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OBSTETRIC ANESTHESIA

A Double-Blinded, Randomized Comparison of Intrathecal and Epidural Morphine for Elective Cesarean Delivery

Department of Anaesthesia and Intensive Care, Helsinki University Central Hospital, Helsinki, Finland

Address correspondence and reprint requests to Johanna Sarvela, MD, PhD, Department of Anaesthesia and Intensive Care, Helsinki University Central Hospital, PO Box 140, Haartmaninkatu 2, FIN-00029 HYKS, Finland. Address e-mail to johanna.sarvela{at}hus.fi

We randomized 150 parturients into a double-blinded trial to receive intrathecal (IT) 100 µg (IT 100 group) or 200 µg (IT 200 group) or epidural 3 mg (Epidural group) of morphine for elective cesarean delivery with a combined spinal/epidural technique. The patients additionally received ketoprofen 300 mg/d. Postoperative pain relief and side effects were registered every 3 h up to 24 h, and all patients were interviewed on the first postoperative day. Pain control was equally good, but the parturients in the IT 100 group requested rescue analgesics more often compared with the other groups (P < 0.05). Itching was a common complaint and was reported by 74% of the parturients in the Epidural group and 65% and 91% in the IT 100 and IT 200 groups, respectively (P < 0.01). Medication for itching was requested by 44%, 24%, and 45% of the patients, respectively (P < 0.05). There was no difference in postoperative nausea or vomiting. The pain relief was perceived as good by >90% of the patients in all groups. In conclusion, because of the decreased incidence of and lesser requirements of medication for itching, IT morphine 100 µg with ketoprofen is recommended in cesarean deliveries. Rescue analgesics nevertheless need to be prescribed.

IMPLICATIONS: Spinal morphine is an effective analgesic after cesarean delivery, but it has several side effects. The purpose of this study was to compare the prevalence of side effects and the level of analgesia of epidural morphine with two different doses of spinal morphine after elective cesarean delivery. Although rescue analgesics may be required, intrathecal morphine 100 µg is suggested for postoperative analgesia after cesarean delivery.

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