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Efficacy of intrathecal morphine with epidural ropivacaine infusion for postcesarean analgesia.
J Clin Anesth. 2010 Jun; 22(4):268-73.JC

Abstract

STUDY OBJECTIVE

To evaluate the analgesia following cesarean delivery and the frequency of side effects of intrathecal morphine when combined with a continuous epidural infusion.

DESIGN

Randomized, double-blinded study.

SETTING

University hospital.

PATIENTS

76 ASA physical status I and II term parturients undergoing cesarean delivery with combined spinal-epidural anesthesia.

INTERVENTIONS

Patients were randomized to one of three groups to receive 0, 50, or 100 microg (Group 0, Group 50, and Group 100, respectively) intrathecal morphine in addition to 8 mg of hyperbaric bupivacaine. Each patient received a continuous epidural infusion of 0.2% ropivacaine at the rate of 6 mL/hr.

MEASUREMENTS

24-hour visual analog pain scores (VAPS), number of patients who requested rescue analgesics, frequency of requests for rescue analgesics per patient, and time interval before the first request for rescue analgesics were recorded. Frequency of pruritus and postoperative nausea and vomiting (PONV) were also recorded.

MAIN RESULTS

Group 50 and Group 100 patients exhibited lower VAPS and longer time intervals before the first request for rescue analgesics, and they requested rescue analgesics less frequently than Group 0 patients. The frequency of pruritus was significantly higher in Group 100 than Group 0. The groups did not differ with regard to PONV.

CONCLUSIONS

50 microg and 100 microg of intrathecal morphine improve analgesia when combined with a continuous epidural infusion of 0.2% ropivacaine (6 mL/hr) after cesarean delivery. 50 microg of intrathecal morphine is associated with a low frequency of side effects such as pruritus and PONV.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Mikuni I
Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical College, Asahikawa, 078-8510, Japan. subetenakusitamamani@yahoo.co.jp
Hirai H
No affiliation info available
Toyama Y
No affiliation info available
Takahata O
No affiliation info available
Iwasaki H
No affiliation info available

MeSH

AdultAmidesAnalgesia, EpiduralAnalgesics, OpioidAnesthetics, LocalBupivacaineCesarean SectionDose-Response Relationship, DrugDouble-Blind MethodDrug Therapy, CombinationFemaleHospitals, UniversityHumansInjections, SpinalMorphinePain MeasurementPain, PostoperativePostoperative Nausea and VomitingPregnancyPruritusRopivacaineTime Factors

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

20522357

Citation

Mikuni, Ikuomi, et al. "Efficacy of Intrathecal Morphine With Epidural Ropivacaine Infusion for Postcesarean Analgesia." Journal of Clinical Anesthesia, vol. 22, no. 4, 2010, pp. 268-73.
Mikuni I, Hirai H, Toyama Y, et al. Efficacy of intrathecal morphine with epidural ropivacaine infusion for postcesarean analgesia. J Clin Anesth. 2010;22(4):268-73.
Mikuni, I., Hirai, H., Toyama, Y., Takahata, O., & Iwasaki, H. (2010). Efficacy of intrathecal morphine with epidural ropivacaine infusion for postcesarean analgesia. Journal of Clinical Anesthesia, 22(4), 268-73. https://doi.org/10.1016/j.jclinane.2009.09.003
Mikuni I, et al. Efficacy of Intrathecal Morphine With Epidural Ropivacaine Infusion for Postcesarean Analgesia. J Clin Anesth. 2010;22(4):268-73. PubMed PMID: 20522357.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of intrathecal morphine with epidural ropivacaine infusion for postcesarean analgesia. AU - Mikuni,Ikuomi, AU - Hirai,Hiroyasu, AU - Toyama,Yuki, AU - Takahata,Osamu, AU - Iwasaki,Hiroshi, PY - 2009/01/12/received PY - 2009/06/25/revised PY - 2009/09/10/accepted PY - 2010/6/5/entrez PY - 2010/6/5/pubmed PY - 2010/9/14/medline SP - 268 EP - 73 JF - Journal of clinical anesthesia JO - J Clin Anesth VL - 22 IS - 4 N2 - STUDY OBJECTIVE: To evaluate the analgesia following cesarean delivery and the frequency of side effects of intrathecal morphine when combined with a continuous epidural infusion. DESIGN: Randomized, double-blinded study. SETTING: University hospital. PATIENTS: 76 ASA physical status I and II term parturients undergoing cesarean delivery with combined spinal-epidural anesthesia. INTERVENTIONS: Patients were randomized to one of three groups to receive 0, 50, or 100 microg (Group 0, Group 50, and Group 100, respectively) intrathecal morphine in addition to 8 mg of hyperbaric bupivacaine. Each patient received a continuous epidural infusion of 0.2% ropivacaine at the rate of 6 mL/hr. MEASUREMENTS: 24-hour visual analog pain scores (VAPS), number of patients who requested rescue analgesics, frequency of requests for rescue analgesics per patient, and time interval before the first request for rescue analgesics were recorded. Frequency of pruritus and postoperative nausea and vomiting (PONV) were also recorded. MAIN RESULTS: Group 50 and Group 100 patients exhibited lower VAPS and longer time intervals before the first request for rescue analgesics, and they requested rescue analgesics less frequently than Group 0 patients. The frequency of pruritus was significantly higher in Group 100 than Group 0. The groups did not differ with regard to PONV. CONCLUSIONS: 50 microg and 100 microg of intrathecal morphine improve analgesia when combined with a continuous epidural infusion of 0.2% ropivacaine (6 mL/hr) after cesarean delivery. 50 microg of intrathecal morphine is associated with a low frequency of side effects such as pruritus and PONV. SN - 1873-4529 UR - https://www.unboundmedicine.com/medline/citation/20522357/Efficacy_of_intrathecal_morphine_with_epidural_ropivacaine_infusion_for_postcesarean_analgesia_ DB - PRIME DP - Unbound Medicine ER -