Intrathecal morphine plus patient-controlled intravenous fentanyl infusion is not as effective as patient-controlled thoracic epidural analgesia in patients undergoing gastrectomy

Abstract

Patient controlled thoracic epidural analgesia (PCTEA) is widely used due to its excellent pain relieving effect even with a small amount of opioid; however, its use is limited by procedural difficulty, patient discomfort, and side effects from the catheter itself. The combined use of intrathecal morphine and intravenous patient controlled analgesia (ITM-IVPCA) has been shown to be a viable approach for analgesia after abdominal surgery. The aim of this study was to compare the analgesic effect and postoperative outcomes of PCTEA and ITM-IVPCA in patients undergoing gasatrectomy.Sixty patients undergoing gastrectomy due to gastric cancer were randomly allocated into the intrathecal morphine group (IT group) or the epidural group (EP group). The IT group received preoperative intrathecal morphine, followed by postoperative IVPCA. The EP group preoperatively underwent thoracic epidural catheterization, followed by postoperative PCTEA. Visual analog scale (VAS) scores and postoperative adverse events were assessed until postoperative day (POD) 2. Times to ambulation, eating, gas passing and postoperative complications within 30 days after surgery were also evaluated.This study failed to demonstrate non-inferiority of intrathecal morphine administration at POD 1. The IT group required more systemic additional analgesics (P = 0.003) and took a longer time to ambulate than the EP group (P = 0.021). In the IT group, postoperative ileus (P = 0.012) and pulmonary complications (P = 0.05) developed more frequently, compared with the EP group.ITM-IVPCA is not as effective as PCTEA in patients undergoing gastrectomy, with respect to greater analgesic requirement, later ambulation, more frequent postoperative ileus and pulmonary complications within 30 days after gastrectomy.