| Postcesarean analgesia with both epidural morphine and intravenous patient-controlled analgesia: neurobehavioral outcomes among nursing neonates. | |
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MedLine Citation:
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PMID: 9296416 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Among nursing parturients after cesarean delivery, intravenous patient-controlled analgesia (PCA) with meperidine is associated with significantly more neonatal neurobehavioral depression than PCA with morphine. A single dose of epidural morphine (4 mg) decreases postcesarean opioid analgesic requirements and may reduce or prevent neonatal neurobehavioral depression associated with PCA meperidine. Prospectively, 102 term parturients underwent cesarean delivery with epidural anesthesia, 2% lidocaine and epinephrine 1:200,000. After umbilical cord clamping, each patient received epidural morphine 4 mg and was randomly allocated to receive either PCA meperidine or PCA morphine. Initial neonatal characteristics, included gestational age, Apgar scores, weight, and umbilical cord gas partial pressures. Brazelton Neonatal Behavioral Assessment Scale (NBAS) examinations were performed on each of the first 4 days of life. Nursing infants (n = 47) were grouped according to maternal PCA opioid in breast milk (meperidine [n = 24] or morphine [n = 23]); bottle-fed infants (n = 56) served as the control group. The three infant groups were equivalent with respect to initial characteristics and NBAS scores on the first 2 days of life. On the third day of life, infants in the morphine group were significantly more alert and oriented to animate human cues compared with infants in the meperidine or control group. On the fourth day of life, infants in the morphine group remained significantly more alert and oriented to animate human auditory cues than infants in the meperidine group. Average PCA opioid consumption through 48 h postpartum was equivalent (0.54 mg/kg morphine and 4.7 mg/kg meperidine); however, even with these small doses, meperidine was associated with significantly poorer neonatal alertness and orientation than morphine. Morphine is the PCA opioid of choice for postcesarean analgesia among nursing parturients. IMPLICATIONS: Among nursing parturients after cesarean delivery, intravenous patient-controlled analgesia with meperidine is associated with more neonatal neurobehavioral depression than patient-controlled analgesia with morphine. In this study, we found that nursing infants exposed to morphine were more alert and oriented to animate human cues than those exposed to meperidine. |
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Authors:
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B Wittels; B Glosten; E A Faure; A H Moawad; M Ismail; J Hibbard; J A Senal; S M Cox; S C Blackman; L Karl; R A Thisted |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Anesthesia and analgesia Volume: 85 ISSN: 0003-2999 ISO Abbreviation: Anesth. Analg. Publication Date: 1997 Sep |
Date Detail:
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Created Date: 1997-09-29 Completed Date: 1997-09-29 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 1310650 Medline TA: Anesth Analg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 600-6 Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesia and Critical Care, University of Chicago, Illinois 60637, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Analgesia, Epidural* Analgesia, Obstetrical* Analgesia, Patient-Controlled* Analgesics, Opioid / administration & dosage*, analysis Breast Feeding* Cesarean Section* Depression, Chemical Double-Blind Method Female Humans Infant Behavior / drug effects* Infant, Newborn Male Meperidine / administration & dosage, analysis Milk, Human / chemistry Morphine / administration & dosage*, analysis Neurologic Examination Pain, Postoperative / drug therapy* Pregnancy Prospective Studies |
| Chemical | |
Reg. No./Substance:
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0/Analgesics, Opioid; 57-27-2/Morphine; 57-42-1/Meperidine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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