Faculty Advisor(s)

Elisha Coppens

Document Type


Publication Date

Spring 2023


© 2023 the Author


Colorectal enhanced recovery after surgery (ERAS) guidelines for patients undergoing major abdominal surgeries have started to include intrathecal morphine (ITM) as part of the protocol to improve patient outcomes. There is interest amongst other abdominal surgical disciplines in expanding the use of ITM. When used as a single bolus, ITM has shown to have an intravenous (IV) opioid sparing effect postoperatively, as well as improved pain scores for up to 24 hours (Koning et al., 2020). However, ITM coincides with unique considerations and side effects. There is a dose-dependent concern of ITM causing respiratory depression postoperatively that necessitates additional monitoring which should be considered with patient selection and dose (Gustafsson et al., 2019). Another less detrimental, albeit more common side effect, is a 30-60% increase in pruritus as compared to use of IV opioids (Wang et al., 2021). The intent of this literature review is to discuss the impact of ITM on pain scores and narcotic use across major abdominal surgery specialties, as well as postoperative side effects such as respiratory depression, pruritis, nausea, length of stay, and their impact on patient satisfaction. The mechanism of action and pharmacodynamics of ITM and how it compares to that of IV opioids will be reviewed.


MSNA Capstone



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