Canadian Journal of Anaesthesia

, Volume 37, Issue 6, pp 636–640

Epidural morphine for analgesia after Caesarean section: a report of 4880 patients

  • John G. Fuller
  • Graham H. McMorland
  • M. Joanne Douglas
  • Lynne Palmer
Reports of Investigation

Abstract

This retrospective study was undertaken to assess the efficacy and safety of epidural morphine in providing analgesia following Caesarean section under epidural anaesthesia. The morphine was administered as a single bolus, following delivery, in doses ranging from 2 to 5 mg. The charts of 4880 Caesarean sections, performed on 4500 patients, were reviewed. The duration of analgesia and the occurrence of any symptoms which might be side-effects of the epidural morphine were recorded. The duration of analgesia was 22.9 ±10.1 hr and was not correlated with the dose of epidural morphine. Eleven per cent of the patients required no supplemental analgesia during the first 48 hr. Twelve patients (0.25 per cent) had respiratory rates < 10 breaths per minute, on at least one occasion. No serious sequelae resulted from these periods of bradypnoea. Pruritus occurred in 58 per cent of patients, nausea and vomiting in 39.9 per cent and dizziness in ten per cent. Herpes simplex labialis was recorded in 3.5 per cent of patients. Epidural morphine is thus confirmed as an effective analgesic technique post-Caesarean section with 3 mg being the optimal dose. Even in this young healthy patient population, clinically detectable respiratory depression occurs so clinical respiratory monitoring is indicated.

Key words

Anaesthesia: obstetric, epidural Analgesia: epidural, postoperative Analgesics: morphine Pain: postoperative 

Résumé

Afin d’en évaluer l’ejficacité et la sûreté en post-op de césarienne sous anesthésie épidurale, nous avons revu au sein de 4500 dossiers, 4880 cas d’analgésie à la morphine par voie épidurale où on avait injecté de 2 à 5 mg de morphine en bolus aprés la naissance. D’abord, la durée de l’analgésie (22,9 ±10,1 hre) semblait indépendante de la dose utilisée et 11 pour cent des patientes n’avaient requis aucun autre analgésique pendant les 48 premiéres heures. Ensuite, de la bradypnée (fréquence respiratoire < 10/min) était survenue chez 12 patientes à au moins une occasion, n’entraînant cependant aucune séquelle; 58 pour cent des patientes s’étaient plaintes de prurit, 39,9 pour cent de nausée ou de vomissement et dix pour cent d’étourdissement. Enfin, on avait observé la présence d’une lésion herpétique labiate dans 3,5 pour cent des cas. Il semble donc que la morphine par voie épidurale constitue un mode d’analgésie efficace aprés une césarienne et qu’une dose de 3 mg soit idéate. Pourtant, même chez ces patientes jeunes et en bonne santé, une dépression respiratoire peut survenir et justifie un monitorage clinique de la respiration.

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Copyright information

© Canadian Anesthesiologists 1990

Authors and Affiliations

  • John G. Fuller
    • 1
  • Graham H. McMorland
    • 1
  • M. Joanne Douglas
    • 1
  • Lynne Palmer
    • 1
  1. 1.Department of AnaesthesiaUniversity of British Columbia and Grace HospitalVancouverCanada
  2. 2.Department of AnaesthesiaSt. Joseph’s Health CentreLondonCanada

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