Epidural morphine for analgesia after Caesarean section: a report of 4880 patients

Fuller, John G.; McMorland, G. H.; Douglas, M. Joanne; Palmer, Lynne

doi:10.1007/bf03006481

Cited by 157 publications

(62 citation statements)

References 18 publications

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“…There were no incidence of backache, headache and drowsiness in our study, which was comparable to studies by Shaloo et al, Fuller JG et al and Escarment J et al 16,20,21 …”

Section: Discussionsupporting

confidence: 92%

Comparative study of intrathecal bupivacaine 0.5% with bupivacaine 0.5% and buprenorphine low dose for postoperative analgesia in lower abdominal surgeries

Rao¹,

Prakash²

2016

Int Surg J

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INTRODUCTIONPain is one of the most common and uncomfortable consequences of a surgery, feared by all. Effective and rapid relief from pain is always a challenge, but is necessary for alleviating nocioception -induced responses like endocrine metabolic responses to surgery, autonomic reflexes with adverse effects on organ function, reflexes leading to muscle spasm, and other undesirable results. 1 ABSTRACT Background: Opiods, like buprenorphine, have been widely used for providing pain relief postoperatively and their advantages of neuraxial narcotics over systemic narcotics are well established. When compared to local anaesthetics, they offer good analgesia while allowing early ambulation of the patient by sparing sympathetic and motor nerves. This study was conducted to compare the efficacy of bupivacaine alone and in combination with low dosage of buprenorphine. Methods: 80 patients between the ages 20-60 undergoing lower abdominal surgeries were divided into 2 groups of 40 each after taking detailed history and undergoing the necessary preliminary tests. Patients in the Group I was given 17.5mg of 0.5% Hyperbaric Bupivacaine along with 60ug of Buprenorphine. The patients in Group II received 17.5mg of 0.5% Hyperbaric Bupivacaine. Onset and duration of analgesia were recorded. The efficacy of analgesia was recorded based on VAS score. Side effects, time of recovery also were noted. Results: In this retrospective study we found that incidence of colorectal carcinoma is more between 40-60 years of age with male predominance; lymph node metastasis is more than metastasis in any other sites. CT scan can diagnose lymphatic metastasis and infiltration in surrounding tissue more accurately. Percentage of sphincter saving procedure was low in rectal malignancies in our study. Conclusions: The onset of analgesia was within 5 minutes in 100% of the cases in Group I while in Group II it was upto 9 minutes. The mean of the duration of analgesia was 15h 33mins and 3 h 18 mins in Group I and II respectively. The pain scoring through VAS in the 2 groups showed that most of the patients in Group I had 0 to mild pain till about 12 hours while in Group II the analgesic effect was felt only till the first 2 hours. The supplementary analgesic was required on Group II within 4 hours post operatively while in Group I the requirement was only after 12 hours. The major side effect among the patients was vomiting and nausea in 12 patients in Group I followed by urinary retention in 6 patients. While in Group II only 6 patients had nausea and no other side effect. Pruritis was observed in 1 patient in Group I Respiratory distress, drowsiness, headache and backache was not observed in any of the cases.

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“…There were no incidence of backache, headache and drowsiness in our study, which was comparable to studies by Shaloo et al, Fuller JG et al and Escarment J et al 16,20,21 …”

Section: Discussionsupporting

confidence: 92%

Comparative study of intrathecal bupivacaine 0.5% with bupivacaine 0.5% and buprenorphine low dose for postoperative analgesia in lower abdominal surgeries

Rao¹,

Prakash²

2016

Int Surg J

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“…The incidence of pruritis reported in previous studies varies considerably and is often only elicited on direct questioning. With morphine the incidence of pruritis ranges from 0% to 100% [2, 3, 5, 11, 13-15, 18, 21, 30, 31, 38] and is dose dependent [6,[29][30][31]. Previous studies have quoted incidences of pruritis for diamorphine 5.3-74% [10,39,49], fentanyl 5-75% [4, 5, 10, 13, 27, 35, 38-40, 42, 50], methadone 0-9% [14,17,33,34] and pethidine 13-59% [9,11,35,37,39].…”

Section: Discussionmentioning

confidence: 99%

“…The patients often received opioids by more than one route in the perioperative period and observations on side-effects were, in many cases, retrospective [1,[3][4][5][6][7].…”

mentioning

confidence: 99%

Side‐effects of epidural infusions of opioid bupivacaine mixtures

Gedney

Liu

1998

Anaesthesia

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SummaryThe incidence of side-effects occurring with epidural diamorphine (0.05 mg.ml ¹1 ), fentanyl (2.0 mg.ml ¹1 ), methadone (0.1 mg.ml ¹1 ), morphine (0.05 mg.ml ¹1 ) and pethidine (1.0 mg.ml ¹1 ) used by infusion in combination with bupivacaine has been compared. One hundred and sixty patients were studied, 32 receiving each opioid. The incidence of nausea and vomiting was significantly greater with morphine than fentanyl (p ¼ 0.0097) and pethidine (p ¼ 0.0021). The incidence of pruritis was significantly greater with morphine and diamorphine than with methadone (p ¼ 0.012) and pethidine (p ¼ 0.027). Morphine was also associated with a significantly greater incidence of urinary retention than pethidine (p ¼ 0.012) and methadone (p ¼ 0.025).

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“…2 The benefits in post-Caesarean mothers are already well documented,3-7 but this is the fin'st extensive Canadian report. Epidural morphine gave prolonged, effective analgesia for a mean of 23 hr, in doses from 2-5 mg. Eleven per cent of subjects needed no other pain relief for 48 hr (reflecting the experience of another large study, in which 16 per cent required no further analgesia before discharge, and oral analgesics sufficed as the only additional pain relief in 44 per cent), s Despite the cumulative clinical experience, which must number in excess of 10,000 women in Canada, some anaesthetists continue to question the safety and desirability ofEM, and prefer shorter-acting agents such as fentanyl, or alternative routes of delivery, such as intravenous PCA.…”

Section: "Among the Remedies Which It Has Pleased A Hnighty God To Gimentioning

confidence: 99%

Epidural morphine for post-Caesarean analgesia

Writer

1990

Can J Anaesth

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Epidural morphine for analgesia after Caesarean section: a report of 4880 patients

Cited by 157 publications

References 18 publications

Comparative study of intrathecal bupivacaine 0.5% with bupivacaine 0.5% and buprenorphine low dose for postoperative analgesia in lower abdominal surgeries

Comparative study of intrathecal bupivacaine 0.5% with bupivacaine 0.5% and buprenorphine low dose for postoperative analgesia in lower abdominal surgeries

Side‐effects of epidural infusions of opioid bupivacaine mixtures

Epidural morphine for post-Caesarean analgesia

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