Randomized study of postcesarean analgesia with intrathecal morphine alone or combined with clonidine

Carvalho, Francisco Amaral Egydio de; Tenório, Sérgio Bernardo; Shiohara, Fabiano T.; Maia, L.R.; Mota, Angela

doi:10.1016/j.jclinane.2016.04.024

Cited by 10 publications

(5 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A total of 145 studies were included, of which 126 were randomised controlled trials and 19 were systematic reviews and meta‐analyses (Fig. 1) [9–153]. The methodological quality assessments of the 126 randomised controlled trials included in the final qualitative analysis are summarised in online Supporting Information Table S1.…”

Section: Resultsmentioning

confidence: 99%

“…Ten trials evaluated the neuraxial administration of ɑ2‐agonists such as clonidine and dexmedetomidine [48–57]. A meta‐analysis showed that neuraxial clonidine increased the duration and quality of analgesia and reduced morphine consumption [48].…”

Section: Resultsmentioning

confidence: 99%

“…No improvements in analgesia were reported with intrathecal or i.v. clonidine, whether administered alone [49] or in combination with intrathecal morphine [50]. One study demonstrated the superiority of intrathecal clonidine to intrathecal fentanyl [51].…”

Section: Resultsmentioning

confidence: 99%

“…Ten trials evaluated the neuraxial administration of ɑ2agonists such as clonidine and dexmedetomidine [48][49][50][51][52][53][54][55][56][57].…”

Section: Neuraxial Adjuvant Drugsmentioning

confidence: 99%

See 3 more Smart Citations

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

View full text Add to dashboard Cite

Caesarean section is associated with moderate-to-severe postoperative pain, which can influence postoperative recovery and patient satisfaction as well as breastfeeding success and mother-child bonding. The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after elective caesarean section under neuraxial anaesthesia. A systematic review utilising procedure-specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language between 1 May 2014 and 22 October 2020 evaluating the effects of analgesic, anaesthetic and surgical interventions were retrieved from MEDLINE, Embase and Cochrane databases. Studies evaluating pain management for emergency or unplanned operative deliveries or caesarean section performed under general anaesthesia were excluded. A total of 145 studies met the inclusion criteria. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, recommendations include intrathecal morphine 50-100 µg or diamorphine 300 µg administered pre-operatively; paracetamol; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone administered after delivery. If intrathecal opioid was not administered, single-injection local anaesthetic wound infiltration; continuous wound local anaesthetic infusion; and/or fascial plane blocks such as transversus abdominis plane or quadratus lumborum blocks are recommended. The postoperative regimen should include regular paracetamol and non-steroidal anti-inflammatory drugs with opioids used for rescue. The surgical technique should include a Joel-Cohen incision; non-closure of the peritoneum; and abdominal binders. Transcutaneous electrical nerve stimulation could be used as analgesic adjunct. Some of the interventions, although effective, carry risks, and consequentially were omitted from the recommendations. Some interventions were not recommended due to insufficient, inconsistent or lack of evidence. Of note, these recommendations may not be applicable to unplanned deliveries or caesarean section performed under general anaesthesia.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Ten trials evaluated the neuraxial administration of ɑ2agonists such as clonidine and dexmedetomidine [48][49][50][51][52][53][54][55][56][57].…”

Section: Neuraxial Adjuvant Drugsmentioning

confidence: 99%

See 2 more Smart Citations

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Clonidine has been shown to improve pain, reduce morphine consumption, decrease PONV, reduce postoperative shivering, and improve hemodynamic and sympathetic stability 259 – 264 . However, there are also published studies which have contradicted these findings 72 , 265 – 268 . Some also reported higher Ramsay sedation scores with clonidine 266 .…”

Section: Perioperative Antiemetic Drugs Used For the Treatment And/ormentioning

confidence: 99%

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

et al. 2020

View full text Add to dashboard Cite

Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor to both PONV and PDNV after surgery. PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal activities of daily living after discharge home, and increase medical costs. The high incidence of PONV and PDNV has persisted despite the introduction of many new antiemetic drugs (and more aggressive use of antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of PONV should be tailored to the patient’s risk level using the validated PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the perioperative period. A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In addition to utilizing prophylactic antiemetic drugs, the management of perioperative pain using opioid-sparing multimodal analgesic techniques is critically important for achieving an enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of PONV (e.g. adequate hydration and the use of nonpharmacologic antiemetic and opioid-sparing analgesic techniques) and implementing multimodal antiemetic and analgesic regimens will reduce the likelihood of patients developing PONV and PDNV after surgery.

show abstract

Correspondence in relation to article by Carvalho FA et al. “randomized study of postcesarean analgesia with intrathecal morphine alone or combined with clonidine”

Bhakta

2017

Journal of Clinical Anesthesia

View full text Add to dashboard Cite

Randomized study of postcesarean analgesia with intrathecal morphine alone or combined with clonidine

Cited by 10 publications

References 42 publications

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

Correspondence in relation to article by Carvalho FA et al. “randomized study of postcesarean analgesia with intrathecal morphine alone or combined with clonidine”

Contact Info

Product

Resources

About