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

Canadian Journal of Anaesthesia volume 41, pages 1063–1068 (1994)Cite this article

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.

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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  1. Department of Anaesthesia, Ottawa Civic Hospital, University of Ottawa, Canada

    Ola P. Rosaeg & M. Patrice Lindsay

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  1. Ola P. Rosaeg
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  2. M. Patrice Lindsay
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Rosaeg, O.P., Lindsay, M.P. Epidural opioid analgesia after Caesarean section: a comparison of patient-controlled analgesia with meperidine and single bolus injection of morphine. Can J Anaesth 41, 1063–1068 (1994). https://doi.org/10.1007/BF03015655

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  • DOI: https://doi.org/10.1007/BF03015655

Key words

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