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OBSTETRIC ANESTHESIA

The Addition of Morphine Prolongs Fentanyl-Bupivacaine Spinal Analgesia for the Relief of Labor Pain

Huei-Ming Yeh, MD^*, Li-Kuei Chen, MD^*, Ming-Kwang Shyu, MD, Chen-Jung Lin, MD^*, Wei-Zen Sun, MD^*, Ming-Jiuh Wang, MD^*, Martin S. Mok, MD, and Shen-Kou Tsai, MD^*

Departments of *Anesthesiology and Gynecology and Obstetrics, National Taiwan University Hospital, Taipei, Taiwan; and Department of Anesthesiology, LAC-USC Medical Center, Los Angeles, California

Address correspondence and reprint requests to Shen-Kou Tsai, MD, Department of Anesthesiology, National Taiwan University Hospital, No 7, Chung-Shan South Rd., Taipei, Taiwan, 100.

The combination intrathecal fentanyl (25 µg) and bupivacaine (2.5 mg) provides effective labor analgesia for approximately 90 minutes. The purpose of this prospective, randomized, double-blinded investigation was to determine if the addition of morphine (150 µg) to the intrathecal combination of fentanyl (25 µg) and bupivacaine (2.5 mg) would prolong labor analgesia. By using the combined spinal epidural technique, 95 healthy primiparous laboring women in early labor received 2 mL of one of the two intrathecal study solutions, either FB (n = 48): fentanyl (25 µg) and bupivacaine (2.5 mg); or FBM (n = 47): fentanyl (25 µg) and bupivacaine (2.5 mg) plus morphine (150 µg). The mean duration of labor analgesia was significantly longer in the FBM group than in the FB group (252 ± 63 min vs 148 ± 44 min, P < 0.01). There were no significant differences between the two groups regarding the sensory levels, the incidence of nausea, vomiting, pruritus, hypotension, or operative delivery. In conclusion, the addition of 150 µg of morphine to the intrathecal combination of fentanyl plus bupivacaine prolonged the duration of labor analgesia duration without increasing adverse effects.

Implications: The addition of morphine (150 µg) to intrathecal fentanyl (25 µg) and bupivacaine (2.5 mg) prolongs the duration of labor analgesia duration without increasing adverse effects.

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