Intrathecal Morphine and Epidural Have Similar Outcomes in Radical Cystectomy

Intrathecal morphine (ITM) may be a viable alternative to epidural analgesia (EDA) in patients undergoing intracorporeal robot-assisted radical cystectomy (RARC), according to study findings published in BMC Anesthesiology.

Researchers at the Rijnstate hospital in The Netherlands identified 153 patients who underwent RARC with Bricker derivation between 2019 and 2021 for participation in this single-center, retrospective study, and evaluated them for outcomes on the basis of analgesic received.

The ITM cohort (n=39, 62% men, median age 71 years) received a single shot of intrathecal bupivacaine/morphine and the EDA cohort (n=114, 69% men, median age 70 years) received an epidural catheter with bupivacaine/sufentanil. In addition, 64% and 51% of the ITM and EDA groups were rated as American Society of Anesthesiology class II, 15% and 25% had previously undergone abdominal surgery, and 15% and 8% had preoperative opioid use, respectively.

To balance for cohort differences, the 39 patients who received ITM were matched with 39 of the EDA recipients.

In the matched cohorts, the 2 groups had similar surgery durations (median range, 280-299 min; P =.680), blood loss (median, 150 ml; P =.875), and use of other medications, except that more of the ITM cohort used non-steroidal anti-inflammatory drugs than the EDA group (77% vs 28%; P <.001).

Postoperative pain scores on a numeric rating scale were similar between the ITM and EDA cohorts on day 0 (median, 1 vs 0; P =.164), day 1 (median, 3 vs 2; P =.106), and day 3 (median, 3 vs 2; P =.575), respectively, but greater pain scores were reported by the ITM recipients on day 2 (median, 3 vs 2; P =.037).

Postoperative morphine equivalent consumption in the first 7 days was similar overall between the ITM (median, 11 mg) and EDA (median, 15 mg; P =.222) cohorts; however, the ITM group had greater opioid consumption on day 0 (P =.031) and day 1 (P =.011) and less consumption on day 4 (P =.040), day 6 (P =.007) and day 7 (P =.016).

The length of stay and time to fit for discharge was significantly shorter for the ITM group compared with the EDA cohort, and no significant group differences in postoperative outcomes or adverse events were observed.

The infection rates among the ITM and EDA cohorts were 13% and 23%, delirium rates were 5% and 5%, respectively. Of the ITM and EDA cohorts, 13% and 13% required transfusion, and 10% and 18% required parenteral nutrition, respectively.

Study limitations include it’s retrospective design and missing data. Moreover, there was a significant difference in the size of the 2 cohorts.

“[O]ur results show that both epidural analgesia and intrathecal morphine lead to adequate analgesia for patients who undergo RARC with Bricker derivation,” the authors noted. A prospective study may be performed to investigate if ITM may be preferred over epidural catheters, because of its less invasive and simpler technique,” they concluded.