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Anesth Analg 2005;100:1472-1476
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000153013.34129.A7

OBSTETRIC ANESTHESIA

Oral Herpes Simplex Reactivation After Intrathecal Morphine: A Prospective Randomized Trial in an Obstetric Population

Paul W. Davies, MD, Manuel C. Vallejo, MD, Kelly T. Shannon, MD, Antonio J. Amortegui, MD, and Sivam Ramanathan, MD

University of Pittsburgh School of Medicine, Department of Anesthesiology, Magee-Womens Hospital, Pittsburgh, Pennsylvania

Address correspondence to Manuel C. Vallejo, MD, Department of Anesthesiology, Magee-Womens Hospital, 300 Halket Street, Pittsburgh PA 15213. Address e-mail to vallejomc{at}anes.upmc.edu.

There is now evidence for an association between the use of epidural morphine and reactivation of herpes simplex labialis (HSL). There are no studies that definitively demonstrate the relationship between HSL reactivation and spinal intrathecal morphine. To investigate this relationship, we randomized and prospectively studied 100 obstetric patients with a history of HSL undergoing cesarean delivery under spinal anesthesia. One group received intrathecal morphine plus IV morphine via patient-controlled analgesia (ITM+PCA group) for postoperative analgesia, and a second group received only IV morphine via patient-controlled analgesia for postoperative analgesia (PCA-only group). Patients were followed for a 30-day period. In the ITM+PCA group 19 (38%) patients had HSL reactivation whereas eight (16.6%) had HSL reactivation in the morphine PCA-only group (P = 0.028). The incidence of pruritus in the ITM+PCA group was also more frequent in the early postoperative period. Our data show HSL reactivation in both the ITM+PCA group and PCA-only morphine group, with a more frequent incidence in the ITM+PCA group.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.