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. Sai Ram Prudhvi, N. S. S. Naga Shyam, Anand Acharya


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.


Intrathecal morphine, Bupivacaine, Abdominal hysterectomy

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