A two-dose epidural morphine regimen for cesarean section patients: therapeutic efficacy.

Abstract

A single dose of epidural morphine (EM) usually produces 24 h of post-cesarean section (CS) analgesia and patients require supplemental analgesics beyond this period. This study assesses if a second dose of EM administered 24 h after the first one offers superior therapeutic efficacy compared to conventional analgesics. Patients (n = 100) were randomized to receive one or two doses of epidural morphine. In all patients, EM 5 mg was administered after delivery. After 24 h patients received epidurally either normal saline (n = 50, Group 1) or morphine 5 mg (n = 50, Group 2). An independent observer used a visual analogue scale to assess nausea, itching, and analgesia 24 h after each injection. Results were expressed as mean +/- 1 s.e. mean and analyzed using nonparametric methods. The second dose of EM produced a significantly lower incidence and severity of nausea and itching than did the first dose (P < 0.01) in Group 2 with no difference in analgesia. The second day postoperative pain score in Group 1 was significantly greater than the first day score in the same group, and significantly greater than the severity score in Group 2. Only 36% of patients receiving two doses of EM required supplemental analgesics beyond 48 h compared to 76% of those receiving one dose (P < 0.01). No serious complications were noted. In summary, the use of a second dose of EM for post-CS analgesia produces better analgesia and reduces the need for oral analgesics. The second dose produced fewer side-effects, probably due to acute tolerance to morphine.

• Authors: M I Zakowski, S Ramanathan, H Turndorf
• Journal: Acta anaesthesiologica Scandinavica (Acta Anaesthesiol Scand) Vol. 36 Issue 7 Pg. 698-701 (Oct 1992) ISSN: 0001-5172 [Print] England
• PMID: 1441873 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Sodium Chloride
• Morphine
• Oxycodone

Topics

• Adult
• Analgesia, Epidural
• Analgesia, Obstetrical
• Cesarean Section (adverse effects)
• Female
• Humans
• Morphine (administration & dosage, adverse effects, therapeutic use)
• Nausea (prevention & control)
• Oxycodone (administration & dosage, therapeutic use)
• Pain Measurement
• Pain, Postoperative (prevention & control)
• Pregnancy
• Pruritus (prevention & control)
• Sodium Chloride
• Time Factors