Epidural Narcotic and Patient-controlled Analgesia for Post-cesarean Section Pain Relief

Harrison, D. M.; Sinatra, Raymond S.; Morgese, L.; Chung, James H.

doi:10.1097/00000542-198803000-00025

Cited by 205 publications

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“…Analgesia and respiratory depression are mediated by Mu receptors, whereas analgesia and sedation are mediated by kappa receptors. The analgesia provided by epidural morphine is more complete than that provided by other routes of administration 25…”

Section: Discussionmentioning

confidence: 98%

“…The analgesia provided by epidural morphine is more complete than that provided by other routes of administration. 25 The majority of studies suggest that using a combination of local anesthetics and opioids after lower or upper abdominal, 26 orthopedics, 27 and thoracic 28 procedures results in much greater dynamic pain alleviation than using just 1 component of the mixture. In some investigations, adjuvant drugs (ketamine 29 and clonidine 30 ) were added to the local anesthetic-opioid combination.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Combined Epidural Morphine and Midazolam on Postoperative Pain in Patients Undergoing Major Abdominal Cancer Surgery

Abdelemam

Fares

Kamal

2022

The Clinical Journal of Pain

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Objective: The objective was to compare analgesic effect of combined epidural morphine-midazolam with either drug alone on postoperative pain in patients undergoing major abdominal cancer surgery. Materials and Methods: Eighty-four patients were allocated in prospective randomized double-blind study to receive epidural analgesia. Patients received 5 mg morphine in morphine (Mor) group, 5 mg midazolam in midazolam (Mid) group, 5 mg morphine + 5 mg midazolam in morphine-midazolam (MM) group, 0.25% bupivacaine was added to injected solution with same volume in all groups. All groups were compared with time of first analgesic request, total analgesic consumption, number of epidural doses, postoperative Visual Analog Scale score, and adverse events. Results: Time of first analgesic request was 4 to 8 hours in Mid versus 12 to 23 and 14 to 24 hours in Mor and MM groups, respectively, with significant difference between Mid versus Mor (P<0.001), Mid versus MM (P<0.001), and Mor versus MM groups (P<0.031). Analgesic consumption was more in Mid than Mor and MM groups, with significant difference between Mid versus Mor (P<0.008), Mid versus MM (P<0.001), with no significant difference between Mor and MM groups (P<0.6). The number of epidural doses in Mid was 1 to 3 versus 1 to 3, and 1 to 2 in Mor and MM groups, respectively, with significant difference between Mid versus Mor (P<0.025), Mid versus MM (P<0.004), with no significant difference between Mor and MM groups (P=1.0). Conclusions: Addition of midazolam to epidural morphine prolonged time of first analgesic request and decreased total analgesic consumption.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Effect of Combined Epidural Morphine and Midazolam on Postoperative Pain in Patients Undergoing Major Abdominal Cancer Surgery

Abdelemam

Fares

Kamal

2022

The Clinical Journal of Pain

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“…At any age group, adequate analgesia in postoperative pain management is a primary aim of treatment and opioids are the cornerstone of the analgesic plan. On the some older studies showed that epidural opioids provide better postoperative analgesia compared to IV route (Eisenach et al 1988, Harrison et al 1988), other older studies have shown these two routes to be equally effective (Camann et al 1992, Camu & Debucquoy 1991, Ellis et al 1990, Glass et al 1992, Loper et al 1990).…”

Section: Systemic Versus Epidural Analgesic Therapy Of Acute Postoper...mentioning

confidence: 99%

Could epidural analgesia be safely used for acute postoperative pain in older adults to enhance recovery?

Shawqi

Mohamed

Hetta

2022

Journal of Perioperative Practice

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Epidural analgesia is often considered cornerstone in multimodal analgesia when used in major surgeries. However, its role in managing acute postoperative pain in elderly patients is debatable because of its known potential complications. Furthermore, postoperative pain in elderly patients is under-treated because of complex comorbidities, and they are more prone to adverse events related to pain therapies. All systemic analgesic drugs have pharmacological limitations and precautions in elderly people. Recent meta-analyses showed that epidural analgesia provided better postoperative pain control compared to intravenous opioids. Interestingly, peripheral nerve blocks had no superior control of pain over epidural analgesia. In addition, epidural analgesia has shown to positively affect perioperative morbidities and mortalities, and reduce opioid-related side effects because of its non-analgesic effects on each organ system. When tailored in a specific multimodal approach, it shortens the intensive care and hospital stays. In conclusion, if complications are identified and treated early, and contraindications are ruled out, epidural analgesia can achieve sufficient postoperative pain management with insignificant adverse events in this population.

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“…Literature Findings: Randomized controlled trials comparing epidural opioids with intermittent injections of IV or intramuscular opioids report improved postoperative analgesia for epidural opioids after cesarean delivery (Category A2-B evidence) [200][201][202][203][204][205][206] ; meta-analysis of RCTs report equivocal findings for nausea, vomiting, and pruritus (Category A1-E evidence). [200][201][202][203][204][206][207][208][209][210][211] RCTs report improved postoperative analgesia when PCEA is compared with IV patient-controlled analgesia (Category A2-B evidence) with equivocal findings for nausea, vomiting, pruritus, and sedation (Category A2-E evidence). 208,211 Survey Findings: The consultants and ASA members strongly agree that for postoperative analgesia after neuraxial anesthesia for cesarean delivery, selecting neuraxial opioids rather than intermittent injections of parenteral opioids should be considered.…”

Section: Neuraxial Opioids For Postoperative Analgesiamentioning

confidence: 99%

Practice Guidelines for Obstetric Anesthesia

Apfelbaum¹,

Hawkins²,

Agarkar³

et al. 2016

Anesthesiology

499

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Epidural Narcotic and Patient-controlled Analgesia for Post-cesarean Section Pain Relief

Cited by 205 publications

References 0 publications

Effect of Combined Epidural Morphine and Midazolam on Postoperative Pain in Patients Undergoing Major Abdominal Cancer Surgery

Effect of Combined Epidural Morphine and Midazolam on Postoperative Pain in Patients Undergoing Major Abdominal Cancer Surgery

Could epidural analgesia be safely used for acute postoperative pain in older adults to enhance recovery?

Practice Guidelines for Obstetric Anesthesia

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