Chloroprocaine may not affect epidural morphine for postcesarean delivery analgesia.
OBJECTIVE
The purpose of this study is to assess the independent effect of epidural chloroprocaine on morphine used for pain relief after cesarean delivery.


METHODS
We used a randomized, double blind, placebo-controlled trial.


METHODS
The study took place at the labor and delivery ward of an academic medical center.


METHODS
Forty pregnant women undergoing elective cesarean delivery under spinal-epidural anesthesia.


METHODS
Patients were randomized to receive either 150 mg of 3% chloroprocaine or placebo, followed by 3 mg of epidural morphine.


METHODS
The primary outcome for this investigation was the duration of pain relief after morphine administration, defined as the time at first use of supplemental opioids for analgesia. Secondary outcomes included pain scores, blood pressure, heart rate, respiratory rate, anesthetic sensory level, nausea and vomiting, pruritus, supplemental use of nonsteroidal anti-inflammatory medications, and satisfaction.


RESULTS
The groups were similar in demographics and duration of spinal anesthesia. Using Kaplan-Meier survival analysis of the duration of morphine analgesia, we found no difference between the groups (chloroprocaine, 1191 minutes, vs placebo, 1267 minutes, P = 0.52). There was no difference in pain scores or the need for supplemental analgesics. Side effects of epidural morphine were similar between the groups.


CONCLUSIONS
We found that epidural chloroprocaine did not reduce the duration or effectiveness of postoperative analgesia from epidural morphine.
Hess
Philip E
PE
Department of Anesthesia, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. phess@bidmc.harvard.edu
Snowman
Caroline E
CE
Hahn
Caroline J
CJ
Kunze
Lisa J
LJ
Ingold
Venesa J
VJ
Pratt
Stephen D
SD
D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000701:Analgesics, Opioid; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local; D002585:Cesarean Section; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D009020:Morphine; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000517:prevention & control; D011247:Pregnancy; D011343:Procaine / Q000031:analogs & derivatives*
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D011343:Procaine; C004616:chloroprocaine; D009020:Morphine