title: Postcesarean analgesia with both epidural morphine and intravenous patient-controlled analgesia: neurobehavioral outcomes among nursing neonates.
abstract: Among nursing parturients after cesarean delivery, intravenous patient-controlled analgesia (PCA) with meperidine is associated with significantly more neonatal neurobehavioral depression than PCA with morphine. A single dose of epidural morphine (4 mg) decreases postcesarean opioid analgesic requirements and may reduce or prevent neonatal neurobehavioral depression associated with PCA meperidine. Prospectively, 102 term parturients underwent cesarean delivery with epidural anesthesia, 2% lidocaine and epinephrine 1:200,000. After umbilical cord clamping, each patient received epidural morphine 4 mg and was randomly allocated to receive either PCA meperidine or PCA morphine. Initial neonatal characteristics, included gestational age, Apgar scores, weight, and umbilical cord gas partial pressures. Brazelton Neonatal Behavioral Assessment Scale (NBAS) examinations were performed on each of the first 4 days of life. Nursing infants (n = 47) were grouped according to maternal PCA opioid in breast milk (meperidine [n = 24] or morphine [n = 23]); bottle-fed infants (n = 56) served as the control group. The three infant groups were equivalent with respect to initial characteristics and NBAS scores on the first 2 days of life. On the third day of life, infants in the morphine group were significantly more alert and oriented to animate human cues compared with infants in the meperidine or control group. On the fourth day of life, infants in the morphine group remained significantly more alert and oriented to animate human auditory cues than infants in the meperidine group. Average PCA opioid consumption through 48 h postpartum was equivalent (0.54 mg/kg morphine and 4.7 mg/kg meperidine); however, even with these small doses, meperidine was associated with significantly poorer neonatal alertness and orientation than morphine. Morphine is the PCA opioid of choice for postcesarean analgesia among nursing parturients.
  
  
  CONCLUSIONS
  Among nursing parturients after cesarean delivery, intravenous patient-controlled analgesia with meperidine is associated with more neonatal neurobehavioral depression than patient-controlled analgesia with morphine. In this study, we found that nursing infants exposed to morphine were more alert and oriented to animate human cues than those exposed to meperidine.
authors.affiliation: Department of Anesthesia and Critical Care, University of Chicago, Illinois 60637, USA.
authors.forename: B
authors.initials: B
authors.lastname: Wittels
authors.forename: B
authors.initials: B
authors.lastname: Glosten
authors.forename: E A
authors.initials: EA
authors.lastname: Faure
authors.forename: A H
authors.initials: AH
authors.lastname: Moawad
authors.forename: M
authors.initials: M
authors.lastname: Ismail
authors.forename: J
authors.initials: J
authors.lastname: Hibbard
authors.forename: J A
authors.initials: JA
authors.lastname: Senal
authors.forename: S M
authors.initials: SM
authors.lastname: Cox
authors.forename: S C
authors.initials: SC
authors.lastname: Blackman
authors.forename: L
authors.initials: L
authors.lastname: Karl
authors.forename: R A
authors.initials: RA
authors.lastname: Thisted
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000032:analysis; D001942:Breast Feeding; D002585:Cesarean Section; D003864:Depression, Chemical; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D018730:Infant Behavior / Q000187:drug effects*; D007231:Infant, Newborn; D008297:Male; D008614:Meperidine / Q000008:administration & dosage / Q000032:analysis; D008895:Milk, Human / Q000737:chemistry; D009020:Morphine / Q000008:administration & dosage* / Q000032:analysis; D009460:Neurologic Examination; D010149:Postoperative Pain / Q000188:drug therapy*; D011247:Pregnancy; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D008614:Meperidine