The objective of this study is to compare the efficacies of 3 different intrathecal doses (80, 120, and 160 mcg) of morphine in achieving postcesarean delivery analgesia and the severity of the side effects thereof.
A prospective, randomized, double-blind study.
A total of 150 pregnant women between the ages of 18 to 40, with a gestational week >36, who were planned to have elective cesarean section were included in the study. Patients were randomized into 3 groups based on the dosages of intrathecal doses of morphine (80, 120, and 160 mcg) they will receive in addition to 10 mg 0.5% hyperbaric bupivacaine and 20 mcg fentanyl. Intravenous (IV) patient-controlled analgesia (PCA) prepared with fentanyl was administered to each patient after the surgery. Postoperative 24-hour total IV PCA-fentanyl consumption was recorded. The patients were evaluated for side effects such as pain, nausea-vomiting, pruritus, sedation score, and respiratory depression after the surgery.
PCA-fentanyl consumption was significantly higher in Group 1 compared to Group 2 and 3 (P = .047). There was no significant differences between the groups in terms of nausea-vomiting scores. The pruritus scores were significantly higher in Group 3 compared to Group 1 (P = .020). The pruritus scores were significantly higher in all groups at the postoperative 8th-hour (P = .013). Respiratory depression, which would require treatment, was not observed in any patient.
Based on the study findings, it was concluded that 120 mcg intrathecal morphine provides adequate analgesia with minimal side effects in cesarean sections.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of PeriAnesthesia Nursing
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal anesthesia: a qualitative and quantitative systematic review of randomized controlled trials.Anesthesiology. 1999; 91: 1919-1927https://doi.org/10.1097/00000542-199912000-00045
- Dose-response relationship of intrathecal morphine for postcesarean analgesia.Anesthesiology. 1999; 90: 437-444https://doi.org/10.1097/00000542-199902000-00018
- Intrathecal injection of morphine for obstetric analgesia.Anesthesiology. 1981; 54: 136-140https://doi.org/10.1097/00000542-198102000-00007
- Perioperative analgesia after intrathecal fentanyl and morphine or morphine alone for cesarean section.Medicine (United States). 2017; 96: e8892https://doi.org/10.1097/MD.0000000000008892
- Neuraxial morphine and respiratory depression: finding the right balance.Drugs. 2011; 71: 1807-1819https://doi.org/10.2165/11596250-000000000-00000
- Intrathecal administration of morphine for elective caesarean section. A comparison between 0.1 mg and 0.2 mg.Anaesthesia. 1996; 51: 871-873https://doi.org/10.1111/j.1365-2044.1996.tb12622.x
- Postoperative pain relief in primigravida caesarean section patients – combination of intrathecal morphine and epinephrine.Acta Anaesthesiol Sin. 1999; 37: 111-114
- The effect of intrathecal morphine dose on outcomes after elective cesarean delivery: a meta-analysis.Anesth Analg. 2016; 123: 154-164https://doi.org/10.1213/ANE.0000000000001255
- Mini-dose intrathecal morphine for the relief of post-cesarean section pain: safety, efficacy, and ventilatory responses to carbon dioxide.Anesth Analg. 1988; 67: 137-143
- Dextromethorphan and intrathecal morphine for analgesia after caesarean section under spinal anaesthesia.Br J Anaesth. 2003; 90: 653-658https://doi.org/10.1093/bja/aeg122
- Comparison of morphine with fentanyl added to intrathecal 0.5% hyperbaric bupivacaine for analgesia after caesarean section.Med J Malaysia. 2009; 64: 71-74
- Efficacy of intrathecal morphine for analgesia following elective cesarean section: comparison with previous delivery.J Nippon Med Sch. 2003; 70: 327-333https://doi.org/10.1272/jnms.70.327
- Intrathecal morphine 100 and 200 μg for post-cesarean delivery analgesia: a trade-off between analgesic efficacy and side effects.Int J Obstet Anesth. 2013; 22: 36-41https://doi.org/10.1016/j.ijoa.2012.09.006
- Comparison of 0.25 mg and 0.1 mg intrathecal morphine for analgesia after Cesarean section.Can J Anaesth. 1999; 46: 856-860https://doi.org/10.1007/BF03012975
- Intrathecal morphine in anesthesia for cesarean delivery: dose-response relationship for combinations of low-dose intrathecal morphine and spinal bupivacaine.J Clin Anesth. 2008; 20: 180-185https://doi.org/10.1016/j.jclinane.2007.07.010
- Intrathecal morphine for caesarean section: an assessment of pain relief, satisfaction and side-effects.Anaesthesia. 1997; 52: 373-377https://doi.org/10.1111/j.1365-2044.1997.az0083c.x
Cousins MJ, Mather LE, Smart N, White D. The spinal route of analgesia: opioids and future options 1994:195-226. doi:10.1007/978-94-011-0816-4_16
- Ondansetron for treatment of intrathecal morphine-induced pruritus after cesarean delivery.Reg Anesth Pain Med. 2000; 25: 535-539https://doi.org/10.1053/rapm.2000.7809
- The effective duration of analgesia after intrathecal morphine in patients without additional opioid analgesia: a randomized double-blind multicentre study on orthopaedic patients.Eur J Anaesthesiol. 2009; 26: 683-688https://doi.org/10.1097/EJA.0b013e328329b045
- Intrathecal morphine for postoperative analgesia: a randomized, controlled, dose-ranging study after hip and knee arthroplasty.Anesth Analg. 2003; 97: 1452-1457https://doi.org/10.1213/01.ANE.0000083374.44039.9E
- An optimal dose study of intrathecal morphine in gynecological patients.J Med Assoc Thail. 2003; 86: S331-S337
- Combined intrathecal morphine and bupivacaine for elective postcesarean pain.Jpn J Anesthesiol. 2009; 58: 416-421
- Low dose intrathecal morphine and pain relief following caesarean section.Int J Obstet Anesth. 1994; 3: 87-91https://doi.org/10.1016/0959-289X(94)90175-9
- Intrathecal sufentanil, fentanyl, or placebo added to bupivacaine for cesarean section.Anesth Analg. 1997; 85: 1288-1293https://doi.org/10.1097/00000539-199712000-00020
- Efficacy of intrathecal morphine with epidural ropivacaine infusion for postcesarean analgesia.J Clin Anesth. 2010; 22: 268-273https://doi.org/10.1016/j.jclinane.2009.09.003
- A double-blinded, randomized comparison of intrathecal and epidural morphine for elective cesarean delivery.Anesth Analg. 2002; 95: 436-440https://doi.org/10.1213/00000539-200208000-00037
- Small doses of intrathecal morphine combined with systemic diclofenac for postoperative pain control after cesarean delivery.Anesth Analg. 1998; 86: 538-541https://doi.org/10.1213/00000539-199803000-00017
- Comparison of 50 μg and 25 μg doses of intrathecal morphine on postoperative analgesic requirements in patients undergoing transurethral resection of the prostate with intrathecal anesthesia.J Clin Anesth. 2010; 22: 329-333https://doi.org/10.1016/j.jclinane.2009.09.006
- Adverse effects of extradural and intrathecal opiates: report of a nationwide survey in sweden.Br J Anaesth. 1982; 54: 479-486https://doi.org/10.1093/bja/54.5.479
- Relief of postoperative pain with low dose intrathecal morphine.Pain. 1981; 10https://doi.org/10.1016/0304-3959(81)90355-9
- Combined intrathecal morphine and bupivacaine for cesarean section.Anesth Analg. 1988; 67: 370-374https://doi.org/10.1213/00000539-198804000-00014
- Delayed respiratory depression associated with 0.15 mg intrathecal morphine for cesarean section: a review of 1915 cases.J Anesth. 2008; 22: 112-116https://doi.org/10.1007/s00540-007-0593-z
- A retrospective assessment of the incidence of respiratory depression after neuraxial morphine administration for postcesarean delivery analgesia.Anesth Analg. 2013; 117: 1368-1370https://doi.org/10.1213/ANE.0b013e3182a9b042
Published online: March 28, 2023
Publication stageIn Press Corrected Proof
Conflict of Interest: None to report.
Funding: This study was supported by Ondokuz Mayıs University with the project number PYO.TIP.1904.18.010.
© 2022 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.