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LETTER TO THE EDITOR

Efficacy of Postoperative Epidural Morphine for Postpartum Tubal Ligation

Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, r-marcus{at}northwestern.edu

In Response:

We would like to thank Dr. Balestrieri et al. for their interest in our article.

We disagree with their statement that postpartum tubal ligation (PPTL) postoperative pain is mild. As discussed in our article, pilot data from our institution showed that postoperative PPTL patients, despite receiving more oral analgesics, experience moderate to severe pain when compared with a cohort (1).

Our data revealed the optimal dose of epidural morphine associated with the fewest side effects was 2 mg when combined with regular NSAID therapy. No subject had an observed respiratory rate <10 breaths/min or required treatment for respiratory depression. It is doubtful that this small amount of morphine would cause any significant respiratory depression when administered to the appropriate patient population.

In the state of Illinois, insurance companies are now obligated to cover postpartum hospitalization for 48 h. PPTL procedures are generally performed within several hours of delivery and patients are not discharged for at least 24 h.

Finally, we agree that there are other modalities for PPTL postoperative analgesia. We compared epidural morphine and the standard analgesia technique used at our institution. Studies comparing these other modalities with epidural morphine are needed.

Reference

1. Marcus RL, Wong CA, Lehor A, et al. Postoperative epidural morphine for postpartum tubal ligation analgesia. Anesth Analg 2005;101:876–81.[Abstract/Free Full Text]

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