Postpartum bilateral
tubal ligation (PPBTL) causes
postoperative pain. We designed this study to determine the efficacy of 50 microg intrathecal
morphine for
analgesia after PPBTL. Sixty-five women received
spinal anesthesia with 12.75 mg hyperbaric
bupivacaine, 20 microg of
fentanyl, and either 50 microg of
morphine (
morphine group) or 0.05 mL of saline (control group). Postoperative
analgesia was provided with regular
naproxen 500 mg and
oxycodone 5 mg/
acetaminophen 325 mg mixture as needed. Overall, satisfaction was higher (P=0.003) and
pain was less intense at rest (P=0.008) and on movement (P <0.0001) in the
morphine group. There was no significant overall difference in
nausea,
pruritus, or sedation scores, but
vomiting occurred more frequently in the
morphine group (21.4% versus 3.5%; P=0.052). In post hoc comparisons,
pain at rest within the
morphine group was significantly less at 4 h (P=0.006),
pain on movement was significantly less at 4 h (P=0.002) and 12 h (P=0.0004), and
pruritus was significantly more frequent at 12 h (P=0.002) compared with the control group.
Oxycodone 5 mg/
acetaminophen 325 mg mixture consumption was significantly smaller (P=0.006) and the time to first request of
analgesia was significantly longer (P=0.006) in the
morphine group. We conclude that the addition of 50 microg of
morphine to intrathecal hyperbaric
bupivacaine and
fentanyl provides improved postoperative
analgesia in women undergoing PPBTL.