British Journal of Pain 2016, Vol. 10(4) 209–216 © The British Pain Society 2016 Reprints and permissions: sagepub.co.uk/ journalsPermissions.nav DOI: 10.1177/2049463716668904 bjp.sagepub.com Introduction Fear of side effects, such as respiratory depression, over-sedation, nausea and vomiting, from opioid use in patients with morbid obesity often leads to under- treatment of pain. Inadequate analgesia indirectly con- tributes to multiple postoperative complications in patients with morbid obesity. In abdominal surgeries, pain prevents deep breath- ing and further adds to basal lung atelectasis in this 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 Fatma Adel El Sherif 1 , Ahmed Hassan Othman 1 , Ahmad Mohammad Abd El-Rahman 1 and Osama Taha 2 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 I received IT 0.3 mg morphine (0.3 mL) added to 1.2 mL of bupivacaine 0.5%; Group II received 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 sur- gery. 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. Conclusion: 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. Keywords Intrathecal morphine, postoperative pain management, multimodal analgesia, laparoscopic bariatric surgery 1 Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University, Assiut, Egypt 2 Department of Plastic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt Corresponding author: Ahmad Mohammad Abd El-Rahman, Department of Anesthesia, ICU and Pain Relief, El Methaqe Street, Mansheit AlOmara, South Egypt Cancer Institute, Assiut University, Assiut 171516, Egypt. Email: ahmad23679@gmail.com 668904BJP 0 0 10.1177/2049463716668904British Journal of PainEl Sherif et al. research-article 2016 Original Article at EKB-Public-Access PARENT on October 25, 2016 bjp.sagepub.com Downloaded from