title: Effect of subarachnoid morphine on the incidence of spinal headache.
abstract: OBJECTIVE
  The addition of fentanyl to hyperbaric local anesthetics has been shown to reduce the incidence of post dural puncture headache in the obstetric patient. This study was undertaken to evaluate the effects of subarachnoid morphine on the incidence of headache.
  
  
  METHODS
  Eighty-two healthy patients undergoing cesarean delivery with spinal anesthesia were studied. All patients were hydrated with 1500 ml lactated Ringer's solution. Patients were randomly assigned to receive, in a double-blind fashion, 0.2 mg of either morphine (Group 1, n = 40) or saline (Group 2, n = 42) in 0.2 ml volume mixed with 0.75% bupivacaine in 8.25% dextrose plus 0.2 ml 1:1000 epinephrine. Spinal anesthesia was induced using a 25-gauge spinal needle at L3-4 interspace with the bevel, in most cases, parallel to the dural fibers. Patients were followed for three days to evaluate the incidence and severity of headache using a four-category rank scale (none, mild, moderate, severe). Data were analyzed for statistical significance using Student's t-test or chi-square test as appropriate. A p value less than 0.05 was considered significant. Results. The incidence of post dural puncture headache did not differ significantly between groups. Eight patients in Group 1 versus nine patients in Group 2 developed headache (p greater than 0.05). Similarly, the use of blood patch or intravenous caffeine sodium benzoate to treat the headache did not differ significantly between groups.
  
  
  CONCLUSIONS
  It is concluded from our study that subarachnoid morphine did not decrease the incidence of post dural puncture headache in the obstetric patient.
authors.affiliation: Department of Anesthesiology, Los Angeles County-University of Southern California Medical Center 90033.
authors.forename: T K
authors.initials: TK
authors.lastname: Abboud
authors.forename: J
authors.initials: J
authors.lastname: Zhu
authors.forename: A
authors.initials: A
authors.lastname: Reyes
authors.forename: H
authors.initials: H
authors.lastname: Miller
authors.forename: Z
authors.initials: Z
authors.lastname: Steffens
authors.forename: K
authors.initials: K
authors.lastname: Afrasiabi
authors.forename: A
authors.initials: A
authors.lastname: Afrasiabi
authors.forename: G
authors.initials: G
authors.lastname: Sherman
authors.forename: B
authors.initials: B
authors.lastname: Emershad
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D004311:Double-Blind Method; D005260:Female; D006261:Headache / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D009020:Morphine / Q000008:administration & dosage* / Q000627:therapeutic use; D011247:Pregnancy; D013129:Spinal Puncture / Q000009:adverse effects*; D013346:Subarachnoid Space; D014481:United States / Q000453:epidemiology
chemical_list: D009020:Morphine