Document Detail


Postoperative epidural morphine for postpartum tubal ligation analgesia.
MedLine Citation:
PMID:  16116007     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Women undergoing postoperative postpartum tubal ligation (PPTL) often experience considerable pain. We hypothesized that epidural morphine, as part of a multi-modal analgesic regimen, would decrease postoperative pain and the need for systemic analgesia after PPTL. In a double-blinded study, patients were randomized to receive epidural saline or morphine 2 mg, 3 mg, or 4 mg after epidural anesthesia for PPTL. Postoperatively, ibuprofen 600 mg was administered every 6 h and patients could request acetaminophen 325 mg/hydrocodone 10 mg. The primary outcome variable was time to first request for supplemental analgesia. Verbal rating scores for pain and the incidence and severity of side effects were recorded for 24 h. Morphine group subjects requested supplemental analgesia later and received fewer doses compared with the saline group subjects. Peak cramping and incisional verbal rating scores for pain and the area under the verbal rating scores for pain x time curve for cramping pain were less after epidural morphine compared with saline, but there were no differences among morphine groups. Nausea, vomiting, and pruritus occurred more often in all morphine groups and subjects who received morphine 4 mg required treatment for these side effects more frequently than the saline or morphine 2 mg groups. In conclusion, epidural morphine 2 mg as part of a multi-modal analgesic regimen improved analgesia and decreased the need for supplemental analgesics after PPTL. The need to treat side effects with morphine 2 mg was not increased compared to a regimen of oral acetaminophen/opioid/nonsteroidal antiinflammatory analgesics.
Authors:
R-Jay L Marcus; Cynthia A Wong; Amy Lehor; Robert J McCarthy; Edward Yaghmour; Meltem Yilmaz
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  101     ISSN:  0003-2999     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-08-23     Completed Date:  2005-09-27     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  876-81, table of contents     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, 251 E. Huron, F 5-704, Chicago, IL 60611, USA. r-marcus@northwestern.edu
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MeSH Terms
Descriptor/Qualifier:
Acetaminophen / administration & dosage,  adverse effects,  therapeutic use
Administration, Oral
Adult
Analgesia, Epidural*
Analgesics, Non-Narcotic / administration & dosage,  adverse effects,  therapeutic use
Analgesics, Opioid / administration & dosage*,  adverse effects,  therapeutic use*
Anti-Inflammatory Agents, Non-Steroidal / administration & dosage,  adverse effects,  therapeutic use
Double-Blind Method
Female
Humans
Hydrocodone / administration & dosage,  adverse effects,  therapeutic use
Ibuprofen / administration & dosage,  adverse effects,  therapeutic use
Morphine / administration & dosage*,  adverse effects,  therapeutic use*
Pain Measurement / drug effects
Pain, Postoperative / drug therapy*
Postoperative Nausea and Vomiting / epidemiology
Preanesthetic Medication
Pruritus / chemically induced,  epidemiology
Respiratory Mechanics / drug effects,  physiology
Sterilization, Tubal*
Chemical
Reg. No./Substance:
0/Analgesics, Non-Narcotic; 0/Analgesics, Opioid; 0/Anti-Inflammatory Agents, Non-Steroidal; 103-90-2/Acetaminophen; 125-29-1/Hydrocodone; 15687-27-1/Ibuprofen; 57-27-2/Morphine
Comments/Corrections
Comment In:
Anesth Analg. 2006 Apr;102(4):1297-8; author reply 1298   [PMID:  16551957 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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