Intrathecal morphine reduces breakthrough pain during labour epidural analgesia

Vasudevan, Anasuya; Snowman, C.E.; Sundar, Siyam; Sarge, Todd; Hess, Philip E.

doi:10.1093/bja/ael346

Cited by 30 publications

(13 citation statements)

References 13 publications

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“…During dilatation, there was no significant difference in pain control but satisfaction was worse among women in the CSEA group because they were experiencing discomfort owing to adverse effects of the intrathecal morphine (nausea, pruritus, drowsiness) as compared with LEA patients. During delivery, pain control was better among women in the CSEA group because they had the epidural component in use at that point in time, blocking breakthrough pain as previously described [24].…”

Section: Discussionmentioning

confidence: 56%

Effect of combined spinal–epidural analgesia versus epidural analgesia on labor and delivery duration

Pascual-Ramírez

Haya

Pérez‐López

et al. 2011

Intl J Gynecology & Obste

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Section: Discussionmentioning

confidence: 56%

Effect of combined spinal–epidural analgesia versus epidural analgesia on labor and delivery duration

Pascual-Ramírez

Haya

Pérez‐López

et al. 2011

Intl J Gynecology & Obste

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“…Opioid rotation and co-administration have been used to enhance pain relief and limit these side effects 28,44 . Although animal studies report additive antinociceptive effects when morphine and fentanyl are co-administered 5,39 , clinical research indicates that the analgesic efficacy of co-administered morphine and fentanyl is greater than administration of either opioid alone 28,47 . This effect appears to be the result of maintained fentanyl potency despite the development of tolerance to morphine 42 .…”

Section: Introductionmentioning

confidence: 99%

Lack of Antinociceptive Cross-Tolerance With Co-Administration of Morphine and Fentanyl Into the Periaqueductal Gray of Male Sprague-Dawley Rats

Bobeck

Schoo

Ingram

et al. 2019

The Journal of Pain

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Tolerance to the antinociceptive effect of mu-opioid receptor (MOPr) agonists, such as morphine and fentanyl, greatly limits their effectiveness for long-term use to treat pain. Clinical studies have shown that combination therapy and opioid rotation can be used to enhance opioid-induced antinociception once tolerance has developed. The mechanism and brain regions involved in these processes are unknown. The purpose of this study was to evaluate the contribution of the ventrolateral periaqueductal gray (vlPAG) to antinociceptive tolerance and cross-tolerance between administration and coadministration of morphine and fentanyl. Tolerance was induced by pretreating rats with morphine or fentanyl or low-dose combination of morphine and fentanyl into the vlPAG followed by assessment of cross-tolerance to the other opioid. In addition, tolerance to the combined treatment was assessed. Cross-tolerance did not develop between repeated vlPAG microinjections of morphine and fentanyl. Likewise, there was no evidence of cross-tolerance from morphine or fentanyl to co-administration of morphine and fentanyl. Co-administration did not cause cross-tolerance to fentanyl. Crosstolerance was only evident to morphine or morphine and fentanyl combined in rats pretreated with co-administration of low-doses of morphine and fentanyl. In conclusion, cross-tolerance does not develop between morphine and fentanyl within the vlPAG. This finding is consistent with the functionally selective signaling that has been reported for antinociception and tolerance following morphine and fentanyl binding to the MOPr. This research supports the notion that combination therapy and opioid rotation may be useful clinical practices to reduce opioid tolerance and other side effects. Perspective: This preclinical study shows that there is a reduction in cross tolerance between morphine and fentanyl within the periaqueductal gray which is key brain region in opioid antinociception and tolerance.

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“…Furthermore, loss of lower limb and pelvic muscle power can affect the bearing-down reflex and result in labor muscle relaxation. Moreover, the recommended doses of opioids have shown variable value in labor pain control in all settings [4]. …”

Section: Introductionmentioning

confidence: 99%

Reduction in labor pain by intrathecal midazolam as an adjunct to sufentanil

Salimi¹,

Nejad²,

Safari³

et al. 2014

Korean J Anesthesiol

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BackgroundAnesthesia today has strived to decrease labor pain in a tolerable and controllable fashion. Intrathecal midazolam has been introduced as an adjunct to analgesics. The study was planned to assess the efficacy, safety and duration of analgesia produced by intrathecal midazolam adjunct to sufentanil in decreasing labor pain.MethodsIn a randomized clinical trial 80 parturient included in the study. The two groups were matched for age, cervical dilation, gravid, gestational age, and other demographic characteristics. Combination of sufentanil and midazolam administered intrathecally to experimental group and compared to sufentanil group. Time to reach maximum block, and pain score was measured and recorded.ResultsGroups were matched for age and weight and other demographic characteristic. No significant adverse effect was seen in both groups including decrease in Apgar score. Duration of analgesia was 92.0 ± 12.7 in sufentanil group and 185.2 ± 15.2 minutes in midazolam and sufentanil group which was significantly different (P = 0.002). Numeric rating scale score was significantly lower in midazolam group compare to sufentanil group at 120 min (P = 0.01), 150 min (P = 0.0014), and 180 min (P = 0.001).ConclusionsIntrathecal midazolam as an adjunct to opioid could significantly enhance analgesia in labor pain with no significant adverse effect. Intrathecal injection of midazolam is an appropriate alternative to parenteral or epidural analgesia in small hospital settings.

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Intrathecal morphine reduces breakthrough pain during labour epidural analgesia

Abstract: The addition of small dose of morphine to the spinal component of the CSE technique improved the effectiveness of epidural labour analgesia and reduced the need for pain medications over 24 h, but resulted in a small increase in nausea.

Cited by 30 publications

References 13 publications

Effect of combined spinal–epidural analgesia versus epidural analgesia on labor and delivery duration

Effect of combined spinal–epidural analgesia versus epidural analgesia on labor and delivery duration

Lack of Antinociceptive Cross-Tolerance With Co-Administration of Morphine and Fentanyl Into the Periaqueductal Gray of Male Sprague-Dawley Rats

Reduction in labor pain by intrathecal midazolam as an adjunct to sufentanil

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