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The intrathecal analgesia group had significantly lower pain intensity (NRS) at 30 minutes, 12 hours and 24 hours after tracheal extubation (Table 2).
The failure rate of adequate postoperative analgesia at 12 hours and 24 hours following tracheal extubation (Proportion of patients with pain score of more than 3 on NRS) was significantly lower in the intrathecal analgesia group (Table 3).
However, the incidence of mild pruritus was significantly higher in the intrathecal analgesia group (Table 4).
Our study is novel as we compared the safety and efficacy of intrathecal analgesia with morphine and bupivacaine combined with relaxant general anaesthesia and controlled ventilation, without use of anaesthesia workstation, anaesthetic gases and inhalation agents as opposed to a traditional anaesthetic protocol for major abdominal surgery.
Intrathecal analgesia with morphine-bupivacaine combined with relaxant general anaesthesia and intravenous midazolam in a simulated resource poor setting (without anaesthesia workstation, nitrous oxide and volatile agent) is safe for a wide range of major abdominal surgery.
Intrathecal analgesia may be an ideal pain management option in situations where epidural anesthesia is not available.
Major complications are rare with intrathecal analgesia. Spinal headache occurs in 1% to 5% of patients, varying with operator technique and equipment used.[4,6,8] treatment options include a blood patch, or conservative management with bed rest, fluids, analgesics, and caffeine.
Urinary retention can also occur after intrathecal analgesia, and should be treated with intermittent catheterization as needed.
Intrathecal analgesia is very effective for this type of pain.