Analgesic efficacy and adverse effects of epidural morphine compared to parenteral opioids after elective caesarean section: A systematic review

Bonnet, Marie‐Pierre; Mignon, Alexandre; Mazoit, Jean‐Xavier; Ozier, Yves; Marret, Emmanuel

doi:10.1016/j.ejpain.2010.03.003

Cited by 94 publications

(50 citation statements)

References 59 publications

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“…It requires optimal perioperative pain management; which not only allows the mother to ambulate early but also plays a key role in the postoperative rehabilitation after CS [1].…”

Section: Introductionmentioning

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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“…It requires optimal perioperative pain management; which not only allows the mother to ambulate early but also plays a key role in the postoperative rehabilitation after CS [1].…”

Section: Introductionmentioning

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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“…Maternal satisfaction from this protocol and the use of rectal analgesia has not been previously studied. Also, the use of opioids is associated with side effects such as nausea, vomiting, confusion, constipation, tolerance and physical dependency 9,10,11 .…”

Section: Introductionmentioning

confidence: 99%

Rectal Versus Intramuscular Diclofenac Sodium for Pain Relief Following Caesarean Section: A Randomised Controlled Trial

Adebayo¹

2018

jmscr

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“…4 CS induces moderate to severe pain for 48 hours. 5 Postoperative pain leads to patient discomfort, decreased level of satisfaction, prolonged recovery, and higher health costs. Adequate post operative analgesia hastens ambulation, decreases maternal morbidity, improves patient outcome, and facilitates care of the newborn.…”

Section: Introductionmentioning

confidence: 99%

Tramadol and its combination with piroxicam in post-cesarean pain management: a comparative study

Ambika

Mamatha

Prabha

2017

Int J Basic Clin Pharmacol

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Background: Cesarean delivery is a major surgical procedure, requiring high quality pain relief to facilitate early ambulation, infant care and prevention of post-operative morbidity. There is no gold standard for post-cesarean pain management.Methods: Cases were randomly assigned to 2 groups of 30 cases each. One group received Tramadol 100mg and another, Tramadol 100mg+ Piroxicam 20mg. Injections were given intramuscularly, postoperatively after skin closure. Diclofenac 75mg was the rescue analgesia. Primary outcome measure was control of pain, assessed by visual analogue scale (VAS). Secondary outcomes were sedation and time to rescue analgesia. Safety of the drugs was assessed by adverse drug reactions. Data was analysed by student’s t test, analysis of variance and post-hoc test.Results: Multimodal group showed better analgesia compared to unimodal group (p<0001). Drowsiness was the main adverse effect in both treatment groups.Conclusions: Multimodal analgesic combination of tramadol and piroxicam showed superior analgesic effect with better pain control and longer duration of action compared to tramadol alone.

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Analgesic efficacy and adverse effects of epidural morphine compared to parenteral opioids after elective caesarean section: A systematic review

Abstract: A single bolus of epidural morphine provides better analgesia than parenteral opioids but with an effect limited to the first postoperative day after caesarean section and with an increase in morphine side effects.

Cited by 94 publications

References 59 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

Rectal Versus Intramuscular Diclofenac Sodium for Pain Relief Following Caesarean Section: A Randomised Controlled Trial

Tramadol and its combination with piroxicam in post-cesarean pain management: a comparative study

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