Comparison of Epidural and Intravenous Opioid Analgesia after Elective Caesarean Section

Abstract

Patient acceptance is a particularly relevant method of assessing currently employed epidural and intravenous techniques of opioid analgesia after elective caesarean section. We have prospectively studied 71 such patients, randomised postoperatively to receive epidural morphine, intravenous morphine or intravenous pethidine. When compared with either intravenous opioid, epidural morphine provided twofold better average or excellent analgesia with 30% less drowsiness but with about 50% more pruritus. In spite of this troublesome complication, more patients (83% vs 74%) preferred epidural to intravenous opioid analgesia.

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

“…Nine trials were not selected: six were non‐randomized studies (Crawford, 1981; Donchin et al, 1981; Kanto et al, 1985; Kotelko et al, 1984; Lim et al, 2005; Smith et al, 1991), and three others were retrospective studies (Chadwick and Ready, 1988; Cohen et al, 1991; Fuller et al, 1990). Eleven other studies were also excluded for the following reasons: use of two different doses of EM in the same group of patients (Pan and James, 1994), repeated EM injections (Cade and Ashley, 1993; Cade et al, 1992; Daley et al, 1990), epidural administration of sustained‐release morphine (Carvalho et al, 2005b, 2007) no analysis of postoperative pain and morphine adverse effects (Brooks et al, 1983; Choi et al, 1989), per‐protocol‐analysis including less than 80% of the patients (Binsted, 1983), CS and other surgical procedures confounded (Writer et al, 1985), elective CS and emergency CS confounded (Chambers et al, 1983). Finally, 10 randomized studies evaluating the analgesic and adverse effects of EM after elective CS were included in this meta‐analysis (Fig.…”

A Randomized, Double-Blind, Placebo-Controlled Trial of Epidural Morphine Analgesia After Vaginal Delivery

“…The benefits compared with systemic opioids have been demonstrated in many postoperative analgesic settings. 4,5 The objective of this study was to determine whether a single dose of epidural morphine given soon after a vaginal delivery would reduce postpartum perineal pain and reduce the use of IV or oral opioid analgesics in the early postpartum period.…”

A survey of opioid administration in an emergency department

“…The above studies using PCA may be criticised on the basis that dose sizes for the different opioids were not shown to be optimal. Cade et al 5 provided nurse‐adjusted intravenous infusions of morphine or pethidine to patients following caesarean section. The two drugs had similar efficacy but pethidine was associated with a lower overall level of side‐effects, which was statistically significant for nausea.…”