Intrathecal administration of morphine for elective Caesarean section

Milner, A. R.; Bogod, David; Harwood, R. J.

doi:10.1111/j.1365-2044.1996.tb12622.x

Cited by 110 publications

(49 citation statements)

References 5 publications

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“…Other limitations possibly include the dose of intrathecal morphine. The dose chosen was standard in our institution; however, there is evidence to suggest that 100 lg of intrathecal morphine may be the optimal dose in the obstetric population, as doses greater than 100 lg may offer no benefit in terms of analgesia, but increase the incidence of side-effects [9,24]. The peri-operative management of patients was not standardised.…”

Section: Discussionmentioning

confidence: 99%

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Subcutaneous naloxone for the prevention of intrathecal morphine induced pruritus in elective Caesarean delivery*

Lockington

Fa'aea

2007

Anaesthesia

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SummaryThe aim of this study was to assess the antipruritic efficacy of subcutaneous naloxone following intrathecal morphine administration. Fifty women undergoing elective Caesarean section using spinal anaesthesia were randomly allocated, in a double-blind study design, to receive either naloxone 400 lg or placebo as a subcutaneous injection at the end of surgery. Spinal anaesthesia was performed using 0.5% hyperbaric bupivacaine, 25 lg fentanyl and 150 lg of preservative-free morphine sulphate. The primary outcome measures were: incidence of pruritus, nausea and vomiting, and quality of analgesia. The incidence of pruritus and nausea and vomiting was not significantly different between the two groups. There was also no significant difference in postoperative analgesia between the two groups. We conclude that pruritus, following intrathecal fentanyl 25 lg and preservative-free morphine sulphate 150 lg, is not reduced by the addition of naloxone 400 lg administered subcutaneously on the completion of surgery.

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Section: Discussionmentioning

confidence: 99%

“…However, in the obstetric population, between 8% and 72% of patients can be expected to need some form of pharmacological intervention to treat pruritus when intrathecal morphine is given in the dose range of 100-200 lg [5,9,10].…”

mentioning

confidence: 99%

Subcutaneous naloxone for the prevention of intrathecal morphine induced pruritus in elective Caesarean delivery*

Lockington

Fa'aea

2007

Anaesthesia

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“…With a dose of 300±400 mg, analgesia for 24 h or more is expected [5] cholecystectomy and spinal analgesia ............................................................................................................................................................................................................................................ respiratory depression while, with lower doses (100± 200 mg) [2,4,5], the duration of action is shorter (< 24 h) and similar to the duration of hospital stay after laparoscopic cholecystectomy. This dose is also convenient with regard to side-effects, especially respiratory depression, which is reported to occur only if doses > 200 mg are used [5].…”

Section: Discussionmentioning

confidence: 99%

Analgesic effect of low‐dose intrathecal morphine and bupivacaine in laparoscopic cholecystectomy

et al. 2000

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SummaryWe assessed the peri-operative analgesic ef®ciency of low-dose intrathecal morphine combined with a low dose of bupivacaine after elective laparoscopic cholecystectomy since postoperative pain in such procedures, although less than after a conventional open technique, may be signi®cant, particularly during the ®rst 12±24 h. After informed consent, 34 ASA I or II patients were randomly allocated to one of two groups to receive either a lumbar intrathecal injection of morphine (75 or 100 mg) combined with 5 mg of isobaric bupivacaine (spinal group) or a subcutaneous injection of a saline solution (control group). Intra-operatively, opioid requirements, blood pressure response and heart rate changes after insuf¯ation were recorded. Postoperatively, morphine requirements, pain scores and opioid-related side-effects were assessed by a physician blinded to the randomisation. Intra-operative opioid requirements did not differ signi®cantly between groups. Mean (SD) postoperative morphine requirements were signi®cantly lower in the spinal group [13 (10) vs. 23 (10) mg; p 0.04] as were postoperative pain scores (p < 0.001). Sideeffects were of comparable incidence and severity between groups. Low-dose intrathecal morphine combined with low-dose bupivacaine provided effective postoperative analgesia for elective laparoscopic cholecystectomy.

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“…The NSAIDs improve analgesia and allow a smaller dose of morphine to be used, decreasing the side effects. [58][59][60][61] While diphenhydramine was used by more than 50% of anesthesiologists to treat pruritus following neuraxial opioids, evidence suggests that nalbuphine is a better choice. [62][63][64] Anesthesia after delivery General anesthesia without an endotracheal tube was often used for manual removal of a retained placenta (Table XXI) -a very curious finding as most parturients in the immediate postpartum period are still considered "full stomach patients."…”

Section: Analgesia After Cesarean Deliverymentioning

confidence: 99%

Obstetric anesthesia practice in Canada

Breen

McNeil

Dierenfield

2000

Can J Anesth/J Can Anesth

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Purpose: To describe obstetric anesthesia in Canada as practiced in 1997: to identify practices at variance with the literature and the opinions of experts: and to identify questions for future research.Methods: In 1997, a detailed postal questionnaire asking about the practice of obstetric anesthesia was mailed to all 1,539 specialist anesthesiologist members of the Canadian Anaesthetists' Society residing in Canada. Nonresponders were mailed a second questionnaire three months later.Results: There were 865 completed questionnaires returned for analysis (56.2%). Of these, 522 anesthesiologists practiced obstetric anesthesia (60.3%). The data were subdivided into those from anesthesiologists with a full or part-time university based practice (40.1%) and those from a community based practice (59.9%). University based and community-based anesthesiologists have very similar patterns of practice. Specific areas where anesthesia practice was different from current recommendations included: (1) information provided when obtaining consent for labour epidural analgesia, (2) use of opioids and local anesthetics for initiation of epidural analgesia, (3) use of coagulation testing in preeclampsia, (4) the common use of cutting spinal needles, (5) use of neuraxial morphine and nonsteroidal anti-inflammatory agents after Cesarean deliveries, (6) optimal treatment of neuraxial opioid side effects, (7) when to insert an endotracheal tube for general anesthesia after delivery, and (8) withdrawing epidural catheters through epidural needles.Conclusions: This survey presents reference data on the practice of obstetric anesthesia in Canada in 1997. Anesthesiologists with university affiliation have very similar practices to those without university affiliations.Objectif: Décrire l'anesthésie obstétricale pratiquée au Canada en 1997; identifier les pratiques qui diffèrent des pratiques documentées et des opinions d'experts et proposer des sujets de recherches ultérieures.Méthode : En 1997, un questionnaire détaillé sur la pratique de l'anesthésie obstétricale a été posté aux 1 539 anesthésiologistes membres de la Société canadienne des anesthésiologistes résidant au Canada. Trois mois plus tard, un second questionnaire a été posté à ceux qui n'avaient pas encore répondu.Résultats : Il y a eu 865 questionnaires remplis et analysés (56,2 %). De ce nombre, 522 provenaient d'anesthé-siologistes pratiquant l'anesthésie obstétricale (60,3 %). Les données ont été subdivisées selon le lieu de pratique, en milieu universitaire à temps complet ou partiel (40,1 %) ou en d'autres centres (59,9 %). Les modèles de pratique étaient très similaires. Certaines activités spécifiques différaient des recommandations courantes : 1) l'information fournie pour obtenir le consentement à l'analgésie épidurale pendant le travail, 2) l'usage d'opioïdes et d'anesthésiques locaux pour amorcer l'analgésie épidurale, 3) l'utilisation d'épreuve de coagulation en préé-clampsie, 4) l'usage courant d'aiguilles rachidiennes tranchantes, 5) l'administration neuraxiale...

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Intrathecal administration of morphine for elective Caesarean section

Abstract: SummaryThis study conzpared

Cited by 110 publications

References 5 publications

Subcutaneous naloxone for the prevention of intrathecal morphine induced pruritus in elective Caesarean delivery*

Subcutaneous naloxone for the prevention of intrathecal morphine induced pruritus in elective Caesarean delivery*

Analgesic effect of low‐dose intrathecal morphine and bupivacaine in laparoscopic cholecystectomy

Obstetric anesthesia practice in Canada

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