JCNRJournal of Clinical and Nursing Research2208-36852208-3693Bio-Byword Scientific Publishing Pty. Ltd.10.26689/jcnr.v10i4.14865ArticleResearch Progress of Intrathecal Morphine in Postoperative Analgesiahttps://artdesignp.com/journal/JCNR/10/4/10.26689/jcnr.v10i4.14865WangXiaohui,WangZhongyu20261042026-04-30Postoperative pain is a common complication in the perioperative period of surgery. It not only reduces patients’ quality of life, but also easily induces adverse events such as pulmonary infection and deep vein thrombosis, hindering the clinical implementation of the concept of enhanced recovery after surgery. As a hydrophilic opioid, intrathecal morphine (ITM) has the advantages of long residence time in cerebrospinal fluid and high analgesic potency, which can achieve long‑term analgesia for 24–48 hours, especially with a significant effect on visceral pain control. It has become a core component of the multimodal analgesia system. This paper systematically reviews the development status, pharmacological basis and core advantages of ITM in postoperative analgesia, focuses on its clinical application optimization strategies and targeted application schemes in different types of surgery, analyzes the shortcomings of current research, and prospects future research directions, so as to provide accurate and comprehensive practice guidance for clinicians.

Chinese Society of Anesthesiology, 2025, Clinical Practice Guidelines for Adult Postoperative Pain Management (2024 Edition). Chinese Journal of Anesthesiology, 45(9): 1045–1079.

Patel K, Shergill S, Vadivelu N, et al., 2022, Analgesia for Gynecologic Oncologic Surgeries: A Narrative Review. Current Pain and Headache Reports, 26(1): 1–13.

Wang J, Nauss L, Thomas J, 1979, Pain Relief by Intrathecally Applied Morphine in Man. Anesthesiology, 50(2): 149–151.

Dost B, Kaya C, 2025, Intrathecal Morphine for Postoperative Analgesia: Balance of Efficacy and Safety. Journal of Perianesthesia Nursing, 40(1): 234–235.

Gibson A, Cooper N, Albrecht E, et al., 2025, Intrathecal Morphine Versus Other Techniques for Postoperative Pain Management in the Context of Multimodal Analgesia: A Meta-Analysis. Pharmaceuticals, 18(4): 512.

Pitre L, Garbee D, Tipton J, et al., 2020, Effect of Intrathecal Morphine Plus Patient-Controlled Analgesia with Morphine Versus Patient-Controlled Analgesia With Morphine Alone on Total Morphine Dose 24 Hours Post-Surgery: A Systematic Review. JBI Evidence Synthesis, 18(8): 1611–1640.

Pirie K, Traer E, Finniss D, et al., 2022, Current Approaches to Acute Postoperative Pain Management After Major Abdominal Surgery: A Narrative Review and Future Directions. British Journal of Anaesthesia, 129(3): 378–393.

Gan T, Belani K, Bergese S, et al., 2020, Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesthesia & Analgesia, 131(2): 411–448.

Desjardins P, Menassa M, Desbiens F, et al., 2023, Effect of Single-Shot Intrathecal Morphine Versus Continuous Epidural Analgesia on Length of Stay After Gastrectomy for Cancer: A Retrospective Cohort Study. Gastric Cancer, 26(4): 648–652.

Koning M, Teunissen A, Van Der Harst E, et al., 2018, Intrathecal Morphine for Laparoscopic Segmental Colonic Resection as Part of an Enhanced Recovery Protocol: A Randomized Controlled Trial. Regional Anesthesia and Pain Medicine, 43(2): 166–173.

Pathonsamit C, Onklin I, Hongku N, et al., 2021, Randomized Double-Blind Controlled Trial Comparing 0.2 mg, 0.1 mg, and No Intrathecal Morphine Combined with Periarticular Injection for Unilateral Total Knee Arthroplasty. Arthroplasty Today, 7: 253–259.

Teunissen A, Van Gastel L, Stolker R, et al., 2025, The Use of Intrathecal Morphine in Non-Abdominal Surgery: A Scoping Review. BJA Open, 14: 100387.

Albrecht E, Bayon V, Hirotsu C, et al., 2020, Intrathecal Morphine and Sleep Apnoea Severity in Patients Undergoing Hip Arthroplasty: A Randomised, Controlled, Triple-Blinded Trial. British Journal of Anaesthesia, 125(5): 811–817.

Ratnasekara V, Weinberg L, Johnston S, et al., 2023, Multimodal Intrathecal Analgesia with Morphine for Reducing Postoperative Opioid Use and Acute Pain Following Hepato-Pancreato-Biliary Surgery: A Multicenter Retrospective Study. PLoS ONE, 18(9): e0291108.

Huang W, Sun L, Zhang J, et al., 2024, Effects of Intercostal Nerve Block Plus Intrathecal Morphine Injection on Patients Undergoing Video-Assisted Thoracoscopic Surgery. Chinese and Foreign Medical Research, 22(13): 5–9.

Yorukoglu D, Ates Y, Temiz H, et al., 2005, Comparison of Low-Dose Intrathecal and Epidural Morphine and Bupivacaine Infiltration for Postoperative Pain Control After Surgery for Lumbar Disc Disease. Journal of Neurosurgical Anesthesiology, 17(3): 129–133.

Ganesh A, Kim A, Casale P, et al., 2007, Low-Dose Intrathecal Morphine for Postoperative Analgesia in Children. Anesthesia & Analgesia, 104(2): 271–276.

Bai J, Singh M, Short A, et al., 2020, Intrathecal Morphine and Pulmonary Complications After Arthroplasty in Patients with Obstructive Sleep Apnea. Anesthesiology, 132(4): 702–712.

Engelman E, Marsala C, 2013, Efficacy of Adding Clonidine to Intrathecal Morphine in Acute Postoperative Pain: Meta-Analysis. British Journal of Anaesthesia, 110(1): 21–27.

Gonvers E, El-Boghdadly K, Grape S, et al., 2021, Efficacy and Safety of Intrathecal Morphine for Analgesia After Lower Joint Arthroplasty: A Systematic Review and Meta-Analysis with Meta-Regression and Trial Sequential Analysis. Anaesthesia, 76(12): 1648–1658.

Kamal S, Mohamed S, Fares K, et al., 2022, Immunosuppressive Effect of Intrathecal Morphine, Dexmedetomidine, or Both in Combination with Bupivacaine on Patients Undergoing Major Abdominal Cancer Surgery. Pain Physician, 25: 555–567.

Ibach B, Loeber C, Shukry M, et al., 2015, Duration of Intrathecal Morphine Effect in Children with Idiopathic Scoliosis Undergoing Posterior Spinal Fusion. Journal of Opioid Management, 11(4): 295–303.

Koning M, Reussien E, Vermeulen B, et al., 2022, Serious Adverse Events After a Single Shot of Intrathecal Morphine: A Case Series and Systematic Review. Pain Research and Management, 2022: 4567192.

Renard Y, El-Boghdadly K, Rossel J, et al., 2024, Non-Pulmonary Complications of Intrathecal Morphine Administration: A Systematic Review and Meta-Analysis with Meta-Regression. British Journal of Anaesthesia, 133(4): 823–838.

Nguyen E, Lim G, Ross S, 2021, Mechanistic Insights into Spinal Neurones Involved in Neuraxial Opioid-Induced Pruritus. British Journal of Anaesthesia, 126(4): e179–e181.

Grape S, El-Boghdadly K, Albrecht E, 2023, Management of Adverse Effects of Intrathecal Opioids in Acute Pain. Best Practice & Research Clinical Anaesthesiology, 37: 199–207.

American Society of Anesthesiologists Task Force on Neuraxial Opioids, American Society of Regional Anesthesia and Pain Medicine, 2016, Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuraxial Opioid Administration. Anesthesiology, 124(3): 535–552.

Chinese Society of Anesthesiology, 2017, Expert Consensus on the Prevention and Treatment of Complications of Neuraxial Block (2017 Edition). Chinese Journal of Anesthesiology, 37.

Kang R, Bang Y, Ko J, et al., 2025, Transversus Abdominis Plane Block Enhances Analgesia and Reduces Opioid Use After Laparoscopic Donor Hepatectomy with Intrathecal Morphine: A Randomized Controlled Trial. Regional Anesthesia and Pain Medicine, 0: 1–7.

Zheng L, Lu Y, Lu X, et al., 2026, Intrathecal Morphine for Enhanced Recovery After Laparoscopic Colorectal Surgery: A Randomized Clinical Trial. JAMA Surgery, 161(2): 124–131.

Saini R, Sindwani G, Garg N, et al., 2025, Unveiling the Superior Analgesic: Thoracic Epidural Versus Intrathecal Morphine in Open Live Donor Hepatectomy—A Randomized Controlled Trial. Journal of Anaesthesiology Clinical Pharmacology, 41: 441–447.

Yang Y, Lin W, Zhuo Y, et al., 2024, Intrathecal Morphine and Ropivacaine for Quality of Recovery After Laparoscopic Colorectal Surgery: A Randomized Controlled Trial. Drug Design, Development and Therapy, 18: 6133–6143.

Vijitpavan A, Kittikunakorn N, Komonhirun R, 2022, Comparison Between Intrathecal Morphine and Intravenous Patient-Controlled Analgesia for Pain Control After Video-Assisted Thoracoscopic Surgery: A Pilot Randomized Controlled Study. PLoS ONE, 17(4): e0266324.

Ciconini L, Ramos W, Fonseca A, et al., 2024, Intrathecal Morphine for Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Annals of Cardiac Anaesthesia, 27: 3–9.

Guo M, Tang S, Wang Y, et al., 2023, Comparison of Intrathecal Low-Dose Bupivacaine and Morphine with Intravenous Patient-Controlled Analgesia for Postoperative Analgesia for Video-Assisted Thoracoscopic Surgery. BMC Anesthesiology, 23: 395.

Tiriolo I, Collange V, Doisy V, et al., 2026, Intrathecal Morphine Versus Paravertebral Block for Minimally Invasive Cardiac Surgery: A Single-Centre Retrospective Cohort Study. British Journal of Anaesthesia, 136(3): 1083–1086.

Okbaz V, Turktan M, Gulec E, et al., 2025, Comparison of Two Different Intrathecal Morphine Doses for Postoperative Analgesia After Video-Assisted Thoracoscopic Surgery. Journal of Anaesthesiology Clinical Pharmacology, 41: 219–225.

Nan X, Li S, Jia D, et al., 2022, Clinical Observation of Intrathecal Morphine Combined with Continuous Femoral Nerve Block for Early Rehabilitation Analgesia After Total Knee Arthroplasty. Chinese Journal of Pain Medicine, 28(3): 215–219.

Lei Y, Feng Z, Wang Z, et al., 2025, Intrathecal Morphine Analgesia for Full Endoscopic Lumbar Discectomy: A Prospective Dose-Finding Study. European Spine Journal, 34(10): 4428–4436.

Qi B, Yu J, Qiao W, 2020, Comparison of Intrathecal Morphine Versus Local Infiltration Analgesia for Pain Control in Total Knee and Hip Arthroplasty: A Meta-Analysis. Medicine, 99(36): e21971.

Yue L, Zhang F, Mu G, et al., 2023, Effectiveness and Safety of Intrathecal Morphine for Percutaneous Endoscopic Lumbar Discectomy Under Low-Dose Ropivacaine: A Prospective, Randomized, Double-Blind Clinical Trial. The Spine Journal.

Moisa R, Negrut N, Botea M, et al., 2025, Optimizing Intrathecal Opioid Strategies for Cesarean Section: A Comprehensive Narrative Review of Pharmacology, Clinical Outcomes, and Safety. Cureus, 17(4): e83109.

Dost B, Kandemir H, Tabur K, et al., 2025, Intrathecal Morphine Versus Ultrasound-Guided Bilateral Posterior Quadratus Lumborum Block in Caesarean Delivery. Journal of Anesthesia, Analgesia and Critical Care, 5(1): 14.

Kjolhede P, Bergdahl O, Borendal Wodlin N, et al., 2019, Effect of Intrathecal Morphine and Epidural Analgesia on Postoperative Recovery After Abdominal Surgery for Gynecologic Malignancy: An Open-Label Randomised Trial. BMJ Open, 9(3): e024484.

Bang Y, Lee E, Kim C, et al., 2023, Effect of Intrathecal Morphine on Postoperative Opioid Consumption in Patients Undergoing Abdominal Surgery for Gynecologic Malignancy: A Randomized Sham-Controlled Trial. Anesthesia & Analgesia, 137(3): 525–533.

Feltz K, Hanson N, Jacobson N, et al., 2022, Intrathecal Morphine Use in Adolescent Idiopathic Scoliosis Surgery Is Associated With Decreased Opioid Use and Decreased Length of Stay. Iowa Orthopaedic Journal, 42: 53–56.

Keskin G, Akin M, Senayli Y, et al., 2021, Effects of 5 μg/kg Intrathecal Morphine for Postoperative Analgesia in Pediatric Patients Undergoing Major Surgery. Anaesthesist, 70(10): 743–752.

Kurzova A, Malek J, Klezl P, et al., 2024, A Single Dose of Intrathecal Morphine Without Local Anesthetic Provides Long-Lasting Postoperative Analgesia After Radical Prostatectomy and Nephrectomy. Journal of Perianesthesia Nursing, 39(3): 577–582.

Mittal S, Bhardwaj M, Shekhrajka P, et al., 2024, Comparison of Intrathecal Morphine Versus Erector Spinae Block for Postoperative Analgesia in Patients with End-Stage Kidney Disease Undergoing Kidney Transplantation: A Randomised Clinical Study. Indian Journal of Anaesthesia, 68(7): 644–650.