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Background and Aims Thoracic epidural analgesia (TEA) has traditionally been used for pain management after open liver resection (OLR). Despite its proven analgesic efficacy, TEA may not have the optimal safety profile. Limitations include the risk of epidural hematoma and unplanned delays in postoperative removal of the epidural catheter due to coagulopathy. Intrathecal morphine (ITM) in a multimodal analgesic scheme is an alternative to decrease postoperative pain intensity and opioid requirements. However, there is still no consensus regarding the most appropriate dose that provides effective analgesia while avoiding the risk of side effects. The aim of this work is to assess the analgesic efficacy and the presence of side effects of a low dose of ITM (150 mcg) in patients undergoing OLR. The patients informed consent for publication was obtained.

Methods We retrospectively evaluated 3 patients who underwent OLR and that received 150 mcg of ITM as part of a multimodal analgesic scheme.

Results Patients were evaluated by an anesthesiologist 24 hours after surgery and reported no pain at rest and slight to no pain at movement, with no need for rescue analgesia. No side effects were documented, namely respiratory depression, nausea, vomiting, urinary retention, or pruritus.

Conclusions Low dose of ITM could be an effective strategy to include in a multimodal analgesic scheme to control pain after OLT, with a low risk of respiratory depression. It could avoid the placement of an epidural catheter and the risks associated in case of postoperative coagulopathy.