A Comparison of Morphine, Meperidine, and Oxymorphone as Utilized in Patient-controlled Analgesia Following Cesarean Delivery

Sinatra, Raymond S.; Lodge, Kevin; Sibert, Karen S.; Chung, Keun Sam; Chung, James H.; Parker, A.; Harrison, D. M.

doi:10.1097/00000542-198904000-00005

Cited by 71 publications

(22 citation statements)

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“…Morphine is available in a very limited amount and pethidine is mostly used for postoperative pain management. In the literature, superior pain relief with morphine compared to pethidine has been demonstrated in two studies [21,22], while other studies have failed to show any superiority of morphine [23,24]. In one study [25] PCA morphine and pethidine were equally effective for controlling postoperative pain and had similar side effects.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia Versus Conventional Continuous Infusion

Ismail¹,

Afshan²,

Monem³

et al. 2012

OJAnes

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Background: Management of postoperative pain after caesarean section (CS) requires a balance between pain relief and undesirable side effects of drugs and technique. In order to improve postoperative pain management after caesarean section, we compared intravenous patient controlled analgesia (IV-PCA) with our current hospital practice, which is continuous opioid infusion. Method: We enrolled one hundred and twenty patients in our prospective randomized trial after an uneventful elective caesarean section under spinal anaesthesia. All patients received 0.5 mg/kg bolus of pethidine on first complaint of pain or at 120 minutes after institution of spinal anaesthesia. Depending upon the randomization, Group P received IV-PCA with 0.15 mg/kg bolus pethidine with 10-minute lockout and Group C received continuous pethidine infusion at a rate of 0.15 mg/kg/hr. Statistical Analysis: For qualitative variables means and standard deviations were computed and analyzed by T-test, Mann Whitney U test and repeated measures ANOVA. Frequency and percentages were computed for qualitative data and analyzed by Chi-Square and Fischer exact test. A p-value of less than 0.05 was treated as significant. Results: The numeric rating score for pain, need for rescue analgesia and incidence of nausea and vomiting was significantly lower (p-value < 0.001) in IV-PCA group as compared to continuous infusion group at 6, 12 and 24 hours postoperatively, 98% of the patients were satisfied with pain management in Group P as compared to 70% (p < 0.001) in Group C. Conclusion: Our results showed improved pain control, less need for rescue analgesia for breakthrough pain, lower incidence of nausea and vomiting and greater patient satisfaction with IV-PCA. In the absence of preservative free narcotics for intrathecal use, postoperative pain management can be significantly improved by using IV-PCA instead of continuous opioid infusion in patients undergoing caesarean section.

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Section: Discussionmentioning

confidence: 99%

Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia Versus Conventional Continuous Infusion

Ismail¹,

Afshan²,

Monem³

et al. 2012

OJAnes

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“…Similarly, McKenzie et al [31] found no difference in incidence of emesis (Ϸ 57% of patients reporting nausea and 27% vomiting) between PCA morphine and pethidine. Although some have found differences in incidence and intensity of side-effects between agents [32][33][34] in relation to nausea and vomiting, overall, there appears to be no clear advantage to using one opioid over the others, with each producing a similar incidence of postoperative emesis.…”

Section: Decreasing the Incidence Of Postoperative Nausea And Vomitingmentioning

confidence: 99%

Nausea and vomiting in the postoperative patient‐controlled analgesia environment

Woodhouse

Mather

1997

Anaesthesia

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SummaryDespite common clinical opinion that patient-controlled analgesia should be renamed 'patientcontrolled nausea', there is little evidence in support of the notion that postoperative nausea and vomiting are exacerbated by the method. Indeed, data indicate that opioid-sparing techniques are not associated with less postoperative nausea and vomiting. Although some evidence suggests that certain opioids are less emetogenic than others, this too does not stand scrutiny when compared across patients, although research is still required to find whether individual patients are better treated with a particular opioid. Similarly, the emerging practice of combining anti-emetics with patient-controlled analgesia needs wider study before it can be supported. Nausea and vomiting are distressing adverse events which frequently follow surgery. The incidence of postoperative nausea and vomiting is difficult to estimate because of methodological differences between studies; however, there are reports of from 8% to 92% of postsurgical patients experiencing postoperative emesis [1]. Lerman [2] and Watcha & White [3] suggest that the incidence of postoperative nausea and vomiting has remained fairly constant for decades with Ϸ20-30% of patients suffering from these unpleasant side-effects. However, it is common to find reports of a much higher incidence in a variety of surgical populations [4][5][6][7][8][9][10]. Differentiation of opioidinduced nausea and vomiting from that of other perioperative factors, including those associated with uncontrolled pain [11], is difficult enough without complications introduced by patient-controlled analgesia (PCA) which allows patients to medicate on irregular and inconsistent bases. This review focuses on the issues associated with nausea and vomiting as encountered in the postoperative PCA environment.

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“…The efficacy of intravenous patient-controlled analgesia (PCA) has been well documented with a variety of opioid analgesics in postcesarean delivery patients [100][101][102]. Although morphine is the standard analgesic used in this setting, a recent blinded comparison noted a more rapid onset of pain relief and less sedation with meperidine [102].…”

Section: Effect Of Opiates On Breastfeedingmentioning

confidence: 99%

Effects of Prenatal Opiates Exposure on Human Pregnancy and Breastfeeding

Malek¹

2012

Pharm Anal Acta

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Opiates like heroin, morphine and their semisynthetic and synthetic analogs act to relieve pain, as well as produce tolerance and physical dependence, by mimicking the various endogenous opioids and by binding to an opioid receptor. Substance use (alcohol, nicotine and illegal drugs including opiates/opioids) and substance use disorders are not uncommon amongst women of reproductive age and during pregnancy. Opioids include naturally occurring, semi-synthetic and synthetic drugs which are used as analgesics; and prescription use of this class of drugs increases during pregnancy over the past decade. Opiates like heroin and methadone are the most commonly used forms by pregnant women. The synthetic opiates such as methadone and buprenorphine are used as substitution therapy for the abused drug like heroin. This class of drugs is both transported to the fetus and alters the placental function. This review summarizes the impact of opiates on the human pregnancy and breastfeeding.

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A Comparison of Morphine, Meperidine, and Oxymorphone as Utilized in Patient-controlled Analgesia Following Cesarean Delivery

Cited by 71 publications

References 0 publications

Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia Versus Conventional Continuous Infusion

Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia Versus Conventional Continuous Infusion

Nausea and vomiting in the postoperative patient‐controlled analgesia environment

Effects of Prenatal Opiates Exposure on Human Pregnancy and Breastfeeding

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