A Double-Blinded, Randomized Comparison of Intrathecal and Epidural Morphine for Elective Cesarean Delivery

Sarvela, J.; Halonen, P.; Soikkeli, A.; Korttila, K.

doi:10.1097/00000539-200208000-00037

Cited by 36 publications

(16 citation statements)

References 15 publications

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“…In current obstetric anaesthetic practice, such large doses of morphine are rarely used because they are associated with significant side-effects such as nausea, vomiting, pruritus, shivering, etc. Therefore, much smaller doses of morphine are used instead for caesarean section [6,7]. It is not known whether such a small dose of morphine also intensifies the hypothermic action associated with spinal anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

A randomised double‐blind controlled study evaluating the hypothermic effect of 150 μg morphine during spinal anaesthesia for Caesarean section

et al. 2005

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SummaryWe studied the hypothermic effect of adding 150 lg morphine during spinal anaesthesia in 60 parturients scheduled for elective caesarean section. All the parturients received intrathecal injection of a solution containing 150 lg morphine or normal saline in addition to 10-12 mg hyperbaric bupivacaine 0.5%. In both groups, a significant decrease in body temperature was noted. There was no difference in the area under the curve for temperature against time for the two groups; however, the maximum decrease in temperature from baseline was significantly larger after morphine than after saline injection (mean (SD) 1.11 (0.61)°C vs 0.76 (0.39)°C, respectively; p = 0.01) and the time to nadir temperature was significantly longer (59.5 (17.6) min vs 50.4 (15.9) min, respectively; p = 0.047). The lowest temperature observed in the morphine group was 34.3°C. We conclude that intrathecal injection of 150 lg morphine intensified the intra-operative hypothermic effect of bupivacaine spinal anaesthesia for caesarean section. Intra-operative hypothermia has been reported in parturients receiving spinal anaesthesia [1]. For parturients undergoing caesarean section, bupivacaine is a commonly used agent for providing spinal anaesthesia. When morphine is used in addition to local anaesthetics, it prolongs the duration of analgesia and provides postoperative pain relief [2]. Severe hypothermia has been reported when a large dose of morphine was used in spinal anaesthesia [3]. Although hypothermia associated with smaller doses of morphine has been reported sporadically [4,5], it is not known whether a very small dose of morphine (150 lg) would also intensify spinal anaesthesia-induced hypothermia. This randomised double-blind controlled study was performed to evaluate the effect of adding 150 lg of morphine to bupivacaine on body temperature in parturients during elective caesarean section under spinal anaesthesia. MethodsWe included 60 term pregnant women (ASA physical status 1-2) scheduled for elective caesarean section after informed consent. This study was approved by the institutional reviewing board. The individuals were assigned to receive either morphine or saline by a computer-generated randomisation table. The assignments were blinded to both the parturients and the anaesthetists who performed the spinal injection and measured the body temperature. After the parturients were transferred to the operating room, regular noninvasive blood pressure was recorded every 3 min. Lead-II configuration of the ECG and pulse oximetry were continuously displayed. Body temperatures were recorded from the same ear with an infrared tympanic thermometer (Welch Allyn 9000, accuracy ± 0.2°F). The room temperature was kept constant at 24°C. The parturients were prehydrated with 1000 ml Hartmann's solution, which was prewarmed to 37°C. After hydration, the baseline body temperature was obtained. A 27-G Quincke spinal needle was introduced into the subarachnoid space at the L2-3 or L3-4 interspace in the lateral decubitus position, and 10-...

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Section: Discussionmentioning

confidence: 99%

A randomised double‐blind controlled study evaluating the hypothermic effect of 150 μg morphine during spinal anaesthesia for Caesarean section

et al. 2005

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“…Median [IQR] total IV morphine PCA use did not differ between the control (15 mg) and intervention groups (15 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] mg; P = 0.92). Similarly, the total 24 hour opioid use, including fentanyl and oxycodone converted to morphine equivalents, a did not differ between groups (21 [11-37] mg and 15 mg in the control and intervention groups, respectively; P = 0.72).…”

Section: Resultsmentioning

confidence: 99%

“…The higher dose of spinal morphine chosen in this study and the additional doses of acetaminophen are considered to be within safe limits from previous studies and have a long history of efficacy and safety. [12][13][14][15] However, as a precaution, we excluded patients with signs or symptoms or risk of liver diseases and proscribed the delivery of other acetaminophen-containing drugs during the 24-hour study period to avoid exceeding the 4 g/24 h limit. The effectiveness of other agents such as oral gabapentin, used as a component of multimodal postoperative analgesic for acute and chronic pain in obstetric populations, is inconclusive and its use may result in significant sedation.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial Comparing Two Multimodal Analgesic Techniques in Patients Predicted to Have Severe Pain After Cesarean Delivery

Booth

Harris

Eisenach

et al. 2016

Survey of Anesthesiology

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BACKGROUND-Improved pain control after cesarean delivery remains a challenging objective. Poorly treated acute pain following delivery is associated with an increased risk of chronic pain and depression. This study was conducted to determine whether the addition of systemic acetaminophen and an increased dose of intrathecal morphine would further reduce acute pain. The primary outcome was pain intensity with movement at 24 hours postoperatively. Secondary measures included persistent pain and depression at 8 weeks.

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“…In this study, we used morphine (100 µg), a dose often recommended for subarachnoid space application in cesarean section, combined with hyperbaric bupivacaine with or without other adjuvants. At this dosage, the incidence of late adverse effects is lower and does not affect the quality of postoperative analgesia 6,[19][20][21][22][23][24][25] . Due to morphine side effects and slow onset of action, liposoluble opioids (fentanyl and sufentanil) are used intrathecally in combination with local anesthetics for cesarean section.…”

Section: Discussionmentioning

confidence: 95%

Raquianestesia em operação cesariana. Emprego da associação de bupivacaína hiperbárica (10 mg) a diferentes adjuvantes

Braga¹,

Frias²,

Braga³

et al. 2012

Rev. Bras. Anestesiol.

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Summary: Braga AA, Frias JAF, Braga FS, Potério GB, Hirata ES, Torres NA -Spinal Anesthesia for Cesarean Section. Use of Hyperbaric Bupivacaine (10 mg) Combined with Different Adjuvants. Background and objectives:Combination of local anesthetics (LA) with adjuvants for spinal anesthesia improves block quality and prolongs the duration of analgesia. It was evaluated the maternal effects and neonatal repercussions of sufentanil, morphine, and clonidine combined with hyperbaric bupivacaine for elective cesarean section.

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A Double-Blinded, Randomized Comparison of Intrathecal and Epidural Morphine for Elective Cesarean Delivery

Cited by 36 publications

References 15 publications

A randomised double‐blind controlled study evaluating the hypothermic effect of 150 μg morphine during spinal anaesthesia for Caesarean section

A randomised double‐blind controlled study evaluating the hypothermic effect of 150 μg morphine during spinal anaesthesia for Caesarean section

A Randomized Controlled Trial Comparing Two Multimodal Analgesic Techniques in Patients Predicted to Have Severe Pain After Cesarean Delivery

Raquianestesia em operação cesariana. Emprego da associação de bupivacaína hiperbárica (10 mg) a diferentes adjuvantes

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