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Background and Aims Postoperative pain management in minimally invasive nephrectomy remains a critical aspect of patient care. This study explores the potential of low dose intrathecal preservative free morphine as a promising analgesic modality for enhancing postoperative pain control while minimizing systemic opioid requirements and associated side effects, thereby improving patient outcomes.

Methods Patients scheduled for elective laparoscopic or robotic-assisted nephrectomy were included in this single-center, double-blind, prospective randomized placebo-controlled trial. Preoperatively patients were randomly assigned using computer generated block randomisation sequence to receive intrathecal morphine 200 mcg with 1 ml 0.5% Bupivacaine hydrochloride in dextrose injection (Group-M) or a sham procedure (Group-C). All patients received standard intraoperative multimodal analgesia and postoperative patient-controlled analgesia with intravenous morphine. Primary outcome was 24-hour intravenous morphine consumption. Secondary outcomes were intraoperative and 48-hour postoperative fentanyl requirement, static pain scores, dynamic pain on first ambulation and on coughing, postoperative complications, postoperative length of hospital stay and patient satisfaction score. P-value < 0.05 was considered as significant.

Results A total of sixty-two patients were recruited. The intravenous morphine consumption 24 hours after surgery was significantly lower in Group-M (16.5 ± 12.3 mg) versus Group-C (27.2 ± 12.1 mg), p=0.001. There were significant differences in static pain scores up to first 12 hours and dynamic pain on first ambulation and coughing. Intraoperative and 48-hour postoperative rescue fentanyl requirements were significantly lower in Group-M, p<0.05 (table 1).

Conclusions Intrathecal morphine significantly reduces postoperative morphine requirement and postoperative pain scores.