Objectives
Adequate pain control without side effects is crucial to enhanced recovery after surgery (ERAS) protocols. Ankara University is implementing an ongoing colorectal ERAS program. The primary analgesia technique utilized in this program is preventive intrathecal (IT) morphine administration with varying doses. The primary objective of this study was to compare different IT morphine doses and conventional analgesic methods on pain scores and to determine the optimal IT morphine dose that would show maximum analgesia with a low incidence of side effects.
Methods
This study was designed retrospectively. All data were collected from the Ankara University Colorectal ERAS program database. The study population (n=355) was divided into three groups based on the analgesia techniques used: conventional analgesic method (Group C, n=74), preventive IT 100 microgram morphine (Group M1, n=94), and IT 200 microgram morphine (Group M2, n=187). The data included demographics and maximum Visual Analog Scale (VAS) scores at rest and during movement at the postoperative 2nd and 6th hours and throughout the first week after the surgery. The opioid-related side effects were also recorded. The chi-square test, Kruskal-Wallis analysis of variance, and analysis of variance in repeated measurements were used.
Results
Forty-two percent of the patients were female, and 58% were male. All patients' mean pain scores were below 4 at all measurement points. The maximum mean pain scores at rest were 2.33 (Group C), 2.55 (Group M1), and 1.92 (Group M2) at postoperative 6th hours, on postoperative Day 1 (POD1) and POD2, respectively. The maximum mean pain scores at movement were 2.79 (Group C), 3.10 (Group M1), and 2.76 (Group M2) on POD2, POD1, and POD2, respectively. Although there was a statistically significant difference between Group C and Group M2 in terms of mean resting VAS values (p?0.05), no difference was found in mean VAS scores at movement. Opioid-related side effects, including nausea and vomiting, pruritis, ileus, and globe, did not differ between the three groups.
Conclusions
This retrospective study revealed that all three analgesia techniques provide adequate pain control in patients undergoing colorectal surgery with ERAS protocol. The maximum mean pain scores at rest and movement were recorded on POD1. Regarding the maximum mean VAS scores, the IT 200 micrograms of morphine administration resulted in better analgesia on POD0 and POD1. Therefore, preventive IT 200 micrograms of morphine administration may provide comfortable mobilization experiences with lower pain scores in this patient population. Besides favorable analgesia, the incidence of opioid-related side effects was similar to the other two methods.
