Unveiling the superior analgesic: Thoracic epidural versus intrathecal morphine in open live donor hepatectomy - A randomized controlled trial.

Abstract

Background and aims: Postoperative pain management in open live donor hepatectomy is vital. This study aimed to compare postoperative analgesia provided by intrathecal morphine (ITM) and epidural in open live donor hepatectomy.

Material and methods: Patients were divided into two groups. In the epidural (EPI) group, a bolus dose of 0.125% levobupivacaine (5-6 mL) with 3 mg of preservative-free morphine (diluted in 5 mL of 0.9% normal saline) was injected. In the postoperative period, infusion of levobupivacaine 0.125% at a rate of 5-8 mL/hour was continued for 3 days. In the intrathecal group (ITM), 0.3 mg morphine with 1.5 mL of 0.5% bupivacaine heavy was injected. General anesthesia was administered. Postoperatively, both groups received intravenous fentanyl patient-controlled analgesia. Numerical rating score (NRS) scores were recorded at 0, 2, 4, 12, 24, 36, 48, and 72 hours postoperatively. Data were analyzed using the Student t-test, Mann-Whitney U test, and Fisher's exact test. P < 0.05 was considered significant.

Results: A total of 60 patients were enrolled. The postoperative fentanyl consumption for the first 24 hours was significantly higher in the EPI group compared to the ITM group (162.5 mcg vs. 75 mcg, respectively; P = 0.023). NRS up to 12 hours in the postoperative period at rest, on movement, and for shoulder pain were significantly lower in the ITM group compared to the EPI group (P = 0.000).

Conclusions: ITM significantly decreased fentanyl consumption in the first 24 hours when compared to the epidural group in patients undergoing open donor hepatectomy.