• Diego Beltrutti, David Niv, Ron Ben-Abraham, Salvatore Di Santo, and Avi A Weinbroum.
• Department of Anesthesia, S. Spirito Hospital, Alba-Bra, Italy.
• J Clin Anesth. 2002 Sep 1;14(6):441-6.

Study ObjectiveTo evaluate the perioperative antinociceptive effect of intrathecal morphine (a pure mu agonist), intravenous (IV) buprenorphine (a partial mu agonist) or their combination.DesignRandomized, double-blind, placebo-controlled study.SettingsAnesthesiology department of a university-affiliated public hospital.Patients45 ASA physical status I, II, and III patients undergoing hysterectomy with general anesthesia.InterventionsPreoperative and postoperative regimens consisted of intrathecal morphine 4.3 microg.kg(-1) plus IV 0.9% saline (Group 1), IV buprenorphine 1.3 microg.kg(-1) plus intrathecal saline (Group 2), and intrathecal morphine 4.3 microg.kg(-1) plus IV buprenorphine 1.3 microg.kg(-1) (Group 3; postoperative supplements consisting of IV buprenorphine 1.3 microg.kg(-1) plus intrathecal saline).Measurements And Main ResultsGroup 2 and 3 patients were given three analgesic dosings compared with two dosings in Group 1 (p < 0.001). The duration of action in Group 2 was significantly shorter (p = 0.001) than in the other two groups. The 12-hour postoperative pain intensity and sedation in Group 3 was significantly lower (p < 0.05) than in the other groups. Side effects (mainly pruritus and nausea and vomiting) were significantly fewer (p < 0.05) in Groups 2 and 3 (26% and 28%, respectively) than in Group 1 (46%).ConclusionsThe concomitant administration of intrathecal morphine and IV buprenorphine alleviates pain sensation and minimizes sedation more effectively than when given after the administration of either drug separately. In addition, IV buprenorphine affords a reduction in side effects.

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