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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright (c) 2026 Ting Suang Kuang, Angelina Swee Ching Chong, Wan Nabilah Nik Nabil, Nik Mohamed Kamel Amiruddin, Azrin Mohd Azidin
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Abstract
Breast reduction surgery is associated with significant postoperative pain, commonly managed with intravenous opioids, which can cause adverse effects such as nausea, vomiting, sedation, ileus, and respiratory depression. This case series evaluates postoperative pain outcomes within an Enhanced Recovery After Surgery (ERAS) protocol incorporating morphine as an adjuvant in intertransverse process blocks. This retrospective case series included four patients who underwent bilateral breast reduction surgery at a tertiary hospital and received preoperative bilateral intertransverse process blocks with 0.375% ropivacaine and 2 mg morphine each side, intraoperative multimodal analgesia (ketamine, dexamethasone, magnesium sulphate, paracetamol, fentanyl), and a protocolized postoperative pain management strategy. Pain scores, opioid consumption, complications, and hospital length of stay were analysed. All patients reported low postoperative pain scores (numerical rating scale 0–4). None required additional intravenous patient-controlled analgesia or rescue opioids at any time during hospital stay beyond the scheduled regimen. All patients were discharged within five days postoperatively. No opioid-related side effects were reported. Morphine as an adjuvant to intertransverse process blocks within the framework of a multimodal ERAS analgesia protocol may be associated with improved postoperative pain outcomes following breast reduction surgery.
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