This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (17) Citing Articles via Google Scholar Google Scholar Articles by Palmer, C. M. Articles by Alves, D. M. Search for Related Content PubMed PubMed Citation Articles by Palmer, C. M. Articles by Alves, D. M.

---

OBSTETRIC ANESTHESIA

Postcesarean Epidural Morphine: A Dose-Response Study

Department of Anesthesiology, University of Arizona Health Sciences Center, Tucson, Arizona

Address correspondence to Craig M. Palmer, MD, Arizona Health Sciences Center, P.O. Box 245114, Tucson, AZ 85724-5114. Address e-mail to cpalmer{at}u.arizona.edu

The purpose of this study was to describe the dose-response relationship of epidural morphine for postcesarean analgesia for quality of analgesia and relation to the side effects of pruritus, nausea, and vomiting. Sixty term parturients undergoing nonurgent cesarean delivery were enrolled and randomized to receive a single dose of epidural morphine after delivery (0,1.25, 2.5, 3.75, or 5 mg). A patient-controlled analgesia (PCA) device provided free access to additional analgesics. PCA morphine use and the incidence and severity of side effects were recorded for 24 h. Data were analyzed with analysis of variance, Student’s t-tests, and ² analysis. Nonlinear regression was used to describe a dose-response curve. PCA use differed significantly among groups (P < 0.001); PCA use was significantly greater in Group 0 mg than Groups 2.5, 3.75, and 5 mg (P < 0.05). PCA use was also significantly greater in Group 1.25 mg than Groups 3.75 and 5 mg (P < 0.05). Pruritus scores were significantly higher in all groups given epidural morphine than the control group (0 mg) (P < 0.05), but did not differ among the treatment groups (1.25–5 mg), although pruritus scores were significantly higher in treatment groups than in the control (P < 0.05). No relation was found between epidural morphine dose and incidence or severity of nausea and vomiting. We concluded that, for optimal analgesia, augmentation of epidural morphine with systemic analgesics or other epidural medications may be necessary.

Implications: Quality of analgesia increases as the dose of epidural morphine increases to at least 3.75 mg; increasing the dose further to 5 mg did not improve analgesia. Side effects were not dose related. For optimal analgesia, augmentation of epidural morphine with systemic analgesics or other epidural medications may be necessary.

This article has been cited by other articles:

				B. Carvalho Respiratory Depression After Neuraxial Opioids in the Obstetric Setting Anesth. Analg., September 1, 2008; 107(3): 956 - 961. [Abstract] [Full Text] [PDF]

				M. K. Kim, S. B. Nam, M. J. Cho, and Y.-S. Shin Epidural naloxone reduces postoperative nausea and vomiting in patients receiving epidural sufentanil for postoperative analgesia Br. J. Anaesth., August 1, 2007; 99(2): 270 - 275. [Abstract] [Full Text] [PDF]

				B. Carvalho, L. M. Roland, L. F. Chu, V. A. Campitelli III, and E. T. Riley Single-Dose, Extended-Release Epidural Morphine (DepoDurTM) Compared to Conventional Epidural Morphine for Post-Cesarean Pain Anesth. Analg., July 1, 2007; 105(1): 176 - 183. [Abstract] [Full Text] [PDF]

				J. Gadsden, S. Hart, and A. C. Santos Post-Cesarean Delivery Analgesia Anesth. Analg., November 1, 2005; 101(5S_Suppl): S62 - 69. [Abstract] [Full Text] [PDF]

				R-J. L. Marcus, C. A. Wong, A. Lehor, R. J. McCarthy, E. Yaghmour, and M. Yilmaz Postoperative Epidural Morphine for Postpartum Tubal Ligation Analgesia Anesth. Analg., September 1, 2005; 101(3): 876 - 881. [Abstract] [Full Text] [PDF]

				B. Carvalho, E. Riley, S. E. Cohen, D. Gambling, C. Palmer, H. J. Huffnagle, L. Polley, H. Muir, S. Segal, C. Lihou, et al. Single-Dose, Sustained-Release Epidural Morphine in the Management of Postoperative Pain After Elective Cesarean Delivery: Results of a Multicenter Randomized Controlled Study Anesth. Analg., April 1, 2005; 100(4): 1150 - 1158. [Abstract] [Full Text] [PDF]

				C. Duale, C. Frey, F. Bolandard, A. Barriere, and P. Schoeffler Epidural versus intrathecal morphine for postoperative analgesia after Caesarean section Br. J. Anaesth., November 1, 2003; 91(5): 690 - 694. [Abstract] [Full Text] [PDF]

				H. K. Eltzschig, E. S. Lieberman, and W. R. Camann Regional Anesthesia and Analgesia for Labor and Delivery N. Engl. J. Med., January 23, 2003; 348(4): 319 - 332. [Full Text] [PDF]

				D. L. Hepner, C. M. Palmer, W. M. Nogami, G. Van Maren, and D. M. Alves Neuraxial Opioids and Respiratory Depression Response Anesth. Analg., December 1, 2000; 91(6): 1560 - 1561. [Full Text] [PDF]