{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T16:40:19Z","timestamp":1792341619590,"version":"4.4.0"},"reference-count":23,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100001136","name":"Australian and New Zealand College of Anaesthetists","doi-asserted-by":"publisher","award":["Pilot Grant"],"award-info":[{"award-number":["Pilot Grant"]}],"id":[{"id":"10.13039\/501100001136","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Anaesth Intensive Care"],"abstract":"<jats:p>\n                    Epidural analgesia using continuous local anaesthetic infusions has declined in popularity, while single-shot intrathecal hydrophilic opioids are increasingly utilised. However, intrathecal opioids have a finite duration of action, which may be insufficient to provide adequate analgesia following major open abdominal surgery. This two-centre randomised controlled trial aimed to determine the feasibility of a strategy combining a single preoperative intrathecal morphine (ITM) injection with postoperative epidural morphine boluses (intervention), compared to ITM alone (control), in terms of recruitment and protocol adherence. Feasibility criteria were met for both recruitment (68%) and protocol adherence (80%). However, the scalability of this study is limited by its resource requirements. Marginal mean pain scores at rest and with movement (dynamic) were similar between groups at all timepoints. Total opioid consumption was comparable between groups, except on postoperative day 1, when consumption was lower in the intervention group (20\u2009mg (IQR 4\u201336; range 0\u2013220)) compared with the control group (48\u2009mg (IQR 6\u201394; range 0\u2013212);\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    =0.04). The number of pruritus events was similar across groups (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u200946), although a greater proportion of patients in the epidural group required treatment with naloxone (14 vs. 5). One patient in the control group received naloxone for sedation; no patients required naloxone for respiratory depression. Further research is required to improve postoperative analgesia and enhance quality of recovery following major abdominal surgery.\n                  <\/jats:p>","DOI":"10.1177\/0310057x261489312","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:11:50Z","timestamp":1792041110000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Combined intrathecal and epidural morphine for major abdominal surgery: A two-centre feasibility randomised controlled trial"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8860-898X","authenticated-orcid":false,"given":"Katrina P","family":"Pirie","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, VIC, Australia"},{"name":"Department of Anaesthesiology and Perioperative Medicine, School of Translational Medicine, Monash University, Melbourne, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4899-641X","authenticated-orcid":false,"given":"Emily A","family":"Traer","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7638-5910","authenticated-orcid":false,"given":"Noam B","family":"Winter","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, VIC, Australia"},{"name":"Department of Anaesthesiology and Perioperative Medicine, School of Translational Medicine, Monash University, Melbourne, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0137-2688","authenticated-orcid":false,"given":"Wendy A","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, VIC, Australia"},{"name":"Department of Anaesthesiology and Perioperative Medicine, School of Translational Medicine, Monash University, Melbourne, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2577-3918","authenticated-orcid":false,"given":"Bernhard","family":"Riedel","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia"},{"name":"Department of Critical Care, and The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3324-5456","authenticated-orcid":false,"given":"Paul S","family":"Myles","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, VIC, Australia"},{"name":"Department of Anaesthesiology and Perioperative Medicine, School of Translational Medicine, Monash University, Melbourne, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)08266-1"},{"issue":"5","key":"e_1_3_3_3_2","first-page":"541","article-title":"Effect of analgesic modality on outcome following open liver surgery: a systematic review of postoperative analgesia","volume":"81","author":"Hughes M","year":"2015","unstructured":"Hughes M, McNally S, McKeown DW, et al. Effect of analgesic modality on outcome following open liver surgery: a systematic review of postoperative analgesia. Minerva Anestesiol 2015; 81(5): 541\u2013556.","journal-title":"Minerva Anestesiol"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/aas.12375"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000237"},{"issue":"1","key":"e_1_3_3_6_2","article-title":"Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery","volume":"2016","author":"Guay J","year":"2016","unstructured":"Guay J, Kopp S. Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. 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Cochrane Database Syst Rev 2018; 8(8): CD010434.","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X20937315"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/anae.16606"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2020.05.061"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2024.05.045"},{"issue":"2","key":"e_1_3_3_12_2","first-page":"298","article-title":"Preoperative analgesia with epidural morphine","volume":"79","author":"Negre I","year":"1994","unstructured":"Negre I, Gueneron JP, Jamali SJ, et al. Preoperative analgesia with epidural morphine. 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