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Background and Aims Pancreatic cancer is an aggressive malignancy with poor prognosis. Surgery is the only curative option, but optimal perioperative analgesia for minimally invasive pancreatic procedures remains unclear. Intrathecal morphine (ITM) offers prolonged analgesia and may enhance recovery, though side effects such as nausea and respiratory depression limit its use.Methods In this single-centre, double-blind, randomized placebo-controlled trial, patients undergoing laparoscopic or robotic pancreatic surgery within an enhanced recovery program received either ITM (4 µg/kg) or placebo. All patients received standard multimodal analgesia and patient-controlled morphine. The primary outcome was morphine consumption in the first 24 hours (see figure 1). Secondary outcomes included morphine use at 48 hours, pain scores, complications, and recovery parameters.Results ITM significantly reduced cumulative morphine use at 24 hours (mean [SD]: 19 [19] mg vs 35 [30] mg; p = 0.0004) and 48 hours (30 [22] mg vs 45 [37] mg; p = 0.0083). Pain scores were similar, but ITM patients used less rescue and PCA opioids (see table 1). No significant differences were observed in respiratory complications, nausea, surgical outcomes, or inflammatory markers. Pruritus was more common in the ITM group (58% vs 25%). Time to discharge readiness and hospital stay were similar (see table 2).Conclusions ITM significantly reduces opioid consumption following minimally invasive pancreatic surgery without increasing serious complications. These findings support its role in multimodal analgesia within enhanced recovery protocols. Further studies should optimize dosing and assess safety in larger cohorts.Abstract EP096 Table 1Primary/key secondary outcomes and pain medication outcomesAbstract EP096 Table 2Secondary and safety outcomesAbstract EP096 Figure 1Primary outcome