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OBSTETRIC ANESTHESIA

Intrathecal Morphine for Analgesia After Postpartum Bilateral Tubal Ligation

Department of Anesthesiology, Division of Women’s Anesthesia, Duke University Medical Center, Durham, North Carolina

Address correspondence and reprint requests to Ashraf S. Habib, MBBCh, FRCA, Department of Anesthesiology, Box 3094, Duke University Medical Center, Durham, NC 27710. Address email to habib001{at}mc.duke.edu

Postpartum bilateral tubal ligation (PPBTL) causes postoperative pain. We designed this study to determine the efficacy of 50 µg intrathecal morphine for analgesia after PPBTL. Sixty-five women received spinal anesthesia with 12.75 mg hyperbaric bupivacaine, 20 µg of fentanyl, and either 50 µg of morphine (morphine group) or 0.05 mL of saline (control group). Postoperative analgesia was provided with regular naproxen 500 mg and oxycodone 5 mg/acetaminophen 325 mg mixture as needed. Overall, satisfaction was higher (P = 0.003) and pain was less intense at rest (P = 0.008) and on movement (P < 0.0001) in the morphine group. There was no significant overall difference in nausea, pruritus, or sedation scores, but vomiting occurred more frequently in the morphine group (21.4% versus 3.5%; P = 0.052). In post hoc comparisons, pain at rest within the morphine group was significantly less at 4 h (P = 0.006), pain on movement was significantly less at 4 h (P = 0.002) and 12 h (P = 0.0004), and pruritus was significantly more frequent at 12 h (P = 0.002) compared with the control group. Oxycodone 5 mg/acetaminophen 325 mg mixture consumption was significantly smaller (P = 0.006) and the time to first request of analgesia was significantly longer (P = 0.006) in the morphine group. We conclude that the addition of 50 µg of morphine to intrathecal hyperbaric bupivacaine and fentanyl provides improved postoperative analgesia in women undergoing PPBTL.

IMPLICATIONS: The addition of 50 µg of morphine to intrathecal hyperbaric bupivacaine and fentanyl provided improved postoperative analgesia, less need for rescue analgesics, and a greater degree of patient satisfaction compared with a similar technique without morphine in women undergoing postpartum bilateral tubal ligation under spinal anesthesia.

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