Efficacy Evaluation of Two Different Doses of Morphine used in Spinal Anesthesia
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Research Article
P: 258-264
September 2023

Efficacy Evaluation of Two Different Doses of Morphine used in Spinal Anesthesia

J Ankara Univ Fac Med 2023;76(3):258-264
1. Ankara Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Ankara, Türkiye
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Received Date: 06.09.2023
Accepted Date: 14.09.2023
Publish Date: 24.10.2023
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ABSTRACT

Objectives:

Spinal anesthesia is the most commonly used anesthesia technique in cesarean sections and intrathecal opioids are frequently used for pain control. Intrathecal morphine provides effective and long-term pain control in the postoperative period. The aim of our study was to compare the intrathecal two different morphine doses in terms of additional analgesic need, patient satisfaction, and side effects.

Materials and Methods:

A total of 165 American Society of Anesthesiologists (ASA) I-II patients who will undergo elective cesarean section at Ankara University Faculty of Medicine, Gynecology and Obstetrics Hospital were included in the study. The study was designed as prospective, randomized and double-blind. The pregnant women were randomly alloceted into three groups to receive either 50 or 100 μg intrathecal morphine and the control group. All patients were anesthetized with 10 mg hyperbaric bupivacaine. Pain levels of the patients were determined by visual analogue scale (VAS) at 24 hours postoperatively and additional analgesic needs were determined. Morphine-related side effects such as nausea-vomiting, pruritus and respiratory depression were evaluated.

Results:

In the postoperative period, VAS scores and additional analgesic needs were found to be significantly lower in the morphine-administered groups compared to the control group. There was no significant difference between Groups II and III in terms of these parameters. Itching and nausea-vomiting were found to be significantly higher in Group III compared to Group II.

Conclusion:

We found that intrathecal 50 μg morphine dose had the same analgesic efficacy as the 100 μg dose for cesarean section operations. We think that 50 μg intrathecal morphine dose is an effective analgesic dose for pain control after cesarean section, due to the lower incidence of postoperative side effects.

Keywords: Caesarean, Intrathecal Morphine, Postoperative Analgesia

References

1
Sharpe EE, Molitor RJ, Arendt KW, et al. Intrathecal Morphine versus Intrathecal Hydromorphone for Analgesia after Cesarean Delivery: A Randomized Clinical Trial. Anesthesiology. 2020;132:1382-1391.
2
Tamura T, Yokota S, Ando M, et al. A triple-blinded randomized trial comparing spinal morphine with posterior quadratus lumborum block after cesarean section. Int J Obstet Anesth. 2019;40:32-38.
3
Yonekura H, Mazda Y, Noguchi S, et al. Trend in neuraxial morphine use and postoperative analgesia after cesarean delivery in Japan from 2005 to 2020. Sci Rep. 2022;12:17234.
4
Carvalho FA, Tenório SB. Comparative study between doses of intrathecal morphine for analgesia after caesarean. Braz J Anesthesiol. 2013;63:492-499.
5
Axelsson K, Widman GB. A comparison of bupivacaine and tetracaine in spinal anaesthesia with special reference to motor block. Acta Anaesthesiol Scand. 1985;29:79-86.
6
AMERICAN ACADEMY OF PEDIATRICS COMMITTEE ON FETUS AND NEWBORN; AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS COMMITTEE ON OBSTETRIC PRACTICE. The Apgar Score. Pediatrics. 2015;136:819-822.
7
Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S240-S252.
8
Şanli M, Gülhaş N, Bilen BT, et al. The effect of addition of ketamine to lidocaine on postoperative pain in rhinoplasties. Turk J Med Sci. 2016;46:789-794.
9
Abouleish E, Rawal N, Fallon K, et al. Combined intrathecal morphine and bupivacaine for cesarean section. Anesth Analg. 1988;67:370-374.
10
Girgin NK, Gurbet A, Turker G, et al. Intrathecal morphine in anesthesia for cesarean delivery: dose-response relationship for combinations of low-dose intrathecal morphine and spinal bupivacaine. Journal of Clinical Anesthesia. 2008;20:180-185.
11
Milner AR, Bogod DG, Harwood RJ. Intrathecal administration of morphine for elective Caesarean section. A comparison between 0.1 mg and 0.2 mg. Anaesthesia. 1996;51:871-873.
12
Uchiyama A, Nakano S, Ueyama H, et al. Low dose intrathecal morphine and pain relief following caesarean section. Int J Obstet Anesth. 1994;3:87-91.
13
Palmer CM, Emerson S, Volgoropolous D, et al. Dose-response relationship of intrathecal morphine for postcesarean analgesia. Anesthesiology. 1999;90:437-444.
14
Ganem EM, Módolo NS, Ferrari F, et al. Efeitos da associação entre pequenas doses subaracnóideas de morfina e cetoprofeno venoso e oral em pacientes submetidas à cesariana [Effects of low spinal morphine doses associated to intravenous and oral ketoprofen in patients submitted to cesarean sections]. Rev Bras Anestesiol. 2003;53:431-439.
15
Aly M, Ibrahim A, Farrag W, et al. Pruritus after intrathecal morphine for cesarean delivery: incidence, severity and its relation to serum serotonin level. Int J Obstet Anesth. 2018;35:52-56.
16
Mikuni I, Hirai H, Toyama Y, et al. Efficacy of intrathecal morphine with epidural ropivacaine infusion for postcesarean analgesia. J Clin Anesth. 2010;22:268-273.
17
Cardoso MM, Carvalho JC, Amaro AR, et al. Small doses of intrathecal morphine combined with systemic diclofenac for postoperative pain control after cesarean delivery. Anesth Analg. 1998;86:538-541.
18
Bauchat JR, Weiniger CF, Sultan P, et al. Society for Obstetric Anesthesia and Perinatology Consensus Statement: Monitoring Recommendations for Prevention and Detection of Respiratory Depression Associated With Administration of Neuraxial Morphine for Cesarean Delivery Analgesia. Anesth Analg. 2019;129:458-474.
19
Kato R, Shimamoto H, Terui K, et al. Delayed respiratory depression associated with 0.15 mg intrathecal morphine for cesarean section: a review of 1915 cases. J Anesth. 2008;22:112-116.
20
Terajima K, Onodera H, Kobayashi M, et al. Efficacy of intrathecal morphine for analgesia following elective cesarean section: comparison with previous delivery. J Nippon Med Sch. 2003;70:327-333.
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