title: Low dose intrathecal morphine effects on post-hysterectomy pain: a randomized placebo-controlled study.
abstract: BACKGROUND
  Spinal anesthesia with different doses of intrathecal morphine has been shown to relieve post-operative pain. We studied in a prospective randomized, double-blind fashion the effects of morphine 0, 100, 200, or 300 μg added to intrathecal bupivacaine on first post-operative 24 h patient-controlled analgesia morphine (PCA-morphine) consumption after abdominal hysterectomy under general anesthesia.
  
  
  METHODS
  One hundred and forty-four American Society of Anesthesiologists I-II women were assigned to receive spinal anesthesia with 12 mg of hyperbaric bupivacaine combined with 100, 200, and 300 μg morphine or saline before standardized general anesthesia was induced. Low transverse incision abdominal hysterectomy was performed. Post-operative outcome measures were recorded at 1, 2, 4, 6, 12, and 24 h. Primary outcome was 24 h PCA-morphine. Secondary outcomes were pain by visual analogue scale (0-10), nausea, pruritus, sedation, and respiratory depression.
  
  
  RESULTS
  Intrathecal morphine reduced accumulated 24 h post-operative morphine consumption. Morphine 100 μg significantly reduced morphine consumption vs. placebo at 0-6 h, 6-12 h, and for the entire 0-24 h time interval post-operation. Morphine 200 μg further significantly reduced morphine consumption vs. morphine 100 μg at 0-6 h and for the entire 0-24 h post-operation. There was no further reduction of morphine consumption seen with morphine 300 μg. No serious side effects were seen. Emesis was similar in all groups, and pruritus was experienced only in the morphine groups.
  
  
  CONCLUSIONS
  Intrathecal morphine supplementation to bupivacaine reduces first 24 h PCA-morphine consumption after abdominal hysterectomy under general anesthesia, and we found no benefit from increasing the dose over 200 μg.
authors.affiliation: Department of Anaesthesia & Intensive Care Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. anette.hein@ds.se
authors.forename: A
authors.initials: A
authors.lastname: Hein
authors.forename: P
authors.initials: P
authors.lastname: Rösblad
authors.forename: C
authors.initials: C
authors.lastname: Gillis-Haegerstrand
authors.forename: K
authors.initials: K
authors.lastname: Schedvins
authors.forename: J
authors.initials: J
authors.lastname: Jakobsson
authors.forename: G
authors.initials: G
authors.lastname: Dahlgren
mesh_terms: D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use*; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local; D002045:Bupivacaine; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007278:Injections, Spinal; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine