Determination of an effective dose of intrathecal morphine for pain relief after cesarean delivery.

UNLABELLED Very small doses of intrathecal (i.t.) morphine (25-200 microg) have been used in an effort to provide effective postoperative pain relief while minimizing side effects after cesarean delivery. We performed a double-blinded study in 40 patients presenting for elective cesarean delivery in which i.t. morphine was administered along with oral hydrocodone/acetaminophen and other medications commonly administered after cesarean delivery. We administered i.t. morphine by up-down sequential allocation of doses. For the purposes of this study, adequate postoperative analgesia was defined as comfort not requiring i.v. morphine for 12 h after spinal anesthesia with bupivacaine, fentanyl, and morphine. In addition, a time and cost comparison was performed for study patients receiving intrathecal morphine compared with a historical group of patients receiving patient-controlled analgesia with i.v. morphine. We were unable to determine with meaningful precision a dose of i.t. morphine to provide analgesia in this context. However, very small doses of i.t. morphine combined with oral hydrocodone/acetaminophen and other medications commonly prescribed after cesarean delivery provided postoperative pain relief with no more time commitment than patient-controlled analgesia (148 +/- 61 vs 150 +/- 57 min) and with significantly less acquisition cost ($15.13 +/- $4.40 vs $34.64 +/- $15.55). IMPLICATIONS When used along with oral analgesics, very small doses of spinal morphine provide adequate pain relief after cesarean delivery. Spinal anesthetics, oral analgesics, and other medications commonly prescribed to treat side effects after cesarean delivery contribute significantly to this analgesia. When small doses of spinal morphine are used in this setting, they provide adequate analgesia and patient satisfaction that is time- and cost-effective.

[1]  J. Carvalho,et al.  Small Doses of Intrathecal Morphine Combined with Systemic Diclofenac for Postoperative Pain Control After Cesarean Delivery , 1998, Anesthesia and analgesia.

[2]  J. Jakobsson,et al.  Intrathecal Sufentanil, Fentanyl, or Placebo Added to Bupivacaine for Cesarean Section , 1997, Anesthesia and analgesia.

[3]  A. Sunshine,et al.  Analgesic Efficacy of a Hydrocodone with Ibuprofen Combination Compared with Ibuprofen Alone for the Treatment of Acute Postoperative Pain , 1997, Journal of clinical pharmacology.

[4]  P. Bragg,et al.  Peri-operative multi-modal pain therapy for Caesarean section: analgesia and fitness for discharge , 1997, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[5]  J. Eisenach,et al.  Intrathecal neostigmine for post-cesarean section analgesia: dose response. , 1997, Anesthesia and analgesia.

[6]  M. Swart,et al.  Intrathecal morphine for Caesarean section: an assessment of pain relief, satisfaction and side‐effects , 1997, Anaesthesia.

[7]  P. Norman,et al.  Food and Drug Administration Guidelines for Machine Checkout Need Modification , 1997 .

[8]  D. Bogod,et al.  Intrathecal administration of morphine for elective Caesarean section , 1996, Anaesthesia.

[9]  G. Lyons,et al.  Determination of the Minimum Local Analgesic Concentrations of Epidural Bupivacaine and Lidocaine in Labor , 1995, Anesthesia and analgesia.

[10]  C. Campobasso,et al.  Pain relief after caesarean section: comparison of different techniques of morphine administration. , 1994, International journal of obstetric anesthesia.

[11]  S. Emerson,et al.  What Is the Optimal Dose of Subarachnoid Morphine for Post-Cesarean Analgesia?: A Dose-Response Study , 1994 .

[12]  M. Zakowski,et al.  Hemodynamic Effects of Intrathecal Fentanyl in Term Parturients , 1994 .

[13]  N. R. Connelly,et al.  The use of fentanyl added to morphine-lidocaine-epinephrine spinal solution in patients undergoing cesarean section. , 1994, Anesthesia and analgesia.

[14]  S. Inomata,et al.  End‐tidal Sevoflurane Concentration for Tracheal Intubation and Minimum Alveolar Concentration in Pediatric Patients , 1994, Anesthesiology.

[15]  J. Sear,et al.  Pregnanolone: a new steroid intravenous anaesthetic , 1992, Anaesthesia.

[16]  L. Subak,et al.  Analgesia after Cesarean Delivery: Patient Evaluations and Costs of Five Opioid Techniques , 1991, Regional Anesthesia & Pain Medicine.

[17]  N. Rawal,et al.  The Addition of 0.2 mg Subarachnoid Morphine to Hyperbaric Bupivacaine for Cesarean Delivery: A Prospective Study of 856 Cases , 1991, Regional anesthesia and pain medicine.

[18]  J. Moore,et al.  Mini‐Dose Intrathecal Morphine for the Relief of Post‐Cesarean SectionPain: Safety, Efficacy, and Ventilatory Responses to Carbon Dioxide , 1988, Anesthesia and analgesia.

[19]  J. Halpern,et al.  Ketorolac and spinal morphine for postcesarean analgesia. , 1996, International journal of obstetric anesthesia.