Intrathecal diamorphine for analgesia after Caesarean sectionA dose finding study and assessment of side‐effects

Kelly, Mary; Carabine, U. A.; Mirakhur, R. K.

doi:10.1046/j.1365-2044.1998.00307.x

Cited by 67 publications

(29 citation statements)

References 26 publications

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“…Recent studies have shown diamorphine to be as effective as morphine for analgesia after surgery [8,9]. The optimum dose of diamorphine is between 0.25 and 0.375 mg, with more side-effects at the higher end of the dose range [20,21]. Patients receiving intrathecal diamorphine receive less supplemental analgesia during surgery [12,20].…”

Section: Discussionmentioning

confidence: 99%

“…The optimum dose of diamorphine is between 0.25 and 0.375 mg, with more side-effects at the higher end of the dose range [20,21]. Patients receiving intrathecal diamorphine receive less supplemental analgesia during surgery [12,20]. Furthermore, Husaini demonstrated a decrease in unwanted side-effects with diamorphine, especially pruritus [8].…”

Section: Discussionmentioning

confidence: 99%

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A comparison of intrathecal fentanyl and diamorphine as adjuncts in spinal anaesthesia for Caesarean section

et al. 2005

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SummaryThis randomised controlled trial examines the effects of fentanyl and diamorphine, alone and in combination, as adjuncts to spinal anaesthesia for Caesarean section. Ninety-nine women undergoing elective Caesarean section with spinal anaesthesia using 0.5% hyperbaric bupivacaine were randomly allocated to receive fentanyl 15 lg (F), diamorphine 0.25 mg (D), or fentanyl 15 lg plus diamorphine 0.25 mg (FD), intrathecally. All women received morphine via a patient controlled analgesia system after surgery. There was no significant difference between the groups in time to achieve a block, discomfort, ephedrine use, nausea and vomiting, pruritus and sedation during surgery. Significant differences were observed in morphine consumption 4, 8, 12 and 24 h after surgery between both F and D groups, and F and FD groups, and also at 2 h between F and FD groups. There was a significant difference in pruritus at 4 h between the F and FD group. Our results suggest that diamorphine alone provides optimum benefits during and after surgery, when used in combination with hyperbaric bupivacaine for Caesarean section. Since the discovery of opiate receptors in the brain and spinal cord, the use of intrathecal opioids has become common practice as an effective method of analgesia. No area has utilised this knowledge more than obstetric anaesthesia and the benefits of intrathecal opioids as adjuncts in anaesthesia for Caesarean section (LSCS) are well documented.The use of intrathecal fentanyl as an adjunct during surgery in LSCS has many advantages, namely, improving the quality of spinal anaesthesia [1][2][3] and decreasing the time to establish the block [1]. The use of fentanyl has also been shown to have a bupivacaine-sparing effect [4,5] and therefore leads to fewer episodes of hypotension during surgery.In contrast, the lipophobic opiate morphine has many beneficial effects of its own. Many studies have shown that intrathecal morphine can produce excellent analgesia after surgery [6,7], and it is therefore often used in combination with fentanyl.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A comparison of intrathecal fentanyl and diamorphine as adjuncts in spinal anaesthesia for Caesarean section

et al. 2005

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“…In a doubleblind study of primigravidae, epidural diamorphine has been found to effective for pain relief in labour [29]. Diamorphine has been used after Caesarean section for analgesia [30], and has been found to be safe in a double-blind study of patients undergoing Caesarean section with pain scores and other adverse effects reduced in a dose-dependent manner by intrathecal diamorphine [31]. It is an indication of the relaxed attitude of British physicians to diamorphine that it is also used with newborn infants and with children.…”

Section: Discussionmentioning

confidence: 99%

The Unique Role of Diamorphine in British Medical Practice: A Survey of General Practitioners and Hospital Doctors

et al. 2005

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Aims: Diamorphine (heroin) is one of the longest established medications with a 130-year history. In British medicine diamorphine is sometimes used as a maintenance treatment for opiate addiction but is also routinely used in clinical practice to treat a number of general medical conditions. These uses are very different but are often confused by observers of the British system. The routine clinical use of diamorphine in medicine is unique to the UK, but this is not well known outside the UK. The present study investigates the use of diamorphine to treat medical conditions by general practitioners and by hospital doctors. Method: In a survey of 141 medical practitioners who had prescribed diamorphine for the treatment of a medical condition, data were collected on conditions prescribed for, numbers of patients, dosage, routes of administration, duration of treatment, worries about prescribing diamorphine and observed adverse effects. Findings: Many doctors had prescribed diamorphine to a large number of patients. The four main conditions for which diamorphine had been prescribed in the previous year were myocardial infarction, palliative care, pulmonary oedema, and post-operative pain. More than half of the sample (57%) reported no reservations about prescribing diamorphine. Of the doctors (n = 60, 43%) who expressed worries, this was most often about possible problems of respiratory depression or respiratory arrest. Respiratory arrest/failure was also the most frequent observed adverse effect. Relatively few doctors reported worries about addiction. Conclusions: Although diamorphine was widely used and most doctors regarded it as a useful medication, there remains insufficient research information about current clinical practice. At a time when diamorphine may be coming under increased scrutiny, more detailed information is required of its uses and applications.

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“…18,19 In addition, when inducing spinal anaesthesia in the sitting position, the specific technique, the drugs used and their doses are critical otherwise there is considerable potential for the spinal to fail. [20][21][22] Such critical reliance on the technicalities is much less important when a lateral position is used.…”

Section: Sitting Position and Anaesthetist Harmmentioning

confidence: 99%

Routine use of the sitting position for spinal anaesthesia should be abandoned in obstetric practice

Russell

2008

International Journal of Obstetric Anesthesia

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Intrathecal diamorphine for analgesia after Caesarean sectionA dose finding study and assessment of side‐effects

Cited by 67 publications

References 26 publications

A comparison of intrathecal fentanyl and diamorphine as adjuncts in spinal anaesthesia for Caesarean section

A comparison of intrathecal fentanyl and diamorphine as adjuncts in spinal anaesthesia for Caesarean section

The Unique Role of Diamorphine in British Medical Practice: A Survey of General Practitioners and Hospital Doctors

Routine use of the sitting position for spinal anaesthesia should be abandoned in obstetric practice

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