• Preben Kjølhede, Olga Bergdahl, Borendal WodlinNinnieNChildren and Women's Health, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden., and Lena Nilsson.
• Children and Women's Health, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
• BMJ Open. 2019 Mar 4; 9 (3): e024484.

ObjectivesWe aimed to determine whether regional analgesia with intrathecal morphine (ITM) in an enhanced recovery programme (enhanced recovery after surgery [ERAS]) gives a shorter hospital stay with good pain relief and equal health-related quality of life (QoL) to epidural analgesia (EDA) in women after midline laparotomy for proven or assumed gynaecological malignancies.DesignAn open-label, randomised, single-centre study.SettingA tertiary referral Swedish university hospital.ParticipantsEighty women, 18-70 years of age, American Society of Anesthesiologists I and II, admitted consecutively to the department of Obstetrics and Gynaecology.InterventionsThe women were allocated (1:1) to either the standard analgesic method at the clinic (EDA) or the experimental treatment (ITM). An ERAS protocol with standardised perioperative routines and standardised general anaesthesia were applied. The EDA or ITM started immediately preoperatively. The ITM group received morphine, clonidine and bupivacaine intrathecally; the EDA group had an epidural infusion of bupivacaine, adrenalin and fentanyl.Primary And Secondary Outcome MeasuresPrimary endpoint was length of hospital stay (LOS). Secondary endpoints were QoL and pain assessments.ResultsLOS was statistically significantly shorter for the ITM group compared with the EDA group (median [IQR]3.3 [1.5-56.3] vs 4.3 [2.2-43.2] days; p=0.01). No differences were observed in pain assessment or QoL. The ITM group used postoperatively the first week significantly less opioids than the EDA group (median (IQR) 20 mg (14-35 mg) vs 81 mg (67-101 mg); p<0.0001). No serious adverse events were attributed to ITM or EDA.ConclusionsCompared with EDA, ITM is simpler to administer and manage, is associated with shorter hospital stay and reduces opioid consumption postoperatively with an equally good QoL. ITM is effective as postoperative analgesia in gynaecological cancer surgery.Trial Registration NumberNCT02026687; Results.© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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