The Addition of 0.2 mg Subarachnoid Morphine to Hyperbaric Bupivacaine for Cesarean Delivery

Abouleish, Ezzat; Rawal, Narinder; Rashad, M. N.

doi:10.1097/00132586-199206000-00020

Cited by 28 publications

(34 citation statements)

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“…1~ However, respiratory depression is unlikely with the doses currently used. [2][3][4][5][6] Various authors have shown that NSAIDs can decrease the amount of other analgesic drugs required in the post-operative period. 11,12 The combination of opioids and NSAIDs may result in a synergistic action that provides satisfactory postoperative pain control.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 0.25 mg and 0.1 mg intrathecal morphine for analgesia after Cesarean section

Yang

Breen

Archer

et al. 1999

Can J Anesth/J Can Anesth

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Purpose: To test the hypothesis that O. I mg intrathecal morphine plus NSAIDs provides satisfactory analgesia post-Cesarean section with fewer side effects than 0.25 mg intrathecal morphine. Methods: Sixty women, scheduled for elective Cesarean section under spinal anesthesia, were randomized to receive either 0. I mg or 0.25 mg intrathecal morphine combined with hyperbaric bupivacaine 0.75% and 20/lg fentanyl. All patients received a I O0 mg indomethacin suppository at the end of surgery and 500 mg naproxen po b.i.d, was started the evening of surgery and continued until discharge. A blinded researcher recorded the pain, pruritus, and nausea scores, the time to first request for additional analgesics, a visual analogue scale (VAS) satisfaction score, and the use of additional opioids, antipruritics, and/or antiemetics. Results: Of the 60 patients enrolled, two were not included in the data analysis because of protocol violations leaving 30 patients in the 0. I mg group and 28 in the 0.25 mg group. There were no differences in the VAS pain scores or the number of women requesting an opioid other than codeine between the two groups. The VAS pruritus scores in the 0. I mg group were lower throughout the 24 hr (P < 0.001 ). Fewer women in the 0. I mg group (4/30 vs 12/28) requested nalbuphine'to treat itching (P = 0.018). Nausea scores were lower in the 0. I mg group (P < 0.00 I). Conclusion: The use of 0. I mg intrathecal morphine plus NSAIDs provides analgesia of similar quality to 0.25 mg but with fewer undesirable side effects following Cesarean section.Objectis : V&ifier I'hypoth~se qui veut que O, I mg de morphine intrath6cale combin~e ~ des AINS foumissent une analg&ie satisfaisante ~ la suite d'une c&arienne et moins d'effets secondaires que 0,25 mg de morphine intrath&ale. M~thode 9 Soixante femmes, admises pour une c&arienne planiti& sous rachianesth&ie et r~parties au hasard ont regu 0, I. mg ou 0,25 mg de morphine intrath&ale combin& ~ de la bupivacaine hyperbare 0,75 % et ~ 20 /~g de fentanyl. Toutes ont regu un suppositoire de 100 mg d'indom6thacine ~ la fin de I'op&ation et 500 mg de naproxEne po b.i.d. ~ partir du premier soir jusqu'au jour du d~part. Un anesth6.siologiste impartial a enregistr~ les scores de douleurs, de prurit et de naus~es, le temps avant la premiere demande d'analg&iques suppl~men-taires, le degrE de satisfaction ~ I'&helle visuelle analogue (EVA) et I'usage d'opidides, d'antiprurigineux et/ou d'anti6m&iques additionnels. l~.sultats : Des 60 patientes recrut&s, deux front pu participer ~ la cueillette de donn~es ~ cause de violations au protocole de recherche; il est restE 30 patientes clans le groupe de 0, I mg et 28 dans celui de 0,25 mg. II n'y a pas eu de diff&ence intergroupe pour les scores ~ I'EVA ou le nombre de femmes qui ant demand~ un opio'l'de autre que la cod6ine. Le degr6 de prurit fourni par I'EVA a 6t~ plus bas dans le groupe de 0, I mg pendant 24 h (P < 0,001). Moins de femmes du groupe de O, I mg (4/30 vs 12/28) ont demand6 de la nalbuphine contre le prurit (P ...

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Section: Discussionmentioning

confidence: 99%

Comparison of 0.25 mg and 0.1 mg intrathecal morphine for analgesia after Cesarean section

Yang

Breen

Archer

et al. 1999

Can J Anesth/J Can Anesth

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“…1,2 Intrathecal morphine provides an excellent long-lasting analgesia and the addition of morphine to spinal anesthesia has been used for postoperative analgesia after many surgical procedures. [3][4][5][6][7][8][9][10] Cunningham et al demonstrated that intrathecal morphine was effective for analgesia after TURP. 11 On the other hand, intrathecal morphine is often accompanied by adverse effects such as pruritus, nausea and respiratory depression.…”

Section: Méthode : L'étude Prospective Et à Double Insu Comportait 42mentioning

confidence: 99%

“…7,11 Therefore, lower doses of intrathecal morphine are widely used for analgesia following surgery to avoid late respiratory depression. 1,[3][4][5][6] However, intrathecal morphine is often associated with uncomfortable adverse effects, including pruritus and nausea. Recent studies evaluated the incidence or severity of these adverse effects and quality of analgesia to optimize the dose of intrathecal morphine.…”

Section: Méthode : L'étude Prospective Et à Double Insu Comportait 42mentioning

confidence: 99%

Mini-dose (0.05 mg) intrathecal morphine provides effective analgesia after transurethral resection of the prostate

Sakai

Use

Shimamoto

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To determine the optimal dose of intrathecal morphine that produces satisfactory analgesia with minimum side effects in elderly patients undergoing transurethral resection of the prostate (TURP). M Me et th ho od ds s: :In this double-blind prospective study, 42 patients undergoing TURP with spinal anesthesia were allocated to one of three groups. Group A (n = 14) received tetracaine, 10 mg, alone. Group B (n = 13) and Group C (n = 15) received morphine 0.05 mg and 0.10 mg, respectively, in combination with tetracaine. Postoperative pain, nausea and pruritus were evaluated using visual analogue scales (VAS). SpO 2 and respiratory rate were also assessed.R Re es su ul lt ts s: : At three, five, seven and 24 hr after spinal anesthesia, the VAS scores for pain in Groups B and C were significantly less than in Group A. Group C experienced significantly greater VAS scores for pruritus as compared to Groups A and B. There was no significant difference in the intensity of nausea among the three groups. No patient experienced hypoxemia (SpO 2 < 90%) and respiratory depression (respiratory rate < 10 beats·min -1 ) in any group. C Co on nc cl lu us si io on n: : A dose of 0.05 mg in intrathecal morphine with spinal anesthesia would be optimal for elderly patients undergoing TURP. Objectif : Déterminer la dose optimale de morphine intrathécale pour obtenir une analgésie satisfaisante et le moins d'effets secondaires possibles chez des patients âgés devant subir la résection transurétrale de la prostate (RTUP). Méthode : L'étude prospective et à double insu comportait Résultats : À trois, cinq et 24 h après la rachianesthésie, les scores de douleur à l'EVA ont été significativement plus bas dans les groupes B et C que dans le groupe A. Dans le groupe C, les patients ont eu des scores de prurit significativement plus élevés que ceux des groupes A et B. Il n'y a pas eu de différence intergroupe significative quant à l'intensité des vomissements. Aucun patient n'a souffert d'hypoxémie (SpO 2 < 90 %) ou de dépression respiratoire (fréquence respiratoire < 10 respirations·min -1 ). Conclusion : Une dose de 0,05 mg de morphine intrathécale combinée à la rachianesthésie serait optimale chez des patients âgés qui subissent une RTUP.FTER transurethral resection of the prostate (TURP), patients often suffer from pain caused by detrusor muscle spasm. 1,2 Intrathecal morphine provides an excellent long-lasting analgesia and the addition of morphine to spinal anesthesia has been used for postoperative analgesia after many surgical procedures. [3][4][5][6][7][8][9][10] Cunningham et al. demonstrated that intrathecal morphine was effective for analgesia after TURP. 11 On the other hand, intrathecal morphine is often accompanied by adverse effects such as pruritus, nausea and respiratory depression. Clinicians tend to use smaller doses to reduce the incidence of adverse effects. This study was carried out to examine the efficacy and adverse effects associated with low-dose intrathecal morphine in patients undergoi...

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“…With a dose of 300±400 mg, analgesia for 24 h or more is expected [5] cholecystectomy and spinal analgesia ............................................................................................................................................................................................................................................ respiratory depression while, with lower doses (100± 200 mg) [2,4,5], the duration of action is shorter (< 24 h) and similar to the duration of hospital stay after laparoscopic cholecystectomy. This dose is also convenient with regard to side-effects, especially respiratory depression, which is reported to occur only if doses > 200 mg are used [5].…”

Section: Discussionmentioning

confidence: 99%

Analgesic effect of low‐dose intrathecal morphine and bupivacaine in laparoscopic cholecystectomy

et al. 2000

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SummaryWe assessed the peri-operative analgesic ef®ciency of low-dose intrathecal morphine combined with a low dose of bupivacaine after elective laparoscopic cholecystectomy since postoperative pain in such procedures, although less than after a conventional open technique, may be signi®cant, particularly during the ®rst 12±24 h. After informed consent, 34 ASA I or II patients were randomly allocated to one of two groups to receive either a lumbar intrathecal injection of morphine (75 or 100 mg) combined with 5 mg of isobaric bupivacaine (spinal group) or a subcutaneous injection of a saline solution (control group). Intra-operatively, opioid requirements, blood pressure response and heart rate changes after insuf¯ation were recorded. Postoperatively, morphine requirements, pain scores and opioid-related side-effects were assessed by a physician blinded to the randomisation. Intra-operative opioid requirements did not differ signi®cantly between groups. Mean (SD) postoperative morphine requirements were signi®cantly lower in the spinal group [13 (10) vs. 23 (10) mg; p 0.04] as were postoperative pain scores (p < 0.001). Sideeffects were of comparable incidence and severity between groups. Low-dose intrathecal morphine combined with low-dose bupivacaine provided effective postoperative analgesia for elective laparoscopic cholecystectomy.

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The Addition of 0.2 mg Subarachnoid Morphine to Hyperbaric Bupivacaine for Cesarean Delivery

Cited by 28 publications

References 0 publications

Comparison of 0.25 mg and 0.1 mg intrathecal morphine for analgesia after Cesarean section

Comparison of 0.25 mg and 0.1 mg intrathecal morphine for analgesia after Cesarean section

Mini-dose (0.05 mg) intrathecal morphine provides effective analgesia after transurethral resection of the prostate

Analgesic effect of low‐dose intrathecal morphine and bupivacaine in laparoscopic cholecystectomy

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