy. Material and Methods: Patients were divided into two groups. In the epid...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2025-07-01
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| Series: | Journal of Anaesthesiology Clinical Pharmacology |
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| Online Access: | https://journals.lww.com/10.4103/joacp.joacp_173_24 |
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| author | Rohit Saini Gaurav Sindwani Neha Garg Mahesh K. Arora Viniyendra Pamecha Nihar Mohapatra |
| author_facet | Rohit Saini Gaurav Sindwani Neha Garg Mahesh K. Arora Viniyendra Pamecha Nihar Mohapatra |
| author_sort | Rohit Saini |
| collection | DOAJ |
| description | Background and Aims:
Postoperative pain management in open live donor hepatectomy is vital. This study aimed to compare postoperative analgesia provided by intrathecal morphine (ITM) and epidural in open live donor hepatectomy.
Material and Methods:
Patients were divided into two groups. In the epidural (EPI) group, a bolus dose of 0.125% levobupivacaine (5–6 mL) with 3 mg of preservative-free morphine (diluted in 5 mL of 0.9% normal saline) was injected. In the postoperative period, infusion of levobupivacaine 0.125% at a rate of 5–8 mL/hour was continued for 3 days. In the intrathecal group (ITM), 0.3 mg morphine with 1.5 mL of 0.5% bupivacaine heavy was injected. General anesthesia was administered. Postoperatively, both groups received intravenous fentanyl patient-controlled analgesia. Numerical rating score (NRS) scores were recorded at 0, 2, 4, 12, 24, 36, 48, and 72 hours postoperatively. Data were analyzed using the Student t-test, Mann–Whitney U test, and Fisher’s exact test. P < 0.05 was considered significant.
Results:
A total of 60 patients were enrolled. The postoperative fentanyl consumption for the first 24 hours was significantly higher in the EPI group compared to the ITM group (162.5 mcg vs. 75 mcg, respectively; P = 0.023). NRS up to 12 hours in the postoperative period at rest, on movement, and for shoulder pain were significantly lower in the ITM group compared to the EPI group (P = 0.000).
Conclusions:
ITM significantly decreased fentanyl consumption in the first 24 hours when compared to the epidural group in patients undergoing open donor hepatectomy. |
| format | Article |
| id | doaj-art-2594e549a2e14c9ab4e2c19d89d9b6c0 |
| institution | Matheson Library |
| issn | 0970-9185 2231-2730 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Anaesthesiology Clinical Pharmacology |
| spelling | doaj-art-2594e549a2e14c9ab4e2c19d89d9b6c02025-07-05T14:52:32ZengWolters Kluwer Medknow PublicationsJournal of Anaesthesiology Clinical Pharmacology0970-91852231-27302025-07-0141344144710.4103/joacp.joacp_173_24Unveiling the superior analgesic: Thoracic epidural versus intrathecal morphine in open live donor hepatectomy – A randomized controlled trialRohit SainiGaurav SindwaniNeha GargMahesh K. AroraViniyendra PamechaNihar MohapatraBackground and Aims: Postoperative pain management in open live donor hepatectomy is vital. This study aimed to compare postoperative analgesia provided by intrathecal morphine (ITM) and epidural in open live donor hepatectomy. Material and Methods: Patients were divided into two groups. In the epidural (EPI) group, a bolus dose of 0.125% levobupivacaine (5–6 mL) with 3 mg of preservative-free morphine (diluted in 5 mL of 0.9% normal saline) was injected. In the postoperative period, infusion of levobupivacaine 0.125% at a rate of 5–8 mL/hour was continued for 3 days. In the intrathecal group (ITM), 0.3 mg morphine with 1.5 mL of 0.5% bupivacaine heavy was injected. General anesthesia was administered. Postoperatively, both groups received intravenous fentanyl patient-controlled analgesia. Numerical rating score (NRS) scores were recorded at 0, 2, 4, 12, 24, 36, 48, and 72 hours postoperatively. Data were analyzed using the Student t-test, Mann–Whitney U test, and Fisher’s exact test. P < 0.05 was considered significant. Results: A total of 60 patients were enrolled. The postoperative fentanyl consumption for the first 24 hours was significantly higher in the EPI group compared to the ITM group (162.5 mcg vs. 75 mcg, respectively; P = 0.023). NRS up to 12 hours in the postoperative period at rest, on movement, and for shoulder pain were significantly lower in the ITM group compared to the EPI group (P = 0.000). Conclusions: ITM significantly decreased fentanyl consumption in the first 24 hours when compared to the epidural group in patients undergoing open donor hepatectomy.https://journals.lww.com/10.4103/joacp.joacp_173_24abdominal painanalgesiabupivacaineepiduralhepatectomylevobupivacaineliver transplantationliving donorsmorphine derivativespainpostoperativeshoulder painkey message: studies comparing intrathecal morphine with epidural are lacking in patients undergoing open living donor hepatectomy. most of the previous studies have either included carcinomas or other abdominal surgery patients. |
| spellingShingle | Rohit Saini Gaurav Sindwani Neha Garg Mahesh K. Arora Viniyendra Pamecha Nihar Mohapatra Unveiling the superior analgesic: Thoracic epidural versus intrathecal morphine in open live donor hepatectomy – A randomized controlled trial Journal of Anaesthesiology Clinical Pharmacology abdominal pain analgesia bupivacaine epidural hepatectomy levobupivacaine liver transplantation living donors morphine derivatives pain postoperative shoulder pain key message: studies comparing intrathecal morphine with epidural are lacking in patients undergoing open living donor hepatectomy. most of the previous studies have either included carcinomas or other abdominal surgery patients. |
| title | Unveiling the superior analgesic: Thoracic epidural versus intrathecal morphine in open live donor hepatectomy – A randomized controlled trial |
| title_full | Unveiling the superior analgesic: Thoracic epidural versus intrathecal morphine in open live donor hepatectomy – A randomized controlled trial |
| title_fullStr | Unveiling the superior analgesic: Thoracic epidural versus intrathecal morphine in open live donor hepatectomy – A randomized controlled trial |
| title_full_unstemmed | Unveiling the superior analgesic: Thoracic epidural versus intrathecal morphine in open live donor hepatectomy – A randomized controlled trial |
| title_short | Unveiling the superior analgesic: Thoracic epidural versus intrathecal morphine in open live donor hepatectomy – A randomized controlled trial |
| title_sort | unveiling the superior analgesic thoracic epidural versus intrathecal morphine in open live donor hepatectomy a randomized controlled trial |
| topic | abdominal pain analgesia bupivacaine epidural hepatectomy levobupivacaine liver transplantation living donors morphine derivatives pain postoperative shoulder pain key message: studies comparing intrathecal morphine with epidural are lacking in patients undergoing open living donor hepatectomy. most of the previous studies have either included carcinomas or other abdominal surgery patients. |
| url | https://journals.lww.com/10.4103/joacp.joacp_173_24 |
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