title: A two-dose epidural morphine regimen for cesarean section patients: therapeutic efficacy.
abstract: A single dose of epidural morphine (EM) usually produces 24 h of post-cesarean section (CS) analgesia and patients require supplemental analgesics beyond this period. This study assesses if a second dose of EM administered 24 h after the first one offers superior therapeutic efficacy compared to conventional analgesics. Patients (n = 100) were randomized to receive one or two doses of epidural morphine. In all patients, EM 5 mg was administered after delivery. After 24 h patients received epidurally either normal saline (n = 50, Group 1) or morphine 5 mg (n = 50, Group 2). An independent observer used a visual analogue scale to assess nausea, itching, and analgesia 24 h after each injection. Results were expressed as mean +/- 1 s.e. mean and analyzed using nonparametric methods. The second dose of EM produced a significantly lower incidence and severity of nausea and itching than did the first dose (P < 0.01) in Group 2 with no difference in analgesia. The second day postoperative pain score in Group 1 was significantly greater than the first day score in the same group, and significantly greater than the severity score in Group 2. Only 36% of patients receiving two doses of EM required supplemental analgesics beyond 48 h compared to 76% of those receiving one dose (P < 0.01). No serious complications were noted. In summary, the use of a second dose of EM for post-CS analgesia produces better analgesia and reduces the need for oral analgesics. The second dose produced fewer side-effects, probably due to acute tolerance to morphine.
authors.affiliation: Department of Anesthesiology, New York University Medical Center, New York.
authors.forename: M I
authors.initials: MI
authors.lastname: Zakowski
authors.forename: S
authors.initials: S
authors.lastname: Ramanathan
authors.forename: H
authors.initials: H
authors.lastname: Turndorf
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D002585:Cesarean Section / Q000009:adverse effects; D005260:Female; D006801:Humans; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009325:Nausea / Q000517:prevention & control; D010098:Oxycodone / Q000008:administration & dosage / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D011247:Pregnancy; D011537:Pruritus / Q000517:prevention & control; D012965:Sodium Chloride; D013997:Time Factors
chemical_list: D012965:Sodium Chloride; D009020:Morphine; D010098:Oxycodone