High-dose intrathecal diamorphine for analgesia after Caesarean section.
Forty women undergoing elective Caesarean section under spinal anaesthesia using hyperbaric 0.5% bupivacaine were randomly allocated to receive either 0.5 mg or 1 mg intrathecal diamorphine. All women received diclofenac 100 mg at the end of surgery and morphine via a patient-controlled analgesia system. Oral analgesics were not used. Postoperative analgesia was more prolonged and more reliable in the 1-mg group. Mean time to first analgesia was 10.2 h in the 1-mg group and 6.9 h in the 0.5-mg group, and 45% in the 1-mg group used no morphine, compared with 10% in the 0.5-mg group. Mean morphine consumption over 24 h was 5.2 mg in the 1-mg group and 10.6 mg in the 0.5-mg group. Pain scores all tended to be lower in the 1-mg group but this was only significant at 4 h. There were no serious side-effects. Minor side-effects were common but well tolerated, and the incidence did not differ between the groups. If intrathecal diamorphine is used in combination with rectal diclofenac and without oral analgesia, then 1 mg provides superior analgesia to 0.5 mg without any worsening of the side-effects.
Stacey
R
R
Consultant Anaesthetist, Kingston Hospital, Galsworthy Road, Kingston upon Thames KT2 7QB, UK.
Jones
R
R
Kar
G
G
Poon
A
A
D000285:Administration, Rectal; D000328:Adult; D016362:Analgesia, Obstetrical / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000706:statistics & numerical data; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D002585:Cesarean Section / Q000379:methods*; D016009:Chi-Square Distribution; D004008:Diclofenac / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D003932:Heroin / Q000008:administration & dosage*; D006801:Humans; D007278:Injections, Spinal; D010147:Pain Measurement; D011247:Pregnancy; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D003932:Heroin