Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Comparison of 0.25 mg and 0.1 mg intrathecal morphine for analgesia after Cesarean section

  • 629 Accesses

  • 55 Citations

Abstract

Purpose

To test the hypothesis that 0.1 mg intrathecal morphine plus NSAIDs provides satisfactory analgesia post-Cesarean section with fewer side effects than 0.25 mg intrathecal morphine.

Methods

Sixty women, scheduled for elective Cesarean section under spinal anesthesia, were randomized to receive either 0.1 mg or 0.25 mg intrathecal morphine combined with hyperbaric bupivacaine 0.75% and 20 μg fentanyl. All patients received a 100 mg indomethacin suppository at the end of surgery and 500 mg naproxen po b.i.d. was started the evening of surgery and continued until discharge. A blinded researcher recorded the pain, pruritus, and nausea scores, the time to first request for additional analgesics, a visual analogue scale (VAS) satisfaction score, and the use of additional opioids, antipruritics, and/or antiemetics.

Results

Of the 60 patients enrolled, two were not included in the data analysis because of protocol violations leaving 30 patients in the 0.1 mg group and 28 in the 0.25 mg group. There were no differences in the VAS pain scores or the number of women requesting an opioid other than codeine between the two groups. The VAS pruritus scores in the 0.1 mg group were lower throughout the 24 hr (P < 0.001). Fewer women in the 0.1 mg group (4/30 vs 12/28) requested nalbuphine to treat itching (P = 0.018). Nausea scores were lower in the 0.1 mg group (P < 0.001).

Conclusion

The use of 0.1 mg intrathecal morphine plus NSAIDs provides analgesia of similar quality to 0.25 mg but with fewer undesirable side effects following Cesarean section.

Résumé

Objectif

Vérifier l’hypothèse qui veut que 0,1 mg de morphine intrathécale combinée à des AINS fournissent une analgésie satisfaisante à la suite d’une césarienne et moins d’effets secondaires que 0,25 mg de morphine intrathécale.

Méthode

Soixante femmes, admises pour une césarienne planifiée sous rachianesthésie et réparties au hasard ont reçu 0,1. mg ou 0,25 mg de morphine intrathécale combinée à de la bupivacaïne hyperbare 0,75 % et à 20 μg de fentanyl. Toutes ont reçu un suppositoire de 100 mg d’indométhacine à la fin de l’opération et 500 mg de naproxène po b.i.d. à partir du premier soir jusqu’au jour du départ. Un anesthésiologiste impartial a enregistré les scores de douleurs, de prurit et de nausées, le temps avant la première demande d’analgésiques supplémentaires, le degré de satisfaction à l’échelle visuelle analogue (EVA) et l’usage d’opioïdes, d’antiprurigineux et/ou d’antiémétiques additionnels.

Résultats

Des 60 patientes recrutées, deux n’ont pu participer à la cueillette de données à cause de violations au protocole de recherche; il est resté 30 patientes dans le groupe de 0,1 mg et 28 dans celui de 0,25 mg. Il n’y a pas eu de différence intergroupe pour les scores à l’EVA ou le nombre de femmes qui ont demandé un opioïde autre que la codéine. Le degré de prurit fourni par l’EVA a été plus bas dans le groupe de 0,1 mg pendant 24 h (P < 0,001). Moins de femmes du groupe de 0,1 mg (4/30 vs 12/28) ont demandé de la nalbuphine contre le prurit (P = 0,018) et les scores de nausées ont été plus bas dans ce groupe également (P < 0,001).

Conclusion

L’utilisation, après la césarienne, de 0,1 mg de morphine intrathécale combinée à des AINS a fourni une analgésie de qualité semblable à celle qui a été produite avec 0,25 mg, mais comportant moins d’effets secondaires.

References

  1. 1

    Palmer CM, Voulgaropoulos D, Van Maren G, Emerson SS, Alves D. What is the optimal dose of subarachnoid morphine for post-Cesarean analgesia? A dose-response study. Anesthesiology 1994; 81: A1151.

  2. 2

    Patterson GMC, McQuay HJ, Bullingham RES, Moore RA. Intradural morphine and diamorphine. Dose response studies. Anaesthesia 1984; 39: 113–7.

  3. 3

    Uchiyama A, Ueyama H, Nakano S, Nishimura M, Tashiro C. Low dose intrathecal morphine and pain relief following Caesarean section. Int J Obstet Anesth 1994; 3: 87–91.

  4. 4

    Abboud TK, Dror A, Mosaad P, et al. Mini-dose intrathecal morphine for the relief of post-Cesarean section pain: safety, efficacy, and ventilatory responses to carbon dioxide. Anesth Analg 1988; 67: 137–43.

  5. 5

    Abouleish E, Rawal N, Fallon K, Hernandez D. Combined intrathcal morphine and bupivacaine for Cesarean section. Anesth Analg 1988; 67: 370–4.

  6. 6

    Abouleish E, Rawal N, Rashad MN. The addition of 0.2 mg subarachnoid morphine to hyperbaric bupivacaine for Cesarean delivery: a prospective study of 856 cases. Reg Anesth 1991; 16: 137–40.

  7. 7

    Herz A, Teschemocher H-J. Activities and sites of antinociceptive action of morphine-like analgesics and kinetics of distribution following intravenous, intracerebral and intraventricular application. Adv Drug Res 1971; 6: 79–119.

  8. 8

    Chestnut DH. Obstetric Anesthesia. Principles and Practice. St. Louis: Mosby, 1994: 380.

  9. 9

    Chaney MA. Side effects of intrathecal and epidural opioids. Can J Anaesth 1995; 42: 891–903.

  10. 10

    McMorland GH, Marx GF. Handbook of Obstetric Analgesia and Anesthesia. World Federation of Societies of Anaesthesiologists, 1992: 55–6.

  11. 11

    Luthman J, Kay NH, White JB. The morphine sparing effect of diclofenac sodium following Caesarean section under spinal anaesthesia. Int J Obstet Anesth 1994; 3: 82–6.

  12. 12

    Souter AJ, Fredman B, White PF. Controversies in the perioperative use of nonsteroidal antiinflammatory drugs. Anesth Analg 1994; 79: 1178–90.

  13. 13

    Dennis AR, Leeson-Payne CG, Hobbs GJ. Analgesia after Caesarean section. The use of rectal diclofenac as an adjunct to spinal morphine. Anaesthesia 1995; 50: 297–9.

  14. 14

    Cohen SE, Desai JB, Ratner EF, Riley ET, Halpern J. Ketorolac and spinal morphine for postcesarean analgesia. Int J Obstet Anesth 1996; 5: 14–8.

Download references

Author information

Correspondence to Theresa Yang.

Additional information

This study was supported by the Foothills Hospital Foundation.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Yang, T., Breen, T.W., Archer, D. et al. Comparison of 0.25 mg and 0.1 mg intrathecal morphine for analgesia after Cesarean section. Can J Anesth 46, 856 (1999). https://doi.org/10.1007/BF03012975

Download citation

Keywords

  • Morphine
  • Naproxen
  • Elective Cesarean Section
  • Nalbuphine
  • Visual Analogue Scale Pain Score