A Comparison of Epidural and Intramuscular Morphine in Patients Following Cesarean Section

Analgesic efficacy and adverse effects of epidural morphine compared to parenteral opioids after elective caesarean section: A systematic review

“…Nine trials were not selected: six were non‐randomized studies (Crawford, 1981; Donchin et al, 1981; Kanto et al, 1985; Kotelko et al, 1984; Lim et al, 2005; Smith et al, 1991), and three others were retrospective studies (Chadwick and Ready, 1988; Cohen et al, 1991; Fuller et al, 1990). Eleven other studies were also excluded for the following reasons: use of two different doses of EM in the same group of patients (Pan and James, 1994), repeated EM injections (Cade and Ashley, 1993; Cade et al, 1992; Daley et al, 1990), epidural administration of sustained‐release morphine (Carvalho et al, 2005b, 2007) no analysis of postoperative pain and morphine adverse effects (Brooks et al, 1983; Choi et al, 1989), per‐protocol‐analysis including less than 80% of the patients (Binsted, 1983), CS and other surgical procedures confounded (Writer et al, 1985), elective CS and emergency CS confounded (Chambers et al, 1983). Finally, 10 randomized studies evaluating the analgesic and adverse effects of EM after elective CS were included in this meta‐analysis (Fig.…”

Ventilatory effects of epidural clonidine during the first 3 hours after caesarean section

“…The dose of 10 mg of parenteral morphine was chosen because, firstly, it is a popular method of analgesia after caesarean section in France and, secondly, a recent study suggested that a dose of 5 mg of parenteral morphine may not be sufficient as a loading dose to start postoperative analgesia after caesarean section (20). The onset of analgesia occurred within 15 to 20 min following the injection of either subcutaneous morphine or epidural clonidine.…”

Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuraxial Opioid Administration

“…[6][7][8][9][10][11][12][13] Additional RCTs comparing single-injection epidural opioids with intravenous opioids report inconsistent findings regarding respiratory depression, respiratory failure, somnolence, or sedation (Category A2-E evidence). [6][7][8][9][10][11][12][13] Additional RCTs comparing single-injection epidural opioids with intravenous opioids report inconsistent findings regarding respiratory depression, respiratory failure, somnolence, or sedation (Category A2-E evidence).…”