[Morphine analgesia by the intrathecal route].
30 patients for whom an epidural injection using local anaesthesia was hazardous (deformed spine) or contra-indicated (allergic to local anaesthetic agents) received an injection of 0.008 mg cm-1 of morphine chlorhydrate intrathecally. Residual pain scored from 0 to 5 was 2.5 after 10 minutes and 1.5 after 25 minutes. Thereafter there was only a simple ache which was well tolerated right up to the time of delivery. Uterine action was not changed, which allowed 27 labours to be completed vaginally, of which 23 were without forceps. There was no haemodynamic change or respiratory depression, either immediately of later, in the mother nor in the infant (there were 26 Apgar scores of 9 or more). The ratio of plasma concentrations of morphine between the mother and the fetus using radio-immunological assays was inverted as time passed. These were at 6 mg ml-1 or less, which explains the medullary characteristic of the analgesia and the absence of general repercussions. The safety that is offered by the poor diffusion of substance between the fetus and the mother and the ability to prevent secondary effects (pruritus and headache) are features that make intrathecal analgesia and interesting alternative to a conduction block in labour.
D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D000818:Animals; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007278:Injections, Spinal; D008297:Male; D008431:Maternal-Fetal Exchange; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D011247:Pregnancy; D014590:Uterine Contraction
D009020:Morphine
Analgésie morphinique par voie intrathécale au cours de l'accouchement.