Published online Nov 27, 2014. doi: 10.5313/wja.v3.i3.191
Revised: March 31, 2014
Accepted: July 12, 2014
Published online: November 27, 2014
The practice of anesthesiology has always been governed by evidence-based medicine. The quick turnover rate of patients in the operating room and patient safety and satisfaction, have also further changed the way we practice anesthesia. The use of intrathecal (IT) opiates as an effective form of postoperative pain relief has been established for many years. Morphine was the first opioid used by IT route. In clinical practice, morphine is regarded as the gold standard, or benchmark, of analgesics used to relieve intense pain. Perhaps for this reason, IT morphine has been used for over 100 years for pain relief. IT morphine is one of the easiest, cost-effective and reliable techniques for postoperative analgesia and technical failures are rare. And yet there is no consensus amongst anesthesiologists regarding the dose of IT morphine. Like all other methods of pain relief, IT morphine also has some side effects and some of them are serious though not very common. This review article looks into some of the key aspects of the use of IT morphine for post-operative analgesia and various doses for different procedures are discussed. This article also describes the side effects of IT morphine and how to treat and prevent them.
Core tip: Intrathecal (IT) morphine for postoperative pain relief is being used for over 100 years but till today there are no clear guidelines or fixed dose regimes for its use. After an extensive review of the literature, we conclude that: (1) IT morphine is very useful yet cost-effective and reliable albeit with some risk of serious effects; (2) After IT morphine administration, mandatory monitoring for respiration, oxygenation and sedation should be done for the first 24 h; and (3) Further studies are required to determine the exact dose on the basis of body weight for IT administration of morphine.