title: Decreased postpartum use of oral pain medication after a single dose of epidural morphine.
abstract: BACKGROUND
  Pain after vaginal delivery may result from episiotomy, perineal laceration, or uterine involution. Many women have indwelling epidural catheters in place at delivery. We hypothesized that a small dose of epidural morphine would be an effective strategy for postpartum analgesia.
  
  
  METHODS
  Eighty-one healthy parturients receiving epidural analgesia for labor were enrolled. Patients were randomized in double-blind fashion to 1 of 3 groups: all groups received a 4-mL volume of epidural solution consisting of saline (group 1, control), 1 mg (group 2), or 2 mg morphine (group 3) after vaginal delivery. During the first 24 hours postpartum, patients were evaluated for the amount of oral pain medication requested; visual analog scale scores for pain at rest and with movement; satisfaction with postpartum pain treatment; and opioid side effects including nausea, pruritus, urinary retention, and respiratory depression.
  
  
  RESULTS
  Patients who received 2 mg of epidural morphine used an average of 0.7 (0-1, interquartile range) opioid-containing pain pills (acetaminophen with codeine or oxycodone) compared with 1.2 (0-2) in the 1-mg group and 1.9 (0-3) in the control group ( P = .07). There was a statistically significant difference in oral drug usage between those who received epidural morphine and those who did not ( P < .03). There were no differences in side effects except that at 12 hours postpartum there was an increase in Foley catheterization in the 1-mg morphine group ( P = .007).
  
  
  CONCLUSIONS
  These results suggest that epidural morphine decreases the need for oral pain medication in the first 24 hours postpartum. No significant dose-dependent side effects were found.
authors.affiliation: Department of Anesthesiology, Columbia University, New York, NY 10032, USA.
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Goodman
authors.forename: Ana M
authors.initials: AM
authors.lastname: Drachenberg
authors.forename: Sally A
authors.initials: SA
authors.lastname: Johnson
authors.forename: Maria A
authors.initials: MA
authors.lastname: Negron
authors.forename: Susan H
authors.initials: SH
authors.lastname: Kim-Lo
authors.forename: Richard M
authors.initials: RM
authors.lastname: Smiley
mesh_terms: D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003061:Codeine / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010098:Oxycodone / Q000008:administration & dosage / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D049590:Postpartum Period; D011446:Prospective Studies; D016896:Treatment Outcome; D016055:Urinary Retention / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D010098:Oxycodone; D003061:Codeine