Evaluation of the efficacy of 150 micrograms of intrathecal morphine with bupivacaine compared to 250 micrograms for postoperative analgesia following abdominal hysterectomy: a double blinded randomized control study


  • G. S. Sri Ram Prudhvi Department of Anaesthesia, Konaseema Institute of Medical Science, Amalapuram, Andhra Pradesh, India
  • N. S. S. Naga Shyam Department of Anaesthesia, Konaseema Institute of Medical Science, Amalapuram, Andhra Pradesh, India
  • Anand Acharya Department of Pharmacology, Konaseema Institute of Medical Science, Amalapuram, Andhra Pradesh, India




Intrathecal morphine, Bupivacaine, Abdominal hysterectomy


Background: The synergistic action of local anesthetics and morphine is well known, morphine probably more superior for postoperative analgesia, when compared to other opioids. Preservative-free morphine is now available in India making intrathecal administration possible. The present randomized double blind study was designed to evaluate the effect of adding preservative free morphine to hyperbaric bupivacaine given intrathecally for abdominal hysterectomy.

Methods: Following approval by the institutional review board and institutional research grant committee, eighty patients presenting for elective abdominal hysterectomy were included in this randomized, double blind study. All drugs used for spinal anesthesia were autoclaved as per the departmental protocol. 3.5 ml of hyperbaric bupivacaine 0.5% [heavy] was given in both groups along with preservative free morphine according to study group.

Results: 27.5% (11/40) patients in group A, 17.5% (7/40) patients in group B received one dose of rescue analgesia (ketorolac 10 mg),during the 24 hours for pain relief  while 29 patients is group A (72.5%) and 82.5% (33/40) patients in group B received 2 doses of rescue analgesia. 10% patients in Group A (4/40) and 10% patients in Group B (4/40) had a sedation score of 1 (drowsy and arousable).

Conclusions: The mean duration of analgesia in patients who received 250 μgms of intrathecal morphine was 18.725±1.38 hours while in patients who received 150 μgms it is 16.075±1.23 hours. We conclude that 250 µgms of preservative-free intrathecal morphine provides longer duration of analgesia when compared to 150 µgms morphine, with hardly any additional adverse effects.


Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anesth. 2001;87:62-72.

Kehlet H, Rung GW, Callesen T. Postoperative opioid analgesia: time for reconsideration. J Clin Anesth. 1996;8:441-5.

Fukuda T, Yamaguchi H, Watanabe S, Takahashi H, Yumiko Ishizawa. Minimal effective dose of intrathecal morphine for pain relief following transabdominal hysterectomy. Anesth Analg. 1989;68(4):537-40.

Gadsden J, Hart S, Santos AC. Post cesarean delivery analgesia. Anesth Analg. 2005;101:62-9.

Yang I, Breen TW, Archer D, Fick G. Comparison of 0.25 mg and 0.1 mg intrathecal morphine for analgesia after cesarean section. Can J Anesth. 1999;46:856-60.

Chadwick HS, Ready LB, Intrathecal and epidural morphine sulfate for postcesarean analgesia: a clinical comparison. Anesthesiol. 1988;68:925-9.

Palmer CM, Emerson S, Volgoropolous D, Alves D. Dose response relationship of intrathecal morphine for postcesarean analgesia. Anesthesiol. 1999;90:437-44.

Yamaguchi H, Watanbe S. Minimal effective dose of intrathecal morphine for pain relief following transabdomial hysterectomy. Anesth Analg. 1989;68:537-40.

Palmer CM, Voulgaropoulos D, Van Maren G, Emerson SS, Alves D. What is the optimal dose of subarachnoid morphine for post cesarean analgesia: a dose response study. Anesthesiol. 1994;81:1151.

Patterson GMC, McQuay HJ, Bullingham RES, Moore RA. Intradural morphine and diamorphine: dose response studies. Anesthesia. 1984;39:113-7.

Austin KL, Stapleton JV, Mather LE Multiple intramuscular injections: a major source of variability in analgesic response to meperidine. Pain. 1980;8:47-62.

Eltzschig HK, Evans P. Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing caeserian section with spinal Anesthesia. Anesthesiol. 1999;91:1919-27.

Lim Y, Jha S, Sia AT, Rawal N. Morphine for post-caesarean section analgesia: intrathecal, epidural or intravenous? Singapore Med J. 2005;46:392-6.

Wang JJ, Ho ST, Liu YH, Ho CM, Liu K, Chia YY. Dexamethasone decreases epidural morphine related nausea & vomiting. Anest Analg. 1999;89;117-20.

White PF, Watcha MF. Postoperative nausea and vomiting: prophylaxis versus treatment. Anesth Analg. 1992;89:1337-9.

Cousins MJ, Mather LE. Intrathecal and epidural administration of opioids. Anesthesiology. 1984:61:276-310.

Dahl JB, Jeppesen IS, Jorgensen H, Wetterslev J, Moiniche S. Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal analgesia: a qualitative and quantitative systematic review of randomized controlled trials. Anesthesiol. 1999;91:1919-27.

Choi DMA Kliffer AP, Douglas MJ. Dextromethorphan and intrathecal morphine for analgesia after Caesarean section under spinal Anesthesia. Br J Anesth. 2003;90:653-8.

Slapprandal R, Weber EWG, Benrrad B, Lebeck JV, Itching after intrathecal morphine, incidents and treatment. European J Anesth. 2000;17:616-21.

Chaney MA. Side effects of intrathecal & epidural opioid. Can J Anest. 1995;72:891-903.

Bromage RP, Camporesi EM, Durant PAC, Nielsen C. Nonrespiratory side effects of epidural morphpine. Anesthesia Analgesia. 1982:61(6):490-5.

Jeong CJ, Baik SW, Kim IS, Chung KS. Clinical study on pruritus due to Intrathecal morphine. Korean J Anesthesiol. 1987;20(5):696-702.

Thom NB, Sundarathi P, Sirikulthorn J, Chaimontri I, Benjaniratana J. A comparison between ondansetron and chlorpheneramine malaeate for the prevention of Intrathecal morphine induced pruritus. Thai J Anaethesiol. 2007;33:4.

Yeh HM, Chen LK, Lin CJ, Chan WH, Chen YP, Lin CS, Sun WZ, Wang MJ, Tsai SK. Prophylactic intravenous Ondansetron reduces the incidence of intrathecal morphine induced pruritus in patients undergoing cesarean delivery. Anest Analg. 2000;91:172-5.

Rawal N. Amer S. Gustafsson LL, Allvin R. Present state of extradural and intrathecal opioid analgesia in Sweden. Br J Anesth. 1987;59:791-9.

Bailey PL, Rhondeau S, Schafer PG, Lu JK, Timmins BS, Foster W, Pace NL, Stanley TH. Dose response pharmacology of intrathecal morphine in human volunteers. Anesthesiology. 1993;79:49-59.

Bernard JM, Hommeril JL, Legendre MP, Passuti N, Pinaud M. Spinal or systemic analgesia after extensive spinal surgery: comparison between intrathecal morphine and intravenous fentanyl plus clonidine. J Clin Anesth. 1993;5:231-6.

Gustafsson LL, Schildt B, Jacobsen K. Adverse effects of extradural and intrathecal opiates: report of a nationwide survey in Sweden. Br J Anesth. 1982;54:479-86.

Kang SB, Goodnough DE, Lee YK, Olson RA, Borshoff JA, Furlano MM, Krueger LS. Comparison of 26 and 27 G needles for spinal anathesia for ambulatory surgery patients. Anesthesiol. 1992;76:734-8.

Younggren B, Merchant E. “Focus On: PostDural Puncture Headache”. ACEP News. 2007.

Lavi R, Yarnitsky D, Rowe JM, Weissman A, Segal D, Avivi I. standard vs atraumatic whit acre needle for diagnostic lumbar puncture a randamised trial. Neurol. 2006;67:1492-4.

Balestrieri PJ. Intrathecal morphine for analgesia after postpartum bilateral tubal ligation. Anesthes Analog. 2005;100;234-43.






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