Overview
VATS/RATS is widely used for diagnosis and treatment of intrathoracic conditions. Despite many benefits, postoperative pain continues to be intense after VATS/RATS. The optimal strategy for pain management has not been defined. In this randomized, placebo-controlled, double-blinded clinical investigation, investigators hypothesize that 5 mcg/kg intrathecal morphine will decrease postoperative analgesic consumption and reduce pain.
Description
This is a randomized, placebo-controlled, double-blinded clinical trial. Patients will be randomized into one of two groups. Group A (Placebo, control group) will receive intrathecal sterile normal saline and Group B (Morphine group) will receive 5mcg/kg preservative free intrathecal morphine.
American Pain Society Outcome Questionnaire (APS-POQ) will be administered to patients prior to discharge (see data sheet).
Patients will be followed up with a phone survey at 1 and 3 months after surgery to assess the presence, nature, and severity of chronic persistent surgical pain. The Brief Pain Inventory is a reliable and valid measures of the interference of pain with physical functioning and will be used. Additionally patients will be asked about use of pain medications
Eligibility
Inclusion Criteria:
- Age 18-80 years old
- Undergoing elective video-assisted thoracoscopic or robotic assisted surgery for anatomical lung resection
- General anesthesia with anticipated intraoperative extubation.
Exclusion Criteria:
- American Society of Anesthesiologists (ASA) classification of 4 or 5
- Anticipated postoperative intubation
- Significant liver disease
- Preoperative use of intravenous inotropes and/or vasopressor support
- Preoperative mechanical ventilation
- Preoperative use of mechanical circulatory support device (intraaortic balloon pump, ventricular assist device, extracorporeal membrane oxygenation)
- Severe pulmonary disease (home oxygen requirement and/or current oral steroid use)
- Morphine allergy
- Opioid or alcohol abuse
- Chronic pain
- Renal failure
- Inability to comprehend English language
- Bleeding disorder
- Abnormal preoperative coagulation
- Infection
- Patient refusal
- Failed spinal
