Intrathecal morphine Plus TAPB Improves Early Recovery and Analgesia After Laparoscopic Colorectal Surgery: JAMA

A new study published in the Journal of American Medical Association showed that transversus abdominis plane block (TAPB) and intrathecal morphine (ITM) together greatly enhance early postoperative recovery and pain management in laparoscopic colorectal surgery.

Moderate to severe pain following laparoscopic colorectal surgery is a major obstacle to enhancing postoperative recovery quality, despite the benefits of minimally invasive surgical procedures. Thus, this study determined if intrathecal morphine in conjunction with transversus abdominis plane block enhances the quality of recovery following laparoscopic colorectal surgery.

The Sun Yat-sen University Cancer Center hosted this prospective, double-blind, randomized clinical study from October 15, 2024, until February 15, 2025. A 1:1 randomization was used to assign adults scheduled for elective laparoscopic colorectal surgery to either ITM or saline placebo. From March 1, 2025, to March 31, 2025, data were examined. As part of the normal enhanced recovery after surgery (ERAS) procedure, liposomal bupivacaine was administered to both groups for TAPB.

While the control group received intrathecal normal saline, the intervention group got ITM at a dose of 3 µg/kg. The Quality of Recovery 15 (QoR-15) score at 24 hours after surgery was the main outcome. Postoperative pain ratings, cumulative opioid intake (measured in morphine milligram equivalents [MME]), time to first flatus, time to first ambulation, frequency of side events, and duration of hospital stay were among the secondary outcomes.

The intention-to-treat analysis comprised 252 patients (mean [SD] age, 58.4 [11.1] years; 112 female patients [44.4%]). Better recovery quality was indicated by the intervention group's considerably higher mean (SE) QoR-15 scores at 24 hours after surgery (114.95 [1.04] vs. 102.22 [0.76]; mean difference, 12.21; 95% CI, 9.91-14.51; P <.001).

The intervention group's postoperative mean (SD) morphine consumption was lower than that of the control group (4.4 [6.4] MME vs. 10.4 [11.1] MME; mean difference, −6.59; 95% CI, −8.88 to −4.31; P<.001). Additionally, nausea was less common in the intervention group (23.8% vs. 37.3%; adjusted risk difference, −15.06%; 95% CI, −26.60% to −3.52%; P =.01), while pruritus was more common.

Overall, although there was a higher chance of pruritus, ITM and TAPB together greatly improved early postoperative recovery and analgesia in patients after laparoscopic colorectal surgery in this randomized clinical trial. After laparoscopic colorectal surgery, this tactic could be a useful part of multimodal analgesia regimes.

Source:

Zheng, L., Lu, Y., Lu, X., You, L., Yu, C., Lai, J., Xu, M., Xie, M., Xiao, Y., & Lai, R. (2025). Intrathecal morphine for enhanced recovery after laparoscopic colorectal surgery: A randomized clinical trial: A randomized clinical trial. JAMA Surgery. https://doi.org/10.1001/jamasurg.2025.5699