This Article 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 Google Scholar Google Scholar Articles by Balestrieri, P. J. Articles by Blank, R. S. Search for Related Content PubMed PubMed Citation Articles by Balestrieri, P. J. Articles by Blank, R. S.

---

LETTER TO THE EDITOR

Efficacy of Postoperative Epidural Morphine for Postpartum Tubal Ligation

Obstetric Anesthesia, Department of Anesthesiology, University of Virginia, pjb8y{at}hscmail.mcc.virginia.edu

To the Editor:

Marcus et al. (1) suggest that postoperative pain relief is better in patients undergoing postpartum tubal ligation when epidural morphine is administered, as also suggested by Campbell et al. (2). There are several drawbacks to the use of epidural morphine in these patients. Most significantly, epidural morphine is associated with delayed respiratory depression, which may appear up to 24 h after administration. With increasing pressure on hospitals to limit the duration of stay of patients, postpartum patients undergoing tubal ligation the day after delivery are commonly discharged on the same day as the surgery. Such patients should not receive epidural morphine, as they will not be adequately monitored for ventilatory depression. There might be a case for epidural morphine if there were no acceptable alternatives and if all such patients remained in hospital for 24 h after their procedure. However, there are numerous alternatives, including infiltration by the obstetricians with local anesthetic, IV agents such as ketorolac and short-acting opioids, and traditional oral analgesics. More than 75% of such procedures worldwide are done using local anesthesia alone (3). In our view, epidural morphine may be excessive for a procedure that produces only modest postoperative pain of short duration (4).

References

1. Marcus R-Jay L, Wong CA, Lehor A, et al. Postoperative epidural morphine for postpartum tubal ligation analgesia. Anesth Analg 2005;101:876–81.[Abstract/Free Full Text]
2. Campbell DC, Riben CM, Rooney ME, et al. Intrathecal morphine for postpartum tubal ligation postoperative analgesia. Anesth Analg 2001;93:1006–11.[Abstract/Free Full Text]
3. Pati S, Sullins V. Female sterilization, evidence. Obstet Gynecol Clin North Am 2000;27:859–99.[Medline]
4. Chestnut DH. Obstetric anesthesia: principles and practice. 3rd ed. St. Louis: Mosby, 2004:415.

This Article 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 Google Scholar Google Scholar Articles by Balestrieri, P. J. Articles by Blank, R. S. Search for Related Content PubMed PubMed Citation Articles by Balestrieri, P. J. Articles by Blank, R. S.