Intrathecal morphine as sole analgesic during labour.

Abstract

Summary and conclusionsIn 12 consecutive unselected patients admitted to a consultant maternity unit one single injection of subarachnoid morphine sulphate 15 mg abolished pain during the first stage of labour. Pain in the second stage was abolished in four patients and lessened in three. During the early puerperium, pain at the site of the episiotomy was much reduced. Side effects included itching of the face, nausea and vomiting, and frontal headache, but these were mild and simply treated. They were even less severe in the last four patients, in whom barbotage was not used in administering the morphine. The high rate of forceps delivery and caesarean section (three cases of each) was not thought to be associated with the use of intrathecal morphine.These findings show that intrathecal morphine can abolish the pain of labour, whether spontaneous or induced, while preserving the mother's full awareness of labour and her co-operation in the second and third stages of labour. Further, controlled, trials are warranted.

Itch elicited by intradermal injection of serotonin, intracisternal injection of morphine, and their synergistic interactions in rats

“…It is commonly prescribed for relief from pain, but side-effects, including severe itch, can limit the amount that be administered, and thus the effectiveness of morphine for producing analgesia. Opioid-induced pruritus is often localized to facial regions of patients (Scott et al, 1980; Baraka et al, 1982; Collier, 1981; Bromage et al, 1982), suggesting the value of using the rodent cheek model of itch to study this phenomenon. The highest incidence of opioid-induced pruritus in human patients (20–100%) occurs following intrathecal administration (Baraka et al,.…”

Addition of low-dose morphine to intrathecal bupivacaine/sufentanil labour analgesia: A randomised controlled study

“…13 In contrast, studies with higher doses of intrathecal morphine, between 250 lg and 1.5 mg, have shown an unacceptably high incidence of side effects. [1][2][3][4] The incidence of respiratory depression with different doses of intrathecal morphine in labour is unknown. In two prospective studies investigating post caesarean section analgesia the incidence was 0/856 with 200 lg morphine 17 and 5/1915 with 150 lg morphine.…”

“…The frequency of pruritus, nausea, vomiting and urinary retention were all high. 1 In a subsequent study side effects persisted despite lowering morphine doses to 0.5-1 mg, and drowsiness was reported in 33-50% of women. 2 Side effects are still a common problem when morphine 250 lg is used in combination with fentanyl 25 lg.…”

Clinical eperience of epidural fentanyl for labor pain

“…All infants tested were neurologically vigorous at 24 hours, that is the NACS were 35 or more (maximum score being 40). 4 until time of delivery. At the time of delivery, blood was drawn from a maternal vein and from the umbilical artery and vein of a doubly clamped segment of the umbilical cord for the analysis of blood gas tensions.…”

“…For example, Scott et a1. 4 and Abboud et al 5 reported that intrathecal administration of morphine eliminated the labor pain. In contrast Hughes et a1.…”