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OBSTETRIC ANESTHESIA

Postoperative Epidural Morphine for Postpartum Tubal Ligation Analgesia

Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois

Address correspondence to R-Jay L. Marcus, MD, Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, 251 E. Huron, F 5–704, Chicago, IL 60611. Address e-mail to r-marcus{at}northwestern.edu.

Women undergoing postoperative postpartum tubal ligation (PPTL) often experience considerable pain. We hypothesized that epidural morphine, as part of a multi-modal analgesic regimen, would decrease postoperative pain and the need for systemic analgesia after PPTL. In a double-blinded study, patients were randomized to receive epidural saline or morphine 2 mg, 3 mg, or 4 mg after epidural anesthesia for PPTL. Postoperatively, ibuprofen 600 mg was administered every 6 h and patients could request acetaminophen 325 mg/hydrocodone 10 mg. The primary outcome variable was time to first request for supplemental analgesia. Verbal rating scores for pain and the incidence and severity of side effects were recorded for 24 h. Morphine group subjects requested supplemental analgesia later and received fewer doses compared with the saline group subjects. Peak cramping and incisional verbal rating scores for pain and the area under the verbal rating scores for pain x time curve for cramping pain were less after epidural morphine compared with saline, but there were no differences among morphine groups. Nausea, vomiting, and pruritus occurred more often in all morphine groups and subjects who received morphine 4 mg required treatment for these side effects more frequently than the saline or morphine 2 mg groups. In conclusion, epidural morphine 2 mg as part of a multi-modal analgesic regimen improved analgesia and decreased the need for supplemental analgesics after PPTL. The need to treat side effects with morphine 2 mg was not increased compared to a regimen of oral acetaminophen/opioid/nonsteroidal antiinflammatory analgesics.

This article has been cited by other articles:

				R-J. Marcus Efficacy of Postoperative Epidural Morphine for Postpartum Tubal Ligation Anesth. Analg., April 1, 2006; 102(4): 1298 - 1298. [Full Text] [PDF]

				P. J. Balestrieri, P. H. Ting, and R. S. Blank Efficacy of postoperative epidural morphine for postpartum tubal ligation. Anesth. Analg., April 1, 2006; 102(4): 1297 - 1298. [Full Text] [PDF]

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