Canadian Journal of Anaesthesia

, Volume 41, Issue 11, pp 1063–1068 | Cite as

Epidural opioid analgesia after Caesarean section: a comparison of patient-controlled analgesia with meperidine and single bolus injection of morphine

  • Ola P. Rosaeg
  • M. Patrice Lindsay
Reports of Investigation

Abstract

The quality of analgesia, patient satisfaction and incidence of side effects following a single bolus of epidural morphine were compared with patient-controlled epidural analgesia (PCEA) with meperidine during the first 24 hr after elective Caesarean section. Seventy-five women were randomly assigned to three equal groups. Group 1 received 30 mg epidural meperidine after delivery and PCEA with meperidine; Group 2 received 3 mg epidural morphine after delivery and PCEA with saline in a double-blind fashion. Group 3 received 3 mg epidural morphine after delivery without saline PCEA. Visual analogue pain scores (VAS) were higher with PCEA meperidine from 8–16 hr postoperatively (P < 0.05) than in both epidural morphine groups. Two patients in Group 1 and one in Group 3 required supplemental parenteral analgesia. The incidence of nausea was 16% in Group 1, compared with 52% in Group 2 and 56% in Group 3 (P < 0.01). Pruritus occurred in 24% of Group 1 patients, 84% of patients in Group 2 and 68% of patients in Group 3 (P< 0.001). Forty-six percent of patients in Group 1 were very satisfied with pain management, compared with 77% in Group 2 and 79% in Group 3. Nurse workload was higher in the PCEA study groups than in Group 3 (P< 0.05). A single bolus of epidural morphine provides superior analgesia and satisfaction at low cost, but with a higher incidence of nausea and pruritus than PCEA with meperidine.

Key words

anaesthesia: epidural, obstetric analgesics: meperidine, morphine pain: postoperative 

Résumé

La qualité de l’analgésie, la satisfaction de la patiente et l’incidence des effets secondaires consécutifs à une dose unique de morphine épidurale sont comparées au cours de l’anesthésie épidurale auto-contrôlée (AEAC) à la mépéridine pendant les premières vingtquatre heures qui suivent la césarienne. Soixantequinze accouchées sont assignées au hasard à un de trois groupes égaux. Le groupe 1 reçoit mépéridine épidurale 30 mg après l’accouchement et l’AEAC à la mépéridine par la suite; le groupe 2 reçoit morphine épidurale 3 mg après l’accouchement et l’AEAC au soluté physiologique en double aveugle. Le groupe 3 reçoit morphine épidurale 3 mg après l’accouchement sans l’AEAC au soluté physiologique. Sur l’échelle visuelle analogue (EVA), les scores sont plus élevés avec la mépéridine en AEAC de 8 à 16 h en postopératoire (P < 0,05) que dans les deux groupes de morphine épidurale. Deux patientes du groupe 1 et une du groupe 3 ont besoin d’analgésie parentérale supplémentaire. L’incidence de la nausée est de 16% dans le groupe 1, comparativement à 52% dans le groupe 2 et 56% dans le groupe 3 (P < 0,01). Vingtquatre pour cent des patientes du groupe 1, 84% des patientes du groupe 2 et 68% des patientes du groupe 3 (P < 0,001) se plaignent de prurit. Quarante-six pour cent des patientes du groupe 1 se déclarent très satisfaites de la façon dont leur douleur a été traitée, comparativement à 77% du groupe 2 et 79% du groupe 3. Pour le personnel infirmier, les groupes d’étude de l’AEAC ont occasionné plus de travail que le groupe 3 (P < 0,05). Le bolus unique de morphine épidurale procure une anesthésie de qualité supérieure associée à une satisfaction à meilleur coût, mais provoque aussi une incidence plus élevée de nausées et de prurit que l’AEAC à la mépéridine.

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Copyright information

© Canadian Anesthesiologists 1994

Authors and Affiliations

  • Ola P. Rosaeg
    • 1
  • M. Patrice Lindsay
    • 1
  1. 1.Department of Anaesthesia, Ottawa Civic HospitalUniversity of OttawaCanada

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