title: Comparison of epidural oxycodone and epidural morphine for post-caesarean section analgesia: A randomised controlled trial.
abstract: OBJECTIVE
  Epidural morphine after caesarean section may cause moderate to severe pruritus in women. Epidural oxycodone has been shown in non-obstetric trials to reduce pruritus when compared to morphine. We hypothesised that epidural oxycodone may reduce pruritus after caesarean section.
  
  
  METHODS
  A randomised controlled trial was conducted in pregnant women at term who underwent caesarean section with combined spinal-epidural technique initiated with intrathecal fentanyl 15 μg. Women received either epidural morphine 3 mg or epidural oxycodone 3 mg via the epidural catheter after delivery. The primary outcome was the incidence of pruritus at 24 h after caesarean section. The secondary outcomes were the pruritus scores, treatment for post-operative nausea and vomiting (PONV), pain scores and maternal satisfaction.
  
  
  RESULTS
  One hundred women were randomised (group oxycodone O = 50, morphine M = 50). There was no difference between Group O and M in the incidence of pruritus (n [%] 28 [56%] vs. 31 [62%], P = 0.68) and the worst pruritus scores (mean [standard deviation] 2.6 (2.8) vs. 3.3 [3.1], P = 0.23), respectively. Both groups had similar pain scores at rest (2.7 [2.3] vs. 2.0 [2.7], P = 0.16) and sitting up (5.0 [2.3] vs. 4.6 [2.4], P = 0.38) at 24 h. Pruritus scores were lower at 4-8, 8-12 and 12-24 h with oxycodone, but pain scores were higher. Both groups had a similar need for treatment of PONV and maternal satisfaction with analgesia.
  
  
  CONCLUSIONS
  There was no difference in the incidence of pruritus at 24 h between epidural oxycodone and morphine. However, pruritus scores were lower with oxycodone between 4 and 24 h after surgery with higher pain scores in the same period.
authors.affiliation: Department of Women's Anaesthesia, KK Women's and Children's Hospital, Bukit Timah, Singapore.
authors.forename: Ban Leong
authors.initials: BL
authors.lastname: Sng
authors.affiliation: Department of Women's Anaesthesia, KK Women's and Children's Hospital, Bukit Timah, Singapore.
authors.forename: Sarah Carol
authors.initials: SC
authors.lastname: Kwok
authors.affiliation: Department of Women's Anaesthesia, KK Women's and Children's Hospital, Bukit Timah, Singapore.
authors.forename: Deepak
authors.initials: D
authors.lastname: Mathur
authors.affiliation: Department of Women's Anaesthesia, KK Women's and Children's Hospital, Bukit Timah, Singapore.
authors.forename: Farida
authors.initials: F
authors.lastname: Ithnin
authors.affiliation: Department of Women's Anaesthesia, KK Women's and Children's Hospital, Bukit Timah, Singapore.
authors.forename: Clare
authors.initials: C
authors.lastname: Newton-Dunn
authors.affiliation: Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Pryseley Nkouibert
authors.initials: PN
authors.lastname: Assam
authors.affiliation: Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Rehena
authors.initials: R
authors.lastname: Sultana
authors.affiliation: Department of Women's Anaesthesia, KK Women's and Children's Hospital, Bukit Timah, Singapore.
authors.forename: Alex Tiong Heng
authors.initials: AT
authors.lastname: Sia
keywords: Caesarean section; morphine; oxycodone; pain