Analgesia produced by epidural diamorphine is better following caesarean section under spinal anaesthesia than under epidural anaesthesia.
In a randomized double-blind study, the efficacy, duration of action and side-effects of epidural diamorphine 2.5 mg in 10 ml normal saline were compared following elective caesarean section under either spinal anaesthesia (using a combined spinal epidural technique, n = 32) or conventional epidural anaesthesia (n = 26). Median visual analogue pain scores were consistently lower in patients who had received spinal anaesthesia and this reached significance at 24 h (P = 0.02). If additional i.m. morphine was required, the mean (SD) time to its administration was significantly greater following spinal anaesthesia (12.6 h (5.9)) than epidural anaesthesia (6.6 h (3.1), P = 0.01). The incidence of side-effects was similar in the two groups. The improved analgesia following spinal anaesthesia is another advantage of the combined spinal epidural technique over conventional epidural anaesthesia for elective caesarean section.
Magill Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.
B J
BJ
Norman
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S
Yentis