A Comparison of Patient Controlled Epidural Pethidine versus Single dose Epidural Morphine for Analgesia after Caesarean Section

Abstract

This double-blind, randomized study of analgesia after caesarean section compared patient controlled epidural analgesia with pethidine (15 mg of a 0.25% solution and a 10 minute lockout period) versus a single bolus of epidural morphine 4 mg. Data were collected on 78 patients at 2, 6, 8, and 24 hours postoperatively and analysed using the Wilcoxon rank sum test. Satisfactory analgesia and nausea/vomiting during the first twenty-four hours did not differ between the two groups. The incidence of pruritus (P<0.001) was lower in the pethidine group at 2, 6, and 8 hours, with no difference by 24 hours. Therefore PCEA pethidine provides a useful alternative to single-dose morphine after caesarean section, particularly in those patients who have suffered severe morphine-induced pruritus previously.

Side effects of opioids during short-term administration: effect of age, gender, and race

“…Fentanyl, meperidine (INN, pethidine), and morphine are opioids commonly used interchangeably, and all produce satisfactory immediate pain relief 4 . Studies that have compared the incidence of side effects among these opioids have produced conflicting results, ranging from no differences in the incidence of side effects between morphine and meperidine, 5 , 6 , 7 , 8 to morphine being the least emetogenic, 9 to morphine being the most emetogenic 10 . Other authors have found that, although the overall incidence of side effects was similar, the severity of nausea and vomiting was greater with morphine than with meperidine or fentanyl 11 .…”

A comparison of patient-controlled epidural pethidine vs. nurse-administered epidural pethidine for analgesia after caesarean section

“…1 Since then, several studies have compared its efficacy with PCEA fentanyl, epidural morphine, and patient-controlled intravenous analgesia (PCIA) with morphine. [2][3][4] However, no study to date has compared its analgesia efficacy with intermittent nurse-administered epidural pethidine in post-caesarean section patients.…”

“…The power of the study was calculated based on a previous study done using PCEA with pethidine for post-caesarean analgesia. 2 A difference of 20 in pain scores at 24 hours between the two groups was assumed to be clinically significant in our project. Thirty-two patients were required to detect this difference, with a power of 80 percent and a significance level of 0.05.…”