Abstract
Purpose
To test the hypothesis that 0.1 mg intrathecal morphine plus NSAIDs provides satisfactory analgesia post-Cesarean section with fewer side effects than 0.25 mg intrathecal morphine.
Methods
Sixty women, scheduled for elective Cesarean section under spinal anesthesia, were randomized to receive either 0.1 mg or 0.25 mg intrathecal morphine combined with hyperbaric bupivacaine 0.75% and 20 μg fentanyl. All patients received a 100 mg indomethacin suppository at the end of surgery and 500 mg naproxen po b.i.d. was started the evening of surgery and continued until discharge. A blinded researcher recorded the pain, pruritus, and nausea scores, the time to first request for additional analgesics, a visual analogue scale (VAS) satisfaction score, and the use of additional opioids, antipruritics, and/or antiemetics.
Results
Of the 60 patients enrolled, two were not included in the data analysis because of protocol violations leaving 30 patients in the 0.1 mg group and 28 in the 0.25 mg group. There were no differences in the VAS pain scores or the number of women requesting an opioid other than codeine between the two groups. The VAS pruritus scores in the 0.1 mg group were lower throughout the 24 hr (P < 0.001). Fewer women in the 0.1 mg group (4/30 vs 12/28) requested nalbuphine to treat itching (P = 0.018). Nausea scores were lower in the 0.1 mg group (P < 0.001).
Conclusion
The use of 0.1 mg intrathecal morphine plus NSAIDs provides analgesia of similar quality to 0.25 mg but with fewer undesirable side effects following Cesarean section.
Résumé
Objectif
Vérifier l’hypothèse qui veut que 0,1 mg de morphine intrathécale combinée à des AINS fournissent une analgésie satisfaisante à la suite d’une césarienne et moins d’effets secondaires que 0,25 mg de morphine intrathécale.
Méthode
Soixante femmes, admises pour une césarienne planifiée sous rachianesthésie et réparties au hasard ont reçu 0,1. mg ou 0,25 mg de morphine intrathécale combinée à de la bupivacaïne hyperbare 0,75 % et à 20 μg de fentanyl. Toutes ont reçu un suppositoire de 100 mg d’indométhacine à la fin de l’opération et 500 mg de naproxène po b.i.d. à partir du premier soir jusqu’au jour du départ. Un anesthésiologiste impartial a enregistré les scores de douleurs, de prurit et de nausées, le temps avant la première demande d’analgésiques supplémentaires, le degré de satisfaction à l’échelle visuelle analogue (EVA) et l’usage d’opioïdes, d’antiprurigineux et/ou d’antiémétiques additionnels.
Résultats
Des 60 patientes recrutées, deux n’ont pu participer à la cueillette de données à cause de violations au protocole de recherche; il est resté 30 patientes dans le groupe de 0,1 mg et 28 dans celui de 0,25 mg. Il n’y a pas eu de différence intergroupe pour les scores à l’EVA ou le nombre de femmes qui ont demandé un opioïde autre que la codéine. Le degré de prurit fourni par l’EVA a été plus bas dans le groupe de 0,1 mg pendant 24 h (P < 0,001). Moins de femmes du groupe de 0,1 mg (4/30 vs 12/28) ont demandé de la nalbuphine contre le prurit (P = 0,018) et les scores de nausées ont été plus bas dans ce groupe également (P < 0,001).
Conclusion
L’utilisation, après la césarienne, de 0,1 mg de morphine intrathécale combinée à des AINS a fourni une analgésie de qualité semblable à celle qui a été produite avec 0,25 mg, mais comportant moins d’effets secondaires.
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This study was supported by the Foothills Hospital Foundation.
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Yang, T., Breen, T.W., Archer, D. et al. Comparison of 0.25 mg and 0.1 mg intrathecal morphine for analgesia after Cesarean section. Can J Anesth 46, 856–860 (1999). https://doi.org/10.1007/BF03012975
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DOI: https://doi.org/10.1007/BF03012975