Journal of Nippon Medical School: Vol.70 No.4 page.327

Journal of Nippon Medical School

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ArticleTitle Efficacy of Intrathecal Morphine for Analgesia Following Elective Cesarean Section: comparison with Previous Delivery

AuthorList Katsuyuki Terajima¹, Hidetaka Onodera¹, Masao Kobayashi¹, Hiroko Yamanaka², Takashi Ohno², Seiichi Konuma² and Ryo Ogawa¹

Affiliation ¹Department of Anesthesiology, Nippon Medical School
²Department of Gynecology, Oyama Municipal Hospital

Language EN

Volume 70

Issue 4

Year 2003

Page 327-333

Received December 12, 2002

Accepted February 7, 2003

Keywords personal satisfaction, postoperative pain, complication, intrathecal injection

Abstract Purpose: To determine the effect of intrathecal injection of morphine 0.2 mg on postoperative analgesia, activity and satisfaction after elective cesarean section.
Method: Forty-five parturients who had previously undergone cesarean section with spinal anesthesia without intrathecal morphine were enrolled in this randomized, double-blinded study. Group 1 received hyperbaric bupivacaine 10 mg intrathecally (IT) and group 2 received morphine 0.2 mg IT in addition to hyperbaric bupivacaine 10 mg IT. All subjects received 20 mg piroxicam rectally at the end of surgery and 18 hours after surgery. Side effects in the first 24 hours after delivery were recorded by a trained nurse. Pain, nausea, pruritus, and satisfaction during the first 24 hours were self-rated using a visual analog scale. Subjects also recorded their memories of these symptoms after their previous cesarean sections. The time to first request for additional analgesics (30 mg pentazocine intramuscularly), total dose of pentazocine within 24 hours postoperatively and nurse observations of walking status within 24 hours postoperatively were also recorded.
Results: In the present cesarean sections, the duration of complete analgesia and the time to first request for additional analgesics were longer in group 2 than in group 1. Group 2 had higher satisfaction scores than group 1 in spite of their more severe pruritus and nausea during the first 24 hours after surgery. The percentage of patients who could not walk during the first 24 hours after cesarean section was higher in group 1 than in group 2.
Conclusion: The addition of morphine 0.2 mg to hyperbaric bupivacaine 0.5% by intrathecal injection reduced postoperative pain and analgesic use, and increased patient satisfaction following cesarean section. The combination of intrathecal injection of morphine and preventive NSAIDs can be easily administered in most hospitals, and is substantially less expensive than the new pain management technologies currently in use.

Correspondence to Katsuyuki Terajima, MD, Department of Anesthesiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo 113-8603, Japan
YIB01174@nifty.com

ArticleTitle	Efficacy of Intrathecal Morphine for Analgesia Following Elective Cesarean Section: comparison with Previous Delivery
AuthorList	Katsuyuki Terajima¹, Hidetaka Onodera¹, Masao Kobayashi¹, Hiroko Yamanaka², Takashi Ohno², Seiichi Konuma² and Ryo Ogawa¹
Affiliation	¹Department of Anesthesiology, Nippon Medical School ²Department of Gynecology, Oyama Municipal Hospital
Language	EN
Volume	70
Issue	4
Year	2003
Page	327-333
Received	December 12, 2002
Accepted	February 7, 2003
Keywords	personal satisfaction, postoperative pain, complication, intrathecal injection
Abstract	Purpose: To determine the effect of intrathecal injection of morphine 0.2 mg on postoperative analgesia, activity and satisfaction after elective cesarean section. Method: Forty-five parturients who had previously undergone cesarean section with spinal anesthesia without intrathecal morphine were enrolled in this randomized, double-blinded study. Group 1 received hyperbaric bupivacaine 10 mg intrathecally (IT) and group 2 received morphine 0.2 mg IT in addition to hyperbaric bupivacaine 10 mg IT. All subjects received 20 mg piroxicam rectally at the end of surgery and 18 hours after surgery. Side effects in the first 24 hours after delivery were recorded by a trained nurse. Pain, nausea, pruritus, and satisfaction during the first 24 hours were self-rated using a visual analog scale. Subjects also recorded their memories of these symptoms after their previous cesarean sections. The time to first request for additional analgesics (30 mg pentazocine intramuscularly), total dose of pentazocine within 24 hours postoperatively and nurse observations of walking status within 24 hours postoperatively were also recorded. Results: In the present cesarean sections, the duration of complete analgesia and the time to first request for additional analgesics were longer in group 2 than in group 1. Group 2 had higher satisfaction scores than group 1 in spite of their more severe pruritus and nausea during the first 24 hours after surgery. The percentage of patients who could not walk during the first 24 hours after cesarean section was higher in group 1 than in group 2. Conclusion: The addition of morphine 0.2 mg to hyperbaric bupivacaine 0.5% by intrathecal injection reduced postoperative pain and analgesic use, and increased patient satisfaction following cesarean section. The combination of intrathecal injection of morphine and preventive NSAIDs can be easily administered in most hospitals, and is substantially less expensive than the new pain management technologies currently in use.
Correspondence to	Katsuyuki Terajima, MD, Department of Anesthesiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo 113-8603, Japan YIB01174@nifty.com