Combined Spinal–General Anaesthesia with Low-Dose Intrathecal Morphine and Atropine for Abdominal Laparoscopy: A Randomised Controlled Trial of Postoperative Nausea, Vomiting and Pain

Postoperative nausea and vomiting (PONV) and pain remain significant concerns following abdominal laparoscopic surgery. This study compared combined spinal–general anesthesia (CSGA) incorporating low-dose intrathecal morphine and atropine with general anesthesia (GA) alone. A single-center, open-label, randomized controlled trial was conducted in Jakarta, Indonesia, from February to March 2026. Adults undergoing elective abdominal laparoscopic surgery received either CSGA with intrathecal bupivacaine (10 mg), morphine (100 ?g), and atropine (100 ?g) or GA alone. Both groups received prophylactic ondansetron and multimodal analgesia. Sixty patients were included in the per-protocol analysis, comprising 33 in the CSGA group and 27 in the GA group. The primary outcome was the incidence of PONV within 24 hours postoperatively, while secondary outcomes included pain scores, rescue medication requirements, fentanyl consumption, and hemodynamic parameters. PONV occurred in 6.1% of CSGA patients compared with 74.1% of GA patients (P < 0.001), corresponding to an absolute risk reduction of 68.0 percentage points. The CSGA group demonstrated lower pain scores at 6–24 hours, reduced postinduction fentanyl consumption, and decreased requirements for rescue ondansetron. No patients in the CSGA group required rescue morphine, compared with 59.3% in the GA group. Three CSGA patients required vasopressor support. These benefits may have been partially associated with reduced opioid exposure, although a mediating effect was not established. CSGA was associated with improved postoperative symptom control under the study conditions; however, the independent contribution of intrathecal atropine remains uncertain. Larger, blinded, multicenter randomized controlled trials are warranted to confirm efficacy and evaluate safety, particularly potential neurological complications associated with intrathecal atropine administration.