Efficacy of intrathecal morphine for analgesia following elective cesarean section: comparison with previous delivery.

PURPOSE To determine the effect of intrathecal injection of morphine 0.2 mg on postoperative analgesia, activity and satisfaction after elective cesarean section. METHOD Forty-five parturients who had previously undergone cesarean section with spinal anesthesia without intrathecal morphine were enrolled in this randomized, double-blinded study. Group 1 received hyperbaric bupivacaine 10 mg intrathecally (IT) and group 2 received morphine 0.2 mg IT in addition to hyperbaric bupivacaine 10 mg IT. All subjects received 20 mg piroxicam rectally at the end of surgery and 18 hours after surgery. Side effects in the first 24 hours after delivery were recorded by a trained nurse. Pain, nausea, pruritus, and satisfaction during the first 24 hours were self-rated using a visual analog scale. Subjects also recorded their memories of these symptoms after their previous cesarean sections. The time to first request for additional analgesics (30 mg pentazocine intramuscularly), total dose of pentazocine within 24 hours postoperatively and nurse observations of walking status within 24 hours postoperatively were also recorded. RESULTS In the present cesarean sections, the duration of complete analgesia and the time to first request for additional analgesics were longer in group 2 than in group 1. Group 2 had higher satisfaction scores than group 1 in spite of their more severe pruritus and nausea during the first 24 hours after surgery. The percentage of patients who could not walk during the first 24 hours after cesarean section was higher in group 1 than in group 2. CONCLUSION The addition of morphine 0.2 mg to hyperbaric bupivacaine 0.5% by intrathecal injection reduced postoperative pain and analgesic use, and increased patient satisfaction following cesarean section. The combination of intrathecal injection of morphine and preventive NSAIDs can be easily administered in most hospitals, and is substantially less expensive than the new pain management technologies currently in use.

[1]  B. Ben-david,et al.  Minidose Lidocaine-Fentanyl Spinal Anesthesia in Ambulatory Surgery: Prophylactic Nalbuphine Versus Nalbuphine Plus Droperidol , 2002, Anesthesia and analgesia.

[2]  D. Cooper,et al.  Patient‐controlled epidural fentanyl following spinal fentanyl at Caesarean section , 2002, Anaesthesia.

[3]  H. Kehlet,et al.  A Qualitative and Quantitative Systematic Review of Preemptive Analgesia for Postoperative Pain Relief: The Role of Timing of Analgesia , 2002, Anesthesiology.

[4]  S. Brull,et al.  Preemptive analgesia I: physiological pathways and pharmacological modalities , 2001, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[5]  S. Ho,et al.  Dexamethasone prophylaxis of nausea and vomiting after epidural morphine for post-Cesarean analgesia , 2001, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[6]  S. Halpern,et al.  Multimodal Therapy for Post-Cesarean Delivery Pain , 2001, Regional Anesthesia & Pain Medicine.

[7]  A. Baraka,et al.  Diclofenac and/or Propacetamol for Postoperative Pain Management After Cesarean Delivery in Patients Receiving Patient Controlled Analgesia Morphine , 2000, Regional Anesthesia & Pain Medicine.

[8]  C. Kern,et al.  Advantages of Intrathecal Nalbuphine, Compared with Intrathecal Morphine, After Cesarean Delivery: An Evaluation of Postoperative Analgesia and Adverse Effects , 2000, Anesthesia and analgesia.

[9]  S. Charuluxananan,et al.  Ondansetron for Treatment of Intrathecal Morphine-Induced Pruritus After Cesarean Delivery , 2000, Regional Anesthesia & Pain Medicine.

[10]  Y. Wu,et al.  Postoperative pain relief in primigravida caesarean section patients--combination of intrathecal morphine and epinephrine. , 1999, Acta anaesthesiologica Sinica.

[11]  J. Eisenach,et al.  Determination of an effective dose of intrathecal morphine for pain relief after cesarean delivery. , 1999, Anesthesia and analgesia.

[12]  I. Greer.  The Special Case of Venous Thromboembolism in Pregnancy , 1998, Pathophysiology of Haemostasis and Thrombosis.

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

[14]  V. Sanansilp,et al.  Droperidol and the Side Effects of Epidural Morphine After Cesarean Section , 1998, Anesthesia and analgesia.

[15]  R. Thisted,et al.  Postcesarean analgesia with both epidural morphine and intravenous patient-controlled analgesia: neurobehavioral outcomes among nursing neonates. , 1997 .

[16]  R. Thisted,et al.  Postcesarean Analgesia with Both Epidural Morphine and Intravenous Patient-Controlled Analgesia: Neurobehavioral Outcomes Among Nursing Neonates , 1992, Anesthesia and analgesia.

[17]  S. Halpern,et al.  Epidural morphine vs hydromorphone in post-Caesarean section patients , 1996, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[18]  A. Asbury,et al.  Patient‐controlled analgesia with morphine and droperidol following caesarean section under spinal anaesthesia , 1996, Acta anaesthesiologica Scandinavica.

[19]  Mariana Duarte De Oliveira,et al.  Inhibition of Epidural Morphine-induced Pruritus by Intravenous Droperidol: The Effect of Increasing the Doses of Morphine and of Droperidol , 1995, Regional Anesthesia & Pain Medicine.

[20]  A. Donner,et al.  Optimal intravenous dosing strategies for sedatives and analgesics in the intensive care unit. , 1995, Critical care clinics.

[21]  P. Brownridge,et al.  The nature and consequences of childbirth pain. , 1995, European journal of obstetrics, gynecology, and reproductive biology.

[22]  O. Rosaeg,et al.  Epidural opioid analgesia after Caesarean section: a comparison of patient-controlled analgesia with meperidine and single bolus injection of morphine , 1994, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[23]  D. Gambling,et al.  Epidural butorphanol does not reduce side effects from epidural morphine after cesarean birth. , 1994, Anesthesia and analgesia.

[24]  I. Broome,et al.  A comparison of postoperative analgesia following spinal or epidural anaesthesia for Caesarean section , 1994, Anaesthesia.

[25]  R. Russell,et al.  A comparison of epidural diamorphine with intravenous patient‐controlled analgesia using the Baxter infusor following Caesarean section , 1994, Anaesthesia.

[26]  R. Russell,et al.  A comparison of epidural diamorphine with intravenous patient‐controlled analgesia using the Baxter infusor following Caesarean section , 1993 .

[27]  A. Stoddart.  Anaesthesia and upper respiratory tract infections , 1993, Anaesthesia.

[28]  R. Small,et al.  Diclofenac sodium. , 2020, Clinical pharmacy.

[29]  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.

[30]  J. Kinney,et al.  SPLANCHNIC OXYGEN CONSUMPTION AND SUBSTRATE RALANCE FOLLOWING ACCIDENTAL INJURY , 1984 .

[31]  L. Mather,et al.  Intrathecal and epidural administration of opioids. , 1984, Anesthesiology.

[32]  Moghissi Ks.  Prostaglandins in reproduction. , 1972 .

[33]  J A Aldrete,et al.  A Postanesthetic Recovery Score , 1970, Anesthesia and analgesia.