*Purpose: Postoperative PAD (pain, agitation, delirium), especially delirium in living donor kidney transplantation (LDKT) recipients is a risk factor for increased morbidity, duration of hospital stay, and graft failure. The American College of Critical Care Medicine recommends in their guideline that management of postoperative pain is crucial prior to treatment of delirium, and accordingly, many previous studies have shown that effective pain control decreases the incidence of postoperative delirium and attenuates its severity. Intrathecal morphine is an effective and widely used method of pain control, and its effectiveness has been analyzed in previous studies. However, effects of preoperative intrathecal morphine on postoperative PAD have not been studied and are unknown thus far in LDKT recipients. The purpose of this retrospective study is to evaluate the effects of preoperative intrathecal morphine on postoperative PAD in LDKT recipients.

*Methods: In our hospital, living donor kidney transplantation recipients without contraindications received intrathecal morphine for the purpose of postoperative pain control. With IRB approval we compared the incidence of PAD between recipients without intrathecal morphine (control group) and with intrathecal morphine (ITM group) in recipients underwent LDKT (Jan. 2014 – Dec. 2018). Patients with missing data, those under 18 years of age, re-operation, and underlying neuropsychiatric disease were excluded. The primary outcome was the incidence of postoperative delirium as detected by CAM-ICU scores. Secondary outcomes were pain expressed as NRS, opioid consumption in milligrams in which various opioid dosages were converted into equivalent morphine dosage, antipsychotics/sedative consumption in frequency, and prolonged hospital/ICU stays in frequency. Chi-square, Mann-Whitney U test, and independent two-sample t tests were used for statistical analyses.

*Results: Finally 339 recipients were included with 166 in control group and 173 in ITM group. The incidence of delirium were 4.82% and 1.16% in control group and ITM group, respectively (p=0.046). There were significant differences in the pain and opioid consumption at POD0 and 1 between two groups. However, there were no significant differences in terms of the agitation level, consumption of antipsychotics/sedative. Also, the lengths of hospital/ICU stay were comparable in the two groups.

*Conclusions: Preoperative intrathecal morphine in LDKT recipients reduced postoperative pain and delirium. Further study is warranted to investigate other risk factors on PAD in the ICU experience of transplantation recipients.

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