Obstetric pain relief using epidural morphine

Booker, Peter D.; Wilkes, R. G.; Bryson, T.H.L.; Beddard, J.B.

doi:10.1111/j.1365-2044.1980.tb05123.x

Cited by 57 publications

(9 citation statements)

References 8 publications

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“…Naguib [89] made a reply to this study, affirming that it is widely known that opioids by epidural means are of little use in childbirth [90] and it is therefore little wonder that ketamine was shown to be of minimal effectiveness. Nonetheless, morphine and ketamine have been found to function well in the control of postoperative pain [83,85,91].…”

Section: Epidural Administrationmentioning

confidence: 81%

The epidural and intrathecal administration of ketamine

Beltrutti

Trompeo

Santo

1999

Current Review of Pain

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An overview of the spinal administration of ketamine is presented. Ketamine acts as a noncompetitive antagonist of the NMDA receptor Ca(++ channel pore. This effect provides interesting possibilities in pain therapy. However, there are still contrasting results that seem to be due to a lack of comparative controlled studies. The presence of systemic and neurotoxic effects presently limits clinical use).

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Section: Epidural Administrationmentioning

confidence: 81%

The epidural and intrathecal administration of ketamine

Beltrutti

Trompeo

Santo

1999

Current Review of Pain

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“…This method of analgesia would be particularly attractive for use in labour since the absence of sympathetic and motor block would obviate the major disadvantages of conventional epidural analgesia and the small dose of morphine would be unlikely to cause neonatal depression. But low dosage (2 mg) epidural morphine does not provide adequate relief of labour pain (Husemeyer et al, 1980;Magora et al, 1980) and although higher dosages (2.5-4 mg) may be more effective, the analgesia is unpredictable and there is a high incidence of vomiting and facial itching (Booker et al, 1980). Epidural pethidine has also been claimed to provide good analgesia although the effective dosages reported have been higher than the equivalent of 2 mg of morphine (Cousins et al, 1979).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Epidural and Intramuscular Pethidine for Analgesia in Labour

Husemeyer¹,

Davenport

Cummings

et al. 1981

BJOG

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Summary Analgesia mediated by a direct spinal action of narcotic drugs administered via the epidural route may have considerable advantages over conventional (conduction block) epidural analgesia in labour. The efficacy, mode of action and placental transfer of epidurally administered narcotics in labour has not yet been established. We have compared the systemic absorption, analgesia and other effects on the mothers and transfer of drug to the fetus in primigravidae who received epidural or intramuscular pethidine 100 mg in labour. The superior analgesia following epidural pethidine did not appear to be attributable to a selective spinal action but rather to higher plasma concentrations of pethidine together with a possible weak regional conduction block due to local anaesthetic action of 1 % pethidine solution. Epidural pethidine is not an advantageous method for providing analgesia in labour.

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“…In contrast, epidural morphine was effective in controlling postoperative pain with duration of relief of up to24 h reported, e Tile effitca~ 3, epidural ketaraine in controlling postoperative pain has also been reported. 9-l t Nevertheless, the small number of patients (4) reported by Schneider and Diltoer is insufficient to draw any conclusion regarding the efficacy of ketaraine, since variability in the duration of analgesia has been observed with epidural ketamine. 9"12 Furthermore, the unpleasant side effects observed couM be attributed to the relatively targe doses of kemmlne 02-60 rag) administered over a short period of time (45-60 rain).…”

Section: Rag) Provided Satisfaclory Analgesia For Six Hours In 66 Permentioning

confidence: 99%

Continuous epidural infusion of ketamine during labour

Schneider¹,

Diltoer²,

Naguib

1987

Can J Anaesth

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Continuous epidural infusion of ketamine during labourTo the Editor: Naguib et al. reported the successful use of a small epidural dose of ketamine for postoperative analgesia.1 Systemic side effects, motor block, vasoplegia or respiratory depression were not observed. Knowing that ketamine is a safe drug for use during labour, a we decided to evaluate the usefulness of a continuous epidural infusion of ketamine for obstetrical pain relief. Four primiparae, ASA physical status I, requesting pain relief during normal early labour were studied. The study was approved by the University Committee and informed consent was obtained from each patient. In two cases an epidural catheter was inserted at the L3-L4 level. A bolus of 30 mg ketamine hydrochloride in IO ml saline was given, immediately followed by a continuous infusion of 30 mg ketamine/10 ml saline/hour. In the two other cases one catheter was inserted at the L~-L-z level and a second at L,-Ls. A solution of 30 mg ketamine in 3 ml saline was administered through the top catheter, immediately followed by a continuous infusion of 30 mg ketamined3 ml saline/hour. The second catheter was intended for use in the second and third stages of labour. Pain scores were obtained using a linear analogue pain scale. Blood pressure, heart rate and respiratory frequency were monitored.None of the patients reported adequate analgesia at any time during the study. The administration of local anaesthetics was necessary within 45 to 60 minutes, due to insufficient analgesia. Furthermore, all patients complained of blurred vision, felt unpleasant and had mood changes.Although we did not sludy a large number of patients, epidural ketamine does not seem to be appropriate for pain relief during labour. Analgesia appears to be insufficient and is accompanied by undesired systemic side effects which seem to be unrelated to the epidurally infused quantity of ketamine.

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Obstetric pain relief using epidural morphine

Cited by 57 publications

References 8 publications

The epidural and intrathecal administration of ketamine

The epidural and intrathecal administration of ketamine

Comparison of Epidural and Intramuscular Pethidine for Analgesia in Labour

Continuous epidural infusion of ketamine during labour

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