Abstract
BackgroundSeveral neuraxial techniques have demonstrated effective post-cesarean section analgesia. According to previous reports, it is likely that patient-controlled epidural analgesia (PCEA) without opioids is inferior to intrathecal morphine (IM) alone for post-cesarean section analgesia. However, little is known whether adding PCEA to IM is effective or not. The aim of this study was to compare post-cesarean section analgesia between IM with PCEA and IM alone.MethodsFifty patients undergoing elective cesarean section were enrolled in this prospective randomized study. Patients were randomized to one of two groups: IM group and IM + PCEA group. All patients received spinal anesthesia with 12 mg of 0.5% hyperbaric bupivacaine, 10 μg of fentanyl, and 150 μg of morphine. Patients in IM + PCEA group received epidural catheterization through Th11–12 or Th12-L1 before spinal anesthesia and PCEA (basal 0.167% levobupivacaine infusion rate of 6 mL/h, bolus dose of 3 mL in lockout interval of 30 min) was commenced at the end of surgery. A numerical rating scale (NRS) at rest and on movement at 4,8,12,24,48 h after the intrathecal administration of morphine were recorded. In addition, we recorded the incidence of delayed ambulation and the number of patients who requested rescue analgesics. We examined NRS using Bonferroni’s multiple comparison test following repeated measures analysis of variance; p < 0.05 was considered as statistically significant.ResultsTwenty-three patients in each group were finally analyzed. Mean NRS at rest was significantly higher in IM group than in IM + PCEA group at 4 (2.7 vs 0.6), 8 (2.2 vs 0.6), and 12 h (2.5 vs 0.7), and NRS during mobilization was significantly higher in IM group than in IM + PCEA group at 4 (4.9 vs 1.5), 8 (4.8 vs 1.9), 12 (4.9 vs 2), and 24 h (5.7 vs 3.5). The number of patients who required rescue analgesics during the first 24 h was significantly higher in IM group compared to IM + PCEA group. No significant difference was observed between the groups in incidence of delayed ambulation.ConclusionsThe combined use of PCEA with IM provided better post-cesarean section analgesia compared to IM alone.Trial registrationUMIN-CTR (Registration No. UMIN000032475). Registered 6 May 2018 – Retrospectively registered.
Highlights
Several neuraxial techniques have demonstrated effective post-cesarean section analgesia
Another study concluded that the combined use of intrathecal morphine and patient-controlled epidural analgesia (PCEA) improved post-cesarean section analgesia compared to PCEA without opioids [2]
We hypothesized that the combined use of PCEA and intrathecal morphine may have an advantage in post-cesarean section analgesia compared to intrathecal morphine alone
Summary
Several neuraxial techniques have demonstrated effective post-cesarean section analgesia. It is likely that patient-controlled epidural analgesia (PCEA) without opioids is inferior to intrathecal morphine (IM) alone for post-cesarean section analgesia. Several neuraxial techniques have demonstrated effective postoperative analgesia following cesarean section [1,2,3,4]. One study reported that intrathecal morphine alone was superior to epidural morphine alone or PCEA without opioids for postoperative analgesia following cesarean section [1]. Based on the literature and one retrospective study [7], it is likely that PCEA without opioids is inferior to intrathecal morphine alone for post-cesarean section analgesia. We hypothesized that the combined use of PCEA and intrathecal morphine may have an advantage in post-cesarean section analgesia compared to intrathecal morphine alone
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have