Optimal analgesia after laparoscopic segmental colon resections with a focus on intrathecal morphine

BACKGROUND Analgesia after laparoscopic segmental colon resections remains controversial. Epidural analgesia and systemic opioids per patient-controlled analgesia (PCA) are commonly used methods of analgesia in The Netherlands. A promising method of analgesia is intrathecal morphine because its analgesic properties fit the pain after laparoscopic surgery. METHODS and RESULTS Recently, a Dutch randomized controlled trial showed an enhanced recovery with intrathecal morphine when compared to an intravenous loading dose and a PCA pump of piritramide. Furthermore, the patients reported lower pain scores in the intrathecal morphine group. Still, the side effects warrant prophylactic measures for pruritus, nausea and vomiting. Late respiratory depression does not occur when a low dose (< 500 pg) is used and no concomitant sedatives are administered. If one adopts this analgesic technique, one should be cautious of the administered concentration since dilution could lead to dosing errors.