Opioid Antagonist Adjuncts to Epidural Morphine for Postcesarean Analgesia

Wittels, Bernard; Glosten, Beth; Faure, Eveline A. M.; Moawad, Atef H.; Ismail, Mahmoud; Hibbard, Judith U.; Amundsen, Laurie B.; Binstock, Wendy; Senal, Jonathon A.; Cox, Suzanne M.; Blackman, Samuel C.; Karl, Leah; Thisted, Ronald A.

doi:10.1213/00000539-199311000-00009

Cited by 43 publications

(10 citation statements)

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“…In fact, the prophylactic administration of buprenorphine was recommended for the prevention of such side effects produced by pure agonist opioids such as morphine, and it was also effectively used for the treatment of intractable pruritus associated with dermatological conditions. [1213] In our study the incidence of nausea and vomiting was lower in the buprenorphine group than in the bupivacaine group, but the differences were not found to be significant. A lower incidence of nausea and vomiting in the buprenorphine group could be due to lower doses of buprenorphine in comparison of other studies.…”

Section: Discussioncontrasting

confidence: 61%

Comparative analgesic efficacy of buprenorphine or clonidine with bupivacaine in the caesarean section

Agarwal

Agrawal

et al. 2010

Indian J Anaesth

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The need for early ambulation for caring of the neonate by mothers makes postoperative pain management after cesarean delivery unique. Favorable results have been observed with buprenorphine, clonidine and bupivacaine as epidural analgesics. This prospective, randomised triple blind control study was carried out among 112 lower segment caesarean segment (LSCS) patients, divided into three groups, to assess the analgesic efficacy and side effects of epidural analgesia, with an intermittent top up of (i) bupivacaine (0.125%) and buprenorphine (0.075 mg) (ii) bupivacaine (0.125%) and clonidine (37.5 microgram) and (iii) bupivacaine (0.125%) alone, in LSCS cases. The demographic characteristics (age, weight and height) of the three groups were comparable and the differences were not statistically significant. The mean duration of the analgesia was significantly longer in the group one patients receiving buprenorphine plus bupivacaine (690 ± 35 minutes) and it was lowest in group three patients receiving bupivacaine (170 ± 31 minutes) alone. The mean highest pain score (VAS scale) was significantly lower (3.4 ± 0.6) in group one patients and it was highest in group three (6.7 ± 0.8) patients. Requirement of continuation of epidural analgesia after 15 hours of operation and requirement of diclonfenac injections as well as incidence of itching and pruritus was significantly lower in group one patients. Incidence of nausea and vomiting was the lowest in group one patients. Incidence of respiratory depression, sedation and hypotension were nil in all three group of patients. Epidural buprenorphine combined with bupivacaine produced significantly longer duration and better quality of analgesia than bupivacaine combined with clonidine or bupivacaine alone, and it was safe in LSCS patients, for post-operative analgesia.

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Section: Discussioncontrasting

confidence: 61%

Comparative analgesic efficacy of buprenorphine or clonidine with bupivacaine in the caesarean section

Agarwal

Agrawal

et al. 2010

Indian J Anaesth

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“…In the Sandie and Heindel (1999) study, only 6% could identify the side‐effects of local anaesthetics and only 5% the side‐effects of opioids. Other studies cite the incidence of pruritus from 62% to 93%, nausea up to 80% and vomiting up to 55%, in patients receiving epidural opioids (Wittels et al . 1993).…”

Section: Discussionmentioning

confidence: 99%

Nursing knowledge and assessment skills in the management of patients receiving analgesia via epidural infusion

Bird

Wallis

2002

Journal of Advanced Nursing

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The results of this study indicated that the nurses' theoretical knowledge outweighed their clinical skill performance and clinical decision-making. Education for nurses regarding the management of epidural infusions needs to be comprehensive, context specific and have the capacity to develop the nurse's autonomous critical thinking and clinical decision-making skills. Strategies for this include self-directed learning packages best supplemented by a demonstration of clinical skills and supervised practice.

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“…This approach is supported by previous studies. [142030] Additionally, diphenhydramine, ondansetron, and phenergan were administered on an as-needed basis. To avoid urinary retention, Foley catheters were placed intraoperatively and maintained for at least 36 hours.…”

Section: Resultsmentioning

confidence: 99%

“…[21] Nevertheless, although epidural narcotic analgesia provides superior pain control when compared with intravenous opioids alone,[2] disadvantages include the need for an in-dwelling epidural catheter, re-dosing, and the risk of respiratory depression. [246111319222530]…”

Section: Introductionmentioning

confidence: 99%

Randomized trial demonstrates that extended-release epidural morphine may provide safe pain control for lumbar surgery patients

Offley¹,

Coyne²,

Horodyski³

et al. 2013

Surg Neurol Int

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Background:Safe and effective postoperative pain control remains an issue in complex spine surgery. Spinal narcotics have been used for decades but have not become commonplace because of safety or re-dosing concerns. An extended release epidural morphine (EREM) preparation has been used successfully in obstetric, abdominal, thoracic, and extremity surgery done with epidural anesthesia. This has not been studied in open spinal surgery.Methods:Ninety-eight patients having complex posterior lumbar surgery were enrolled in a partially randomized clinical trial (PRCT) of low to moderate doses of EREM. Surgery included levels from L3 to S1 with procedures involving combinations of decompression, instrumented arthrodesis, and interbody grafting. The patients were randomized to receive either 10 or 15 mg of EREM through an epidural catheter placed under direct vision at the conclusion of surgery. Multiple safety measures were employed to prevent or detect respiratory depression. Postoperative pain scores, narcotic utilization, and adverse events were recorded.Results:There were no significant differences between the two groups as to supplemental narcotic requirements, pain scores, or adverse events. There were no cases of respiratory depression. The epidural narcotic effect persisted from 3 to 36 hours after the injection.Conclusion:By utilizing appropriate safety measures, EREM can be used safely for postoperative pain control in lumbar surgery patients. As there was no apparent advantage to the use of 15 mg, the lower 10 mg dose should be used.

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Opioid Antagonist Adjuncts to Epidural Morphine for Postcesarean Analgesia

Cited by 43 publications

References 0 publications

Comparative analgesic efficacy of buprenorphine or clonidine with bupivacaine in the caesarean section

Comparative analgesic efficacy of buprenorphine or clonidine with bupivacaine in the caesarean section

Nursing knowledge and assessment skills in the management of patients receiving analgesia via epidural infusion

Randomized trial demonstrates that extended-release epidural morphine may provide safe pain control for lumbar surgery patients

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