Postcesarean Analgesia with Both Epidural Morphine and Intravenous Patient-Controlled Analgesia

Wittels, Bernard; Glosten, Beth; Faure, Eveline A. M.; Moawad, Atef H.; Ismail, Mahmoud; Hibbard, Judith U.; SENAL, JONATHAN A.; Cox, Suzanne M.; Blackman, Samuel C.; Karl, Leah; THISTED, DONALD A.

doi:10.1097/00132586-199810000-00026

Cited by 10 publications

(10 citation statements)

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“…Although opioid analgesics can be taken safely by lactating women, some opioids can result in significant exposures and toxicity in infants, 21 including the risk of neurobehavioural depression in the breastfed newborn. 22 Future research is needed to examine the ability of TAP block to reduce opioid metabolites in infant plasma. As a component of spinal anaesthesia, the superiority of post-Caesarean analgesia produced by long-acting spinal opioids over their systemic counterparts 18 19 makes them an integral part of multimodal analgesic regimens.…”

Section: Discussionmentioning

confidence: 99%

Transversus abdominis plane block for postoperative analgesia after Caesarean delivery performed under spinal anaesthesia? A systematic review and meta-analysis

Abdallah

Halpern

Margarido

2012

British Journal of Anaesthesia

180

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The transversus abdominis plane (TAP) block is a field block that provides postoperative analgesia for abdominal surgery. Its analgesic utility after Caesarean delivery (CD) remains controversial. This systematic review and meta-analysis examines whether TAP block can reduce i.v. morphine consumption in the first 24 h after CD. The authors retrieved randomized controlled trials comparing TAP block with placebo in CD. Postoperative i.v. morphine consumption during the first 24 h was selected as a primary outcome. Pain scores and both maternal and neonatal opioid-related side-effects were secondary outcomes. Where possible, meta-analytic techniques and random effects modelling were used to combine data. Trials were stratified based on whether or not spinal morphine was used as part of the analgesic regimen. Five trials including 312 patients were identified. TAP block reduced the mean 24 h i.v. morphine consumption by 24 mg [95% confidence interval (CI) -39.65 to -7.78] when spinal morphine was not used. TAP block also reduced visual analogue scale pain scores (10 cm line where 0 cm, no pain, and 10 cm, worst pain) by 0.8 cm (95% CI -1.53 to -0.05, P=0.01), and decreased the incidence of opioid-related side-effects. The differences in primary and secondary outcomes were not significant when spinal morphine was used. TAP block provides superior analgesia compared with placebo and can reduce the first 24 h morphine consumption in the setting of a multimodal analgesic regimen that excludes spinal morphine. TAP block can provide effective analgesia when spinal morphine is contraindicated or not used.

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Section: Discussionmentioning

confidence: 99%

Transversus abdominis plane block for postoperative analgesia after Caesarean delivery performed under spinal anaesthesia? A systematic review and meta-analysis

Abdallah

Halpern

Margarido

2012

British Journal of Anaesthesia

180

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“…[2][3][4] Also, neonates may be affected negatively by opiates administered to the mother; previous reports have shown depressed neurobe-havioral scores due to accumulation of opiates and their major metabolites in colostrum and breast milk when opiates were administered postpartum by the PCA technique. 11,12 Multimodal pain therapy has gained in popularity in the management of postoperative pain relief in different types of surgery. In fact, the combined use of different analgesics, which act through synergistic or additive mechanisms, may ensure a higher degree of pain relief while reducing side effects.…”

Section: Discussionmentioning

confidence: 99%

Diclofenac and/or propacetamol for postoperative pain management after cesarean delivery in patients receiving patient controlled analgesia morphine

Siddik

Aouad

Jalbout

et al. 2001

Regional Anesthesia and Pain Medicine

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“…Morphine is popular for intravenous patient-controlled analgesia in obstetrics 11 and is often used as a standard against which other interventions are evaluated. Fentanyl is also an appropriate systemic opioid, in contrast to pethidine, which is rarely used due to accumulation of its active metabolite in breastmilk and adverse effects on the newborn 62 . The combination of alfentanil and morphine may also hold advantages, especially in relation to speed of onset 63 .…”

Section: Intravenous Intramuscular and Subcutaneous Opioidsmentioning

confidence: 99%

Analgesia after Caesarean Delivery

McDonnell

Keating

Muchatuta

et al. 2009

Anaesth Intensive Care

108

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As the number of women giving birth by caesarean increases throughout most of the developed world, so too is research into postoperative pain relief for these women. Like most other post-surgical populations, the new mother needs effective pain relief so that she can mobilise early but she also has the added responsibility of needing to care for her newborn baby. There is no 'gold standard' for post-caesarean pain management; the number of options is large and the choice of method is at least partly determined by drug availability, regional and individual preferences, resource limitations and financial considerations. Most methods rely on opioids, supplemented with anti-inflammatory analgesics, nerve blocks or other adjunctive techniques. The aim of this review is to detail commonly used opioid-based methods and to review the evidence supporting non-opioid methods, when incorporated into a multimodal approach to post-caesarean pain management. Areas of promising research are also discussed.

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Postcesarean Analgesia with Both Epidural Morphine and Intravenous Patient-Controlled Analgesia

Cited by 10 publications

References 0 publications

Transversus abdominis plane block for postoperative analgesia after Caesarean delivery performed under spinal anaesthesia? A systematic review and meta-analysis

Transversus abdominis plane block for postoperative analgesia after Caesarean delivery performed under spinal anaesthesia? A systematic review and meta-analysis

Diclofenac and/or propacetamol for postoperative pain management after cesarean delivery in patients receiving patient controlled analgesia morphine

Analgesia after Caesarean Delivery

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