Intrathecal morphine for Caesarean section: an assessment of pain relief, satisfaction and side‐effects

Abstract

SummarySevoflurane, desflurane and isoflurane were compared using a circle system in 97 patients undergoing short surgical procedures. Using initial high flows, the time intervals to equilibration between inspired and end-expired agent concentrations were measured; equilibration was defined as F E = F I 0:8. The mean (SD) times obtained for sevoflurane, desflurane and isoflurane were 8.2 (2.1) min, 3.8 (0.7) min and 19.7 (6.5) min, respectively. These times were significantly different from each other (p < 0:0001). After equilibration total flows were reduced to 500 ml.min ÿ 1 ; at these flows the initial decline in end-expired agent concentration was minimal with desflurane, intermediate with sevoflurane and greatest with isoflurane. Both desflurane and sevoflurane are appropriate for efficient use of the circle system during short anaesthetics.Keywords Anaesthetics, volatile; sevoflurane, desflurane, isoflurane. Equipment; breathing systems, circle, closed. ...................................................................................... Correspondence to: Dr N. Soni Accepted: 17 November 1996 In contrast to other anaesthetic breathing systems in common use, the circle system has the unique advantage of permitting anaesthesia with low fresh gas flows, thereby conferring physiological, economic and environmental benefits [1, 2]. In clinical practice, the important considerations when using circle systems are firstly the initial period of high gas inflow required to denitrogenate the lungs and attain an adequate alveolar anaesthetic concentration and subsequently the effective maintenance of this concentration during low flows. There is no general agreement as to what constitutes an adequate alveolar concentration before flows can be reduced. Low-flow anaesthesia is commonly instituted only after about 20 min at high flows, but this precludes the efficient use of the circle system for the large proportion of anaesthetics which are of short duration. (The term 'efficient' refers to a low value for the ratio of fresh gas flow to expired minute volume. This is obtained by flows classified minimal (250-500 ml.min ÿ 1 ) or low (500-1000 ml.min ÿ 1 ), using the terminology proposed by Simionescu [3].It has been shown that, when desflurane is used in the circle system, an adequate alveolar concentration, as indicated by end-expired (F E 0 ) desflurane concentration, is rapidly achieved [4]. This allows reduction of fresh gas flow after a very short time, with the end-expired desflurane concentration effectively maintained at flows of 500 ml.min ÿ 1 . In contrast, isoflurane takes longer for endexpired and inspired (F I ) concentrations to equilibrate [4], and after flow reduction end-expired isoflurane concentrations are poorly maintained. Sevoflurane has not been studied in this context, although its physical properties [5] suggest that it should behave similarly to desflurane. This study compares sevoflurane, desflurane and isoflurane for efficient use of the circle system during short anaesthetics. Me...

A Comparative Study Between Intrathecal Morphine and Intrathecal Buprenorphine for Post - Operative Analgesia Following Caesarian Section Under Sub Arachnoid Block

“…15 Buprenorphine, because of its high lipid solubility, high affinity for opiate receptors, 16 and prolonged duration of action seems to be suitable choice for intrathecal administration. Cellena D, Capoga G, 17 and Sunil Dixit, 18 described their experience with spinal buprenorphine for postoperative analgesia after caesarean section.…”

A Randomized Controlled Trial Comparing Two Multimodal Analgesic Techniques in Patients Predicted to Have Severe Pain After Cesarean Delivery

“…Median [IQR] total IV morphine PCA use did not differ between the control (15 mg) and intervention groups (15 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] mg; P = 0.92). Similarly, the total 24 hour opioid use, including fentanyl and oxycodone converted to morphine equivalents, a did not differ between groups (21 [11-37] mg and 15 mg in the control and intervention groups, respectively; P = 0.72).…”

“…The higher dose of spinal morphine chosen in this study and the additional doses of acetaminophen are considered to be within safe limits from previous studies and have a long history of efficacy and safety. [12][13][14][15] However, as a precaution, we excluded patients with signs or symptoms or risk of liver diseases and proscribed the delivery of other acetaminophen-containing drugs during the 24-hour study period to avoid exceeding the 4 g/24 h limit. The effectiveness of other agents such as oral gabapentin, used as a component of multimodal postoperative analgesic for acute and chronic pain in obstetric populations, is inconclusive and its use may result in significant sedation.…”

Définitions de la “dépression respiratoire” de l’analgésie postopératoire réalisée avec de la morphine intrathécale : une revue documentaire

“…40 This method is simple, non-invasive, and the patient is not inconvenienced. 104 While defining RD with bradypnea is superior to no definition whatsoever, it is considered to be an inadequate index of ventilatory depression. 4,10,15,27,81,[113][114][115] RR does not necessarily correlate with ITM dose, hypoxemia or depressed ventilatory response to CO 2 -stimulation.…”

“…118 However, the most practical and effective method for detecting hypoxemia and/or hypoventilation after ITM is unknown. 5,104 Perhaps the term "respiratory depression" should only be used for experimental situations, when there is a depressed ventilatory response to hypercapnia or hypoxemia. Then, a low RR would be better referred to as "bradypnea" and not "respiratory depression".…”