Epidural morphine for analgesia after caesarean section

Abstract

A randomized double blind placebo controlled study of the efficacy, duration and safety of epidural morphine for the management of pain after Caesarean section is reported. Three similar groups of patients received either 0, 4 mg or 8 mg of morphine sulphate in 10 ml of normal saline through an epidural catheter at the completion of the operation. Compared to the saline controls, both the 4 mg and 8 mg epidural morphine groups had significant pain relief as judged by an analogue pain scale (p < 0.001), the time to the first administration of narcotic analgesics (p < 0.001) and the amount of supplemental analgesic required in the first 36 hours after operation (p < 0.001). The side effects occurred in a dose-dependent fashion. Two patients who received epidural morphine 8 mg plus additional narcotic or antihistamine had reduced respiratory rates but were easily rousable. Our experience suggests that the epidural administration of morphine 4 mg may be a safe and reliable method of obtaining prolonged analgesia following Caesarean section.

Hypertonic Saline as a Resuscitation Solution in Hemorrhagic Shock

“…Our results showed that it is possible to improve postoperative analgesia significantly with 5-10 mg of epidural morphine when compared to parenteral opiates given every 4 hr (control group), confirming other work testing this comparison in dose-response studies (3,4,9). This impression was supported by the observation in control patients that after knee replacement the onset of perioperative pain occurred earlier, the 24-hr parenteral narcotic requirements were greater, and the VASHR was higher than it was after femoral-popliteal bypass.…”

“…Patients evidenced a significantly lower VASHR, and more patients required no supplemental parenteral narcotic analgesia. In our patients we did not observe the profound respiratory depression that has been reported by others (3,9,13,14). We cannot determine from our data whether the 10-mg dose was more effective than the 5-mg dose due to an increased duration or to improved receptor occupancy.…”

“…However, some studies have found that 2 mg was adequate (5,9). However, some studies have found that 2 mg was adequate (5,9).…”

“…Since that time, numerous studies have been carried out using epidural administration of opiates in a broad dose range (0.5-20 mg morphine) with varying results (2). Few controlled studies have been done (3)(4)(5)(6)(7)(8)(9) and none have determined the effective dose of epidurally administered opiates for patients with different intensities of postoperative pain. Only two of the controlled studies have assessed their ability to provide a continuum of analgesia from the intraoperative period to the immediate (24 hr) postoperative period (4,9).…”

Analgesic Efficacy of Pfannenstiel Incision Infiltration with Ropivacaine 7.5 mg/mL for Caesarean Section

“…From the 1980s morphine has been used by epidural injection after Caesarean section in doses from 2 to 8 mg [28, 29]. However epidural administration of morphine frequently leads to pruritis, nausea, and vomiting, even with doses <1,25 mg [28–30].…”