TITLE:
Three Different Doses of Intrathecal Morphine as Part of a Multimodal Regimen for Post-Cesarean Delivery Analgesia: A Randomized Double-Blinded Trial
AUTHORS:
Marcio Luiz Benevides, Rubens Jardim Nochi Jr., Carlos Eduardo Solcia, Valter Moreira Xavier Júnior, Adalberto Francisco Buss Lima
KEYWORDS:
Spinal Anesthesia, Cesarean Delivery, Intrathecal Morphine, Postoperative Pain, Multimodal Analgesia
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.8 No.9,
August
2,
2018
ABSTRACT: Brazil
is one of the countries that carry out cesarean delivery in the world. The pain
after cesarean delivery (CD) is one of the main concerns of parturient.
Intrathecal Morphine (ITM) is widely used for the treatment of pain after CD;
however, the optimal dose with minimal side effects is to be established. Objectives: To compare the analgesia and side effects resulted by three different doses
of ITM as part of a multimodal regimen for post-cesarean delivery analgesia. Methods:
One hundred ninety-four patients were sampled in this randomized,
double-blinded, three-arm study (group 0.075: ITM 0.75 mg; group 0.1: ITM 0.1
mg and group 0.15: ITM 0.15 mg). All patients received intravenous
dexamethasone, dipyrone and ketoprofen. The primary endpoint was pain intensity
measured at rest and on movement, while the secondary endpoint was overall
satisfaction with pain relief, the incidence of nausea and vomiting, intensity of pruritus, and the use of additional
tramadol, antipruritic and antiemetic use within 24 hours after postoperation. Results:
The three groups showed similar pain intensity at rest and on movement. The
pain intensity on movement was significantly higher than at rest in the groups
(p 0.001). There were no significant differences among
the groups regarding secondary endpoint. Conclusions: Our findings
suggest that in cases of an elective CD, 0.075 mg of ITM produces postoperative
analgesia of similar quality that provided by 0.1 or 0.15 mg ITM. The patients
should have a multimodal analgesia approach that includes: ITM,
anti-inflammatory agents and access to additional systemic analgesic if
necessary.