An audit of single dose epidural diamorphine during elective caesarean section at a district general hospital

Abstract

Mothers receiving combined spinal-epidural (CSE) anaesthesia for elective caesarean section (n = 188) were audited. A single dose of epidural diamorphine (2–3 mg) was given during surgery. Unless contraindicated, diclofenac 100 mg was given per rectum at the end of surgery. Postoperative analgesia was provided as oral Co-dydramol and diclofenac. All mothers were premedicated with ranitidine 150 mg and metoclopramide 10 mg orally. Observations were recorded for 24 h postoperatively. Pain, nausea, sedation and itching were assessed on a scale of 0 (nil), 1 (mild), 2 (moderate) or 3 (severe). All mothers were reviewed during the second postoperative day. Epidural supplements during surgery and administration of naloxone, systemic opiates and anti-emetics after surgery were recorded. Postoperative analgesia was prolonged and excellent. Over 92% of pain scores were mild or less. Two mothers complained of severe pain, which was resolved with oral Co-dydramol. Postoperative morphine was not used. Itching was common but not troublesome; mild (54%), moderate (16%), severe (3%); 7% of mothers received naloxone. Nausea was uncommon: mild (19%), moderate (10%), severe (2%); 16% of mothers received anti-emetics. Itching was less than previous reports with subarachnoid diamorphine. Single dose epidural diamorphine can be used during elective caesarean section rendering systemic opiates unnecessary.