EFFECTIVE pain management is essential after open liver resection, helping patients recover faster and leave hospital sooner. While various methods are available, finding the safest and most effective approach remains challenging.
This new study compared intravenous pain relief alone with two additional strategies: adding either continuous wound infiltration or intrathecal morphine. Researchers found that patients who received intrathecal morphine experienced significantly lower pain scores and used half as much morphine during the first 24 hours after surgery compared with the other groups. Pain relief was particularly strong during the first 12 hours, both at rest and while moving. Although this benefit did not last beyond the first day, it marked a crucial period for early recovery.
Interestingly, continuous wound infiltration did not offer better pain control than intravenous analgesia alone. This finding contrasts with earlier studies, which may not have included baseline pain relief such as paracetamol or non-steroidal anti-inflammatory drugs. In this study, patients received paracetamol and nefopam, a strategy that may be safer than NSAIDs for patients at high risk of kidney injury, particularly those undergoing major liver surgery.
Despite some limitations, such as the lack of blinding and less frequent pain score recordings, the results clearly show that intrathecal morphine can enhance pain control in the early postoperative period. It reduced morphine use and provided better comfort when patients needed it most. Future studies could explore combining intrathecal morphine with additional agents, such as lidocaine or ketamine, to further improve recovery. For now, intrathecal morphine appears to be a valuable option for patients undergoing open liver surgery, especially when NSAID use is not recommended due to kidney risks. These findings support considering this method as part of enhanced recovery strategies in major liver resections.
Reference
Rousseleau D et al. Comparison of catheter wound infusion, intrathecal morphine, and intravenous analgesia for postoperative pain management in open liver resection: randomized clinical trial. BJS Open. 2025;9(4):zraf074.
