Intrathecal Morphine and Ropivacaine for Quality of Recovery After Laparoscopic Colorectal Surgery: A Randomized Controlled Trial

Ying Yang,1,&ast; Wenjun Lin,1,&ast; Yifen Zhuo,2,&ast; Yuxin Luo,1 Xiaoyan Wu,1 Junyu Li,1 Yusheng Yao1 1Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, Fujian, People’s Republic of China; 2Department of Anesthesiology, Xiamen Haicang Hospital, Xiamen, Fujian, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Junyu Li; Yusheng Yao, Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, 134 Dongjie Street, Fuzhou, Fujian, 350001, People’s Republic of China, Email [email protected]; [email protected]: Intrathecal morphine is increasingly used for pain management in laparoscopic colorectal surgery. While ropivacaine shows advantages of reduced cardiotoxicity and faster motor recovery compared to bupivacaine, the impact of intrathecal morphine-ropivacaine combination on postoperative recovery quality remains unclear. This study aimed to evaluate this combination’s effect on recovery outcomes after laparoscopic colorectal surgery.Patients and Methods: In this randomized, double-blind, placebo-controlled trial, 78 patients undergoing laparoscopic colorectal surgery received either preservative-free intrathecal morphine 250 μg with ropivacaine 15 mg (Intrathecal group) or a sham subcutaneous saline injection (Control group). The primary outcome was the Quality of Recovery-15 (QoR-15) score 24 hours after surgery. Secondary outcomes included pain scores, opioid consumption, and adverse effects.Results: The intrathecal group showed significantly higher QoR-15 scores 24 hours postoperatively compared to the control group (median [IQR]: 121 [109− 128] vs 111 [102− 116], p < 0.001), with improvements in pain management (p < 0.001), physical comfort (p = 0.001), and physical independence (p = 0.002). The intrathecal group had lower pain scores at rest (area under the curve 0– 48 h: 66 [59– 90] vs 107 [89– 126], p < 0.001) and during coughing (152 [137– 172] vs 191 [166– 213], p < 0.001), particularly from 0.5 to 24 hours. They also required less postoperative morphine (0– 48 h: 10 [6– 20] vs 26 [22– 36] mg, p < 0.001). While hypotension (43.6% vs 17.9%, p = 0.014) and pruritus (35.9% vs 2.6%, p < 0.001) were more frequent in the intrathecal group, but no respiratory depression occurred in either group.Conclusion: Intrathecal morphine-ropivacaine administration improves 24-hour postoperative recovery quality and provides superior pain relief after laparoscopic colorectal surgery, despite increased but manageable side effects. Further research should focus on dose optimization and comparative studies of different intrathecal local anesthetic combinations.Trial Registration: The Chinese Clinical Trial Registry, ChiCTR2100052337. Keywords: intrathecal morphine, ropivacaine, pain management, quality of recovery, laparoscopic colorectal surgery