Anesth Analg 2005;101:609
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000159005.02485.41
LETTER TO THE EDITOR
Intrathecal Morphine for Postpartum Bilateral Tubal Ligation
Philip J. Balestrieri, MA, MD
Department of Anesthesiology; University of Virginia Health System; Charlottesville, VA; pjb8y{at}virginia.edu
To the Editor:
Habib et al.’s study (1) advocates the use of intrathecal morphine for postoperative pain relief after bilateral postpartum tubal ligation. There are several limitations to their study, however. The power of the study was only 80%. In addition, their dose of IV ketorolac was only 30 mg. Previous studies (2) using 60 mg of ketorolac in patients undergoing abdominal hysterectomies have indicated that the larger dose is more effective at reducing postoperative IV morphine requirements without increasing side effects. In addition, the incidence of vomiting and pruritus were significantly more likely in the treatment group in Habib et al.’s study. Although delayed respiratory depression is unlikely in patients receiving small-dose intrathecal morphine, this possibility was not considered in their study. I would suggest that improved postoperative pain relief without the increased incidence of nausea and vomiting might be more effectively achieved by using 60 mg of IV ketorolac preoperatively and eliminating the intrathecal morphine. The use of the larger dose of ketorolac, combined with infiltration of ropivacaine by the obstetricians during closure, might well provide superior postoperative pain relief without the side effects associated with intrathecal morphine.
References
- Habib AS, Muir HA, White WD, et al. Intrathecal morphine for analgesia after postpartum bilateral tubal ligation. Anesth Analg 2005;100:239–43.[Abstract/Free Full Text]
- Balestrieri, P et al. The effect of intravenous ketorolac given intraoperatively versus postoperatively on outcome from gynecologic abdominal surgery. J Clin Anesth 1997;9:358–64.[Medline]
