title: Effect of adding intrathecal morphine to a multimodal analgesic regimen for postoperative pain management after laparoscopic bariatric surgery: a prospective, double-blind, randomized controlled trial.
abstract: BACKGROUND
  Pain control after bariatric surgery is a major challenge. Our objective was to study the efficacy and safety of intrathecal (IT) morphine 0.3 mg added to bupivacaine 0.5% for postoperative pain after laparoscopic bariatric surgery.
  
  
  METHODS
  After local ethics committee approval, 100 morbidly obese patients scheduled for laparoscopic bariatric surgery were enrolled in this study. Patients were randomly assigned into two groups:Group Ireceived IT 0.3 mg morphine (0.3 mL) added to 1.2 mL of bupivacaine 0.5%;Group IIreceived IT 0.3 mL saline added to 1.2 mL of bupivacaine 0.5%, immediately before induction of general anaesthesia. For both groups, 60 mg ketorolac and 1000 mg paracetamol were infused 30 minutes before the end of surgery. After wound closure, 20 mL bupivacaine 0.25% was infiltrated at wound edges.
  
  
  RESULTS
  Visual Analogue Scale (VAS) score was significantly lower in group I immediately, 30 minutes and 1 hour postoperatively. Time to first ambulation, return of intestinal sounds and hospital stay were shorter in group I than group II (p < 0.05); total morphine consumption was significantly lower in group I than group II (p < 0.05). Sedation score was significantly higher in group I immediately postoperatively, while at 30 minutes, 1, 2 and 6 hours postoperatively sedation scores were significantly higher in group II. Itching was significantly higher in group I.
  
  
  CONCLUSIONS
  The addition of IT morphine to a multimodal analgesic regimen after laparoscopic bariatric surgery was an effective and safe method that markedly reduced postoperative pain, systemic opioid consumption and length of hospital stay.
authors.affiliation: Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
authors.forename: Fatma Adel
authors.initials: FA
authors.lastname: El Sherif
authors.affiliation: Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
authors.forename: Ahmed Hassan
authors.initials: AH
authors.lastname: Othman
authors.affiliation: Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
authors.forename: Ahmad Mohammad
authors.initials: AM
authors.lastname: Abd El-Rahman
authors.affiliation: Department of Plastic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Osama
authors.initials: O
authors.lastname: Taha
keywords: Intrathecal morphine; laparoscopic bariatric surgery; multimodal analgesia; postoperative pain management