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OBSTETRIC ANESTHESIA

Intrathecal Morphine for Postpartum Tubal Ligation Postoperative Analgesia

Department of Anesthesiology, Royal University Hospital, Saskatoon, Saskatchewan, Canada

Address correspondence and reprint requests to David C. Campbell, MD, MSc, FRCPC, Associate Professor, College of Medicine, University of Saskatchewan, Department of Anesthesiology, Royal University Hospital, 103 Hospital Dr., Saskatoon, Saskatchewan, Canada S7N 0W8. Address e-mail to campbelld{at}sdh.sk.ca

Intrathecal morphine (ITM) provides effective postoperative cesarean delivery analgesia but has not been reported for postoperative postpartum tubal ligation (PPTL) analgesia. We designed this prospective, randomized, double-blinded study to determine the efficacy of 100 µg ITM for postoperative PPTL analgesia. Sixty-six women received spinal anesthesia with 60 mg (1.2 mL) of 5% hyperbaric lidocaine, 10 µg (0.2 mL) of fentanyl, and either 0.2 mL of 0.9% saline (normal saline; NS) or 100 µg (0.2 mL) of morphine (morphine sulfate, MS). Postoperative analgesia was limited to patient-controlled IV analgesia morphine. Six women (three NS and three MS) were excluded because of major protocol violations. Twenty-four-hour patient-controlled IV analgesia morphine use was (mean ± SD) 39.6 ± 19.6 mg in the NS group and 1.1 ± 2.5 mg in the MS group (P < 0.0000001). Visual analog scale scores for crampy and incisional pain (rest and movement) were significantly higher in the NS group compared with the MS group at 4, 8, 12, and 24 h (P < 0.001). The adverse effect profile was similar between groups. Visual analog scale satisfaction scores (mean ± SD) were 96.6 ± 16.0 in the MS group and 84.2 ± 23.6 in NS group (P < 0.05). The results of this study indicate that women experience significant postoperative pain after PPTL surgery, and this pain is effectively obviated by 100 µg ITM.

IMPLICATIONS: This investigation documents the extent of the significant postoperative pain experienced by women after routine postpartum tubal ligation surgery and demonstrates the efficacy of a small dose (100 µg) of intrathecal morphine to obviate this pain with minimal adverse effects.

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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