A Double-Blinded, Randomized Comparison of Intrathecal and Epidural Morphine for Elective Cesarean Delivery

We randomized 150 parturients into a double-blinded trial to receive intrathecal (IT) 100 &mgr;g (IT 100 group) or 200 &mgr;g (IT 200 group) or epidural 3 mg (Epidural group) of morphine for elective cesarean delivery with a combined spinal/epidural technique. The patients additionally received ketoprofen 300 mg/d. Postoperative pain relief and side effects were registered every 3 h up to 24 h, and all patients were interviewed on the first postoperative day. Pain control was equally good, but the parturients in the IT 100 group requested rescue analgesics more often compared with the other groups (P < 0.05). Itching was a common complaint and was reported by 74% of the parturients in the Epidural group and 65% and 91% in the IT 100 and IT 200 groups, respectively (P < 0.01). Medication for itching was requested by 44%, 24%, and 45% of the patients, respectively (P < 0.05). There was no difference in postoperative nausea or vomiting. The pain relief was perceived as good by >90% of the patients in all groups. In conclusion, because of the decreased incidence of and lesser requirements of medication for itching, IT morphine 100 &mgr;g with ketoprofen is recommended in cesarean deliveries. Rescue analgesics nevertheless need to be prescribed.

[1]  K. Korttila,et al.  Comparison of 9 mg of intrathecal plain and hyperbaric bupivacaine both with fentanyl for cesarean delivery. , 1999, Anesthesia and analgesia.

[2]  G. Fick,et al.  Comparison of 0.25 mg and 0.1 mg intrathecal morphine for analgesia after Cesarean section , 1999, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[3]  Alyson Andreasen,et al.  Analgesia, pruritus, and ventilation exhibit a dose-response relationship in parturients receiving intrathecal fentanyl during labor. , 1999, Anesthesia and analgesia.

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

[5]  S. Emerson,et al.  Dose-response relationship of intrathecal morphine for postcesarean analgesia. , 1999, Anesthesiology.

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

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

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

[9]  M. Douglas,et al.  Rectal Indomethacin Potentiates Spinal Morphine Analgesia after Caesarean Delivery , 1995, Anaesthesia and Intensive Care.

[10]  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.

[11]  A. Uchiyama,et al.  Low dose intrathecal morphine and pain relief following caesarean section. , 1994, International journal of obstetric anesthesia.

[12]  C. C. Wu,et al.  Effects of Epidural Morphine and Intramuscular Diclofenac Combination in Postcesarean Analgesia: A Dose‐Range Study , 1992, Anesthesia and analgesia.

[13]  J. Ashley,et al.  Comparison of Epidural and Intravenous Opioid Analgesia after Elective Caesarean Section , 1992, Anaesthesia and intensive care.

[14]  A. C. Primavesi.  Comparison of 0.25 mg and 0.1 mg Intrathecal Morphine for Analgesia after Cesarean Section , 2000 .

[15]  H. S. Chadwick,et al.  Intrathecal and Epidural Morphine Sulfate for Postcesarean Analgesia — A Clinical Comparison , 1989 .

[16]  B. Gutsche,et al.  Mini-Dose Intrathecal Morphine for the Relief of Post-Cesarean Section Pain: Safety, Efficacy, and Ventilatory Responses to Carbon Dioxide , 1989 .