Epidural Morphine after Caesarean Section

Abstract

Morphine sulphate 5 mg and placebo administered epidura//y after caesarean section under epidural analgesia were compared in a double-blind fashion. Morphine was significantly superior to placebo for pain relief, duration of pain relief, and reduction of parenteral narcotic requirements. Pruritis was the most commonly encountered sideeffect. There was no statistical difference between morphine and placebo in the incidence of urinary catheterisation, vomiting, nausea, dizziness or drowsiness. No serious respiratory depression requiring treatment was observed.

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.…”

“…The local anaesthetics used were bupivacaine 0.5% (Eisenach et al, 1988; Rapp‐Zingraff et al, 1997) or 0.75% (Cohen and Woods, 1983; Coombs et al, 1982; Rosen et al, 1983), or lidocaine 2% with epinephrine (Carmichael et al, 1982; Celleno et al, 1991; Harrison et al, 1988; Palmer et al, 2000; Rosen et al, 1983) or chloroprocaine (Youngstrom et al, 1982). EM injection was performed before surgery, concomitantly with the local anaesthetic injection (Celleno et al, 1991; Coombs et al, 1982), 10–20 min after the last epidural injection of local anaesthetic for surgery (Youngstrom et al, 1982), at the time of umbilical cord clamping (Harrison et al, 1988), just after delivery (Eisenach et al, 1988; Palmer et al, 2000), at the time of skin closure (Carmichael et al, 1982), as the patients were admitted to the recovery room (Rapp‐Zingraff et al, 1997), at the first patient's complain of pain (Rosen et al, 1983), or 1 h after the end of surgery (Cohen and Woods, 1983).…”

Pharmacokinetic aspects of spinal morphine analgesia

“…i.m. (RAWAL et al 1981, GUSTAFSSON et al 1982b, LANZ et a1 1982, JENSEN et a1 1982, BINSTED 1983. The overall epidural morphine requirements have been reported to be 1/5th t o l/lOth of the intramuscular requirements (HOLLAND et a1 1981, REIZ et a1 1981, KLINCK & LINDOP 1982.…”

“…Yet, favourable results have also been demonstrated with a lumbar approach of epidural administration for thoracic postoperative pain (WELCH & HRYNASZKIEWICZ 1981, SHULMAN et a1 1983. Epidural opiates have been administered in volumes varying between 5 and 20 rnl (BINSTED 1983, SHUL-MAN et a1 1983.…”

Grand Mal Seizure After Extradural Morphine Analgesia

“…Recent reports indicate that effective and prolonged pain relief can be obtained in man by the injection of small doses of morphine or pethidine into either the subarachnoid [3] or the extradural space [4]. As a result, extradural morphine analgesia is being used increasingly by clinicians [5,6], especially in obstetrics and gynaecology [7]. Side effects attributed to extradural morphine are common, possibly dose-related and include nausea and vomiting, pruritus, urinary retention and (more rarely) early and late respiratory depression [8].…”