Canadian Anaesthetists’ Society Journal

, Volume 32, Issue 4, pp 330–338 | Cite as

Epidural morphine prophylaxis of postoperative pain: report of a double-blind multicentre study

  • W. D. R. Writer
  • J. B Hurtig
  • G. Edelist
  • D. Evans
  • G. S. Fox
  • R. E. Needs
  • C. E. Hope
  • J. B. Forrest
Article

Abstract

In a double.blind placebo-controlled trial, 154 subjects, having intraperitoneal surgery or Caesarean section, and 53 patients undergoing lower limb orthopaedic surgery, received epidural morphine, 5 mg in l0 ml 0.9 per cent NaCl, or placebo, 10 ml 0.9 per cent NaCl, intraoperatively to determine duration of action and efficacy in preventing postoperative pain. Epidaral morphine gave significantly longer postoperative analgesia (>11 h) than placebo (3-6 h) in both groups (p < 0.05) and patients who received morphine required less postoperative analgesic. Obstetric subjects experienced longer pain relief (18.3 ± 1.3 h) than patients undergoing non-obstetric intraperitoneal surgery (9.2 ± 1.2 h) (p < 0.001 ). Generally mild pruritus affected more than 40 per cent of those receiving morphine, but over 90 per cent of obstetric patients receiving morphine. Respiratory depression occurred in 2-7 per cent of subjects who received morphine; unpredictable in onset, it responded rapidly to naloxone. Epidural bupivacaine, if employed for the surgical procedure, appeared to prolong epidural morphine analgesia. We consider epidural morphine useful in preventing postoperative pain, but its use demands close observation of respiratory rate in a high density nursing area.

Key words

analgesia: postoperative analgesics: morphine anaesthesia: obstetric anaesthetic techniques: epidural pain: postoperative 

Résumé

Darts une étude à double insu contrôlée avec un placebo, 154 sujers devant subir une chirurgie intrapéritonéale ou une césarienne, et 53 patients devant subir une chirurgie orthopédique sur les membres inférieurs, ont rerç une injection épidurale de morphine 5 mg dans 10 ml 0.9 pour centNaCl ou duplacebo 10 ml 0.9 pour centNaCl lors de l’opération afin de déterminer la durée de l’action et l’efficacité de prévenir les douleurs post-opératoires. La morphine en injection épidurate procura une analgésie post-opérotoire d’une durée significativement plus longue (>11 h) que le placebo (3-6 h) chez les deux groupes (p < 0.05). Les patients ayant reçu la morphine ont aussi requis moins d’ analgésie post-opératoire. Le groupe obstétrical a profité d’une plus longue analgésic (18.3 ± 1.3 h) que les patients subissant la chirurgie intrapéritonéale non obstétricale (9.2 ± 1.2 h) (p < 0.001). Un prurit en général léger a affecté 40 pour cent et plus des patients ayant reçu la morphine mais pour le groupe obstétrical ce pourcentage était supdriéur d 90 pour cent. La dépression respiratoire survint chez 2-7 pour cent des sujets ayant reçu la morphine. L’apparition de cette dépression respiratoire n’était pas prévisible et répondait rapidement à l’ administration de naloxone. L’administration de bupivacaiïne par vole épidurale si employée pour la procédure ehirurgicale semble prolonger l’analgésie fournie par la morphine épidurale. On considère que l’administration de morphine par voie épidurale est utile pour prévenir la douleur post-opératoire mais son utilisation demande une surveillance accrue de la fréquence respiratoire dans des locaux où les soins infirmiers sont denses.

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Copyright information

© Canadian Anesthesiologists 1985

Authors and Affiliations

  • W. D. R. Writer
    • 1
  • J. B Hurtig
    • 2
  • G. Edelist
    • 3
  • D. Evans
    • 4
  • G. S. Fox
    • 5
  • R. E. Needs
    • 6
  • C. E. Hope
    • 7
  • J. B. Forrest
    • 8
  1. 1.Departments of AnaesthesiaGrace Maternity HospitalHalifax
  2. 2.Ottawa Civic HospitalOttawa
  3. 3.Mount Sinai HospitalToronto
  4. 4.Toronto Western HospitalToronto
  5. 5.Royal Victoria HospitalMontreal
  6. 6.Sunnybrook Medical CentreToronto
  7. 7.Victoria General HospitalHalifax
  8. 8.McMaster UniversityHamilton

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