Epidural analgesia with 4 mg of morphine following caesarean section: effect of injected volume

Abstract

The efficacy and side effects of epidural bolus injection of 4 mg of morphine in a volume of 2 ml, 10 ml, or 20 ml (groups I, II and III) for postoperative analgesia after caesarean section (60 patients) were evaluated. All patients had epidural anaesthesia established up to T4 level with 0.5% bupivacaine 18-20 ml, supplemented with 2% lidocaine with adrenaline, when necessary. Morphine 4 mg in either of the three volumes was injected through the epidural catheter in random order after delivery of the baby. Six patients in each group reported no pain during the 24-h follow-up period. No additional pain medication during the 24 h after surgery was required in 11, 14 and 10 patients in groups I, II and III, respectively. Most of the others managed with the addition of a single dose of rectal ketoprofen. There were no differences in analgesic therapy between the groups. Pruritus was the most common adverse effect (18/20, 19/20 and 18/20 in groups I, II and III, respectively). 10/20, 12/20 and 14/20 (N.S.) patients had nausea and vomiting in groups I, II and III, respectively. Metoclopramide, prescribed for persistent nausea, was given to 4/20 patients in group I, 6/20 patients in group II and 9/20 patients in group III (N.S.). After removal of the urinary catheter 7/20 patient in group III required carbachol for urinary retention compared to 3/20 and 4/20 patients in groups I and II (N.S.).(ABSTRACT TRUNCATED AT 250 WORDS)

Urinary retention in the post‐partum period: The relationship between obstetric factors and the post‐partum post‐void residual bladder volume

“…tum (2). Epidural analgesia's effect on the urinary bladder and urinary retention has been well documented (1,2,8,9,10). Our study patients who had had episiotomy or long labor also had a higher rate of urinary retention, which has not been reported in other studies.…”

“…The regression analysis was performed with epidural analgesia controlled for several reasons. Epidural analgesia is already a well documented associated factor with post-partum urinary retention (1,2,8,9,10) and the intention of this study is to investigate other possible obstetric parameters associated with post-partum urinary retention. The number of patients in this study who had epidural analgesia was small (n= 19), and the majority of patients who had epidural analgesia also had urinary retention (10/19=52.6%).…”

Incidence of Early Postpartum Voiding Dysfunction in Primiparae: Comparison Between Vaginal Delivery and Cesarean Section

“…Risk factors that are associated with PPVD in the literature include: epidural analgesia/anesthesia, instrumental VD, prolonged labor, episiotomy or perineal tear, and infant's birth weight . The effect of epidural analgesia on the urinary bladder and urinary retention has been well documented . In out study, even though more women in the CS group had regional anesthesia than in the VD group (54.2% vs. 21.2%), more women in the VD group had early PPVD.…”

Morphine-associated pruritus after single extradural administration in a horse

“…Pruritus is a common complication of morphine administration in the extradural space in human beings, with a reported prevalence ranging from 8.5 to 90% (Ballantyne et al. 1988; Asantila et al. 1993).…”