The Efficacy of 2 Doses of Epidural Morphine for Postcesarean Delivery Analgesia

Singh, Sudha; Rehou, Sarah; Marmai, K.; Jones, Philip M.

doi:10.1213/ane.0b013e31829cfd21

Cited by 43 publications

(27 citation statements)

References 13 publications

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“…However, it is not only associated with side effects, including nausea, vomiting, pruritus and respiratory depression, but also with an analgesic ceiling effect (19). Singh et al (20) reported that compared with two 3-mg doses of epidural morphine, two 1.5-mg doses of epidural morphine produced equivalent effects on post-cesarean pain with fewer side effects, when used as part of a multimodal analgesia regimen. Epidural morphine alone is not sufficient Values are expressed as the mean ± standard deviation or n (%).…”

Section: Discussionmentioning

confidence: 99%

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Yang

Song

et al. 2020

Exp Ther Med

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The aim of the present study was to evaluate the effectiveness and safety of the combination of epidural dexmedetomidine and morphine in providing anesthesia during cesarean surgery and analgesia for post-cesarean pain relief when added to epidural ropivacaine. A total of 80 females at term scheduled for elective cesarean delivery were randomly assigned to two groups (n=40/group): In the morphine group (group M), patients received an epidural injection of 0.75% ropivacaine (12 ml) and morphine (2 mg) for surgical anesthesia, and epidural infusion of morphine (2 mg) in 100 ml 0.2% ropivacaine at 2 ml/h for 48-h post-operative analgesia; and in the morphine combined with dexmedetomidine group (group DM), patients received an epidural injection of 0.75% ropivacaine (12 ml) and morphine (2 mg) combined with dexmedetomidine (0.5 µg/kg) for surgical anesthesia, and epidural infusion of morphine (2 mg) and dexmedetomidine (200 µg) in 100 ml 0.2% ropivacaine at 2 ml/h for 48-h post-operative analgesia. The primary outcomes included blockade and analgesic effects, sedation and adverse reactions associated with the drugs. Neonatal outcome was also assessed by determining the Apgar score and umbilical cord blood analysis. There was no significant difference between the groups in the cephalad levels of sensory blockade at 20 min post-injection, or in muscle relaxation scores or pain intensity scores at rest or upon movement at 4, 12, 24 or 48 h post-injection (P>0.05). The maternal patients in the DM group experienced more complete motor blockade at 20 min post-injection, better sedation during surgery and following delivery, and less visceral pain caused by peritoneal traction during surgery and by uterine contraction after delivery, compared with those in group M (P<0.05). The patients in group M had a lower incidence and severity score of post-operative nausea than those in the DM group (P<0.05). There was no significant difference between the groups in terms of Apgar score or umbilical cord blood gas values (P>0.05). In conclusion, epidural dexmedetomidine reduces intra-operative and post-operative visceral pain and produces better sedation during surgery and following delivery, without any significant influence on morphine-associated side effects and post-operative analgesia, in females undergoing elective cesarean section under epidural anesthesia with morphine and ropivacaine (registration number ChiCTR1900027942; retrospectively registered with the Chinese Clinical Registry Center on December 6, 2019).

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Section: Discussionmentioning

confidence: 99%

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Yang

Song

et al. 2020

Exp Ther Med

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“…Twelve of the 32 units added morphine to the epidural local anaesthesia, the most common dose was 2 mg. Singh et al found epidural morphine at 1.5 mg provided none-inferior post caesarean analgesia and caused fewer adverse effects compared with 3 mg epidural morphine 20 . Still the majority of responding units decided not to add morphine in epidural analgesia for CS postoperative analgesia.…”

Section: Discussionmentioning

confidence: 99%

Neuraxial opioids as analgesia in labour, caesarean section and hysterectomy: A questionnaire survey in Sweden

2017

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Background: Neuraxial opioids improve labour analgesia and analgesia after caesarean section (CS) and hysterectomy. Undesirable side effects and difficulties in arranging postoperative monitoring might influence the use of these opioids. The aim of the present survey was to assess the use of intrathecal and epidural morphine in gynaecology and obstetrics in Sweden. Methods: A questionnaire was sent to all anaesthetic obstetric units in Sweden concerning the use and postoperative monitoring of morphine, sufentanil and fentanyl in spinal/epidural anaesthesia. Results: A total of 32 of 47 (68%) units responded representing 83% of annual CS in Sweden. In CS spinal anaesthesia, 20/32 units use intrathecal morphine, the most common dose of which was 100 μg (17/21). Intrathecal fentanyl (10-20 μg) was used by 21 units and sufentanil (2.5 -10 μg) by 9/32 of the responding units. In CS epidural anaesthesia, epidural fentanyl (50-100 μg) or sufentanil (5-25 μg) were commonly used (25/32), and 12/32 clinics used epidural morphine, the majority of units used a 2 mg dose. Intrathecal morphine for hysterectomy was used by 20/30 units, with 200 μg as the most common dose (9/32). Postoperative monitoring was organized in adherence to the National Guidelines; the patient is monitored postoperative care or an obstetrical ward over 2-6 hours and up-to 12 hours in an ordinary surgical ward. Risk of respiratory depression/difficult to monitor was a reason for not using intrathecal opioids. Conclusions: Neuraxial morphine is used widely in Sweden in CS and hysterectomy, but is still restricted in some units because of the concern for respiratory depression and difficulties in monitoring.

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“…The authors found the 1.5 mg of epidural morphine to be equally efficacious and associated with lower incidence of nausea and pruritus. [11]…”

Section: Intrathecal and Epidural Opioidsmentioning

confidence: 99%

Post-caesarean analgesia: What is new?

2017

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The Efficacy of 2 Doses of Epidural Morphine for Postcesarean Delivery Analgesia

Abstract: When used as part of a multimodal analgesia regimen, 1.5 mg epidural morphine provided noninferior postcesarean analgesia and caused fewer adverse effects compared with 3 mg epidural morphine.

Cited by 43 publications

References 13 publications

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Neuraxial opioids as analgesia in labour, caesarean section and hysterectomy: A questionnaire survey in Sweden

Post-caesarean analgesia: What is new?

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