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212 Impact of intrathecal diamorphine in enhanced recovery for colorectal surgery; open and laparoscopic
  1. J Luyt,
  2. D Wagstaff and
  3. WL Yap
  1. Countess of Chester Hospital, Chester, UK


Background and Aims There is currently a paucity of evidence in the utility of intrathecal diamorphine for resectional bowel surgery. We audited our departmental practice for perioperative analgesia in the provisions of anaesthesia services for bowel resections.

We looked at the use of a neuraxial block with intrathecal diamorphine, to determine if it has a positive impact on enhanced recovery. Specifically; post-operative opiate requirements, eating and drinking, and mobilising within 24 hours after surgery.

Methods A cohort of randomised patients were selected as per Perioperative Quality Improvement Project (PQIP) data collection protocol from June 2018 to June 2019, 48 patients were eligible. Data was collected from anaesthetic charts, electronic prescribing, and PQIP database. Criteria for data collection included intra- and post-operative analgesia; drinking, eating and mobilising within the first 24 hours of surgery.

Results 77% (n=37) of patients received intrathecal diamorphine perioperatively.

Patient controlled analgesia (PCA) morphine consumption is higher on average, 44 mg: 22 mg, in non-spinal patients.

Conclusions We demonstrated that intrathecal diamorphine reduced post-operative opiate requirements and facilitated earlier mobilisation.

We concluded that the use of intrathecal diamorphine in combination with multimodal analgesia in colorectal surgery is safe and is comparable, if not marginally superior, to PCA in our institution.

We have also shown that despite a wide range of intrathecal diamorphine dosage (0.5–1 mg), there were no post-operative complications which is in keeping with anecdotal experience. Therefore, we feel that intrathecal diamorphine for perioperative analgesia for resectional bowel surgery is a safe and viable technique.

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