Analgesic effect of low‐dose intrathecal morphine and bupivacaine in laparoscopic cholecystectomy

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Abstract
We assessed the peri‐operative analgesic efficiency of low‐dose intrathecal morphine combined with a low dose of bupivacaine after elective laparoscopic cholecystectomy since postoperative pain in such procedures, although less than after a conventional open technique, may be significant, particularly during the first 12–24 h. After informed consent, 34 ASA I or II patients were randomly allocated to one of two groups to receive either a lumbar intrathecal injection of morphine (75 or 100 μg) combined with 5 mg of isobaric bupivacaine (spinal group) or a subcutaneous injection of a saline solution (control group). Intra‐operatively, opioid requirements, blood pressure response and heart rate changes after insufflation were recorded. Postoperatively, morphine requirements, pain scores and opioid‐related side‐effects were assessed by a physician blinded to the randomisation. Intra‐operative opioid requirements did not differ significantly between groups. Mean (SD) postoperative morphine requirements were significantly lower in the spinal group [13 (10) vs. 23 (10) mg; p = 0.04] as were postoperative pain scores (p < 0.001). Side‐effects were of comparable incidence and severity between groups. Low‐dose intrathecal morphine combined with low‐dose bupivacaine provided effective postoperative analgesia for elective laparoscopic cholecystectomy.