title: Intrathecal morphine reduces breakthrough pain during labour epidural analgesia.
abstract: BACKGROUND
  When using the combined spinal-epidural (CSE) technique for labour analgesia, parturients often experience breakthrough pain after the spinal medication has receded. We tested the hypothesis that a small dose of intrathecal morphine would reduce breakthrough pain.
  
  
  METHODS
  This was a randomized, double-blind, placebo-controlled trial. Subjects were randomized to receive either 100 microg of morphine (MS) or placebo (PLCB) with the spinal injection of bupivacaine and fentanyl. Assessments included need for supplementation during labour analgesia, use of pain medications for 24 h after delivery, and side-effects. The primary end-point was the rate of breakthrough pain.
  
  
  RESULTS
  Sixty subjects were enrolled, 55 subjects completed the trial. The MS group had a significantly lower rate of breakthrough pain than the PLCB group [0.6 (0.6) vs 1.1 (0.8) episodes per patient; P < 0.01], and longer time to first episode of breakthrough pain (300 vs 180 min; P = 0.03). The MS group used 75% less opioid medications during the subsequent 24 h, but had a 17% incidence of nausea.
  
  
  CONCLUSIONS
  The addition of small dose of morphine to the spinal component of the CSE technique improved the effectiveness of epidural labour analgesia and reduced the need for pain medications over 24 h, but resulted in a small increase in nausea.
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
authors.forename: A
authors.initials: A
authors.lastname: Vasudevan
authors.forename: C E
authors.initials: CE
authors.lastname: Snowman
authors.forename: S
authors.initials: S
authors.lastname: Sundar
authors.forename: T W
authors.initials: TW
authors.lastname: Sarge
authors.forename: P E
authors.initials: PE
authors.lastname: Hess
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local; D002045:Bupivacaine; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl; D006801:Humans; D048949:Labor Pain; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D009325:Nausea / Q000139:chemically induced; D010147:Pain Measurement; D011247:Pregnancy
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D005283:Fentanyl; D002045:Bupivacaine