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Background and Aims This case report highlights the successful treatment of excessive sweating related to Intrathecal (IT) morphine with atropine.

Methods A 23-year-old male patient, weighing 70 kg and measuring 172 cm, referral to our clinic for segmentectomy. Preoperative vital signs were normal. After obtaining consent from the patient, spinal analgesia was performed 350 mcg of IT morphine. Anesthesia induction was achieved with propofol, rocuronium bromide, and remifentanil. A double-lumen endotracheal tube was placed in the left main bronchus. Forced-air warming was used to prevent hypothermia. Video-assisted thoracoscopic surgery was performed on the left hemithorax, and the mass was excised. Sweating was observed on the patient‘s head and upper body starting from the second hour of the operation. No other intraoperative complications occurred. Three hours later, extubation was performed with suggamadex. Upon arrival in the recovery room, the body temperature was 33.2°C. The patient continued to experience excessive sweating. 0.5 mg of atropine was administered and miraculously, the sweating stopped within 1-2 minutes. With the normalization of vital signs and body temperature, the patient was transferred to the ward. As the patient remained asymptomatic during follow-ups, he was discharged on the second postoperative day.

Conclusions Rarely, excessive sweating accompanied by hypothermia can be observed after IT opioid injection. Among the active treatment options, naloxone and lorazepam are included. Atropine is suggested as an option. Acetylcholine is the main pre- and postganglionic neurotransmitter of the sympathetic nervous system that innervates sweat glands, thus the use of anticholinergic medication like atropine significantly reduces or eliminates sweating.