Effectiveness of A Single Dose of Epidural Morphine for Postpartum Perineal Pain: A Randomized Controlled Trial

Science Insights, 20 June 2017
Volume 2017
Doi: 10.15354/si.17.ar062
 
Article
Effectiveness of A Single Dose of Epidural Morphine for Postpartum Perineal Pain: A Randomized Controlled Trial
 
Mao Mao, MD, MSc;* Zhaohui Wang, MD, MSc;* Caijuan Li, MD, MSc;* Nan Wang, MD, MSc; *Shanwu Feng, MD, MPH;* Shiqin Xu, MD, MPH; Xiaofeng Shen, MD, MPH; *  Xian Wang, MD, MSc; *, ∆
 
Author Affiliations
*: Department of Anesthesiology, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing 210004, China
∆: Correspondence to: Dr. Xian Wang, Email: wangxian2002@126.com
 
 
OBJECTIVE

The purpose of this study was to identify the effectiveness of a single dose of epidural morphine for postpartum perineal pain, and the incidence of side effects.
 
MATERIALS AND METHODS

After institutional review board approval and patient consent, a total of 200 parturients with perineal trauma undergoing epidural analgesia were randomized into three groups: C, M1, and M2, wherein sole saline 10ml, morphine 1mg dissolved in saline 10ml, or morphine 2mg dissolved in saline 10ml was epidurally given immediately after umbilical cord clamp, respectively. Within 24 hours after vaginal delivery, perineal pain at rest and movement evaluated with present pain intensity (PPI) as well as the time to the first request for additional analgesia were recorded. Besides, epidural morphine related side effects including nausea, vomiting, pruritus, and urinary retention were observed as well.
 
RESULTS

The proportion of women with moderate and severe pain at rest was significantly lower in groups M1 and M2 compared to group C (4.5 & 0% vs. 20.6%, respectively). Meanwhile, the proportion of women with moderate and severe pain at movement was al-so significantly lower in groups M1 and M2 compared to group C (10.4 & 12.3% vs. 55.9%, respectively). Further, the proportion of women who require for additional analgesics in the first 24 hours after vaginal delivery in groups M1 and M2 was lower compared with group C (9.0 & 7.7% vs. 52.9%, respectively). The average time to first request for additional analgesia after delivery was prominently longer in groups M1 and M2 compared to group C (12.79±5.49 & 15.61±4.90 h vs. 7.17±3.84 h, respectively). No significant difference was found between groups M1 and M2 with regard to morphine efficacy. However, epidural morphine 2mg remarkably increased the incidence of nausea, vomiting, and pruritus compared to sole saline (P<0.05), and the incidence of nausea and pruritus compared to morphine 1mg (P<0.05).
 
CONCLUSIONS


Epidural morphine 1mg could decrease the proportion of moderate-severe PPI pain, prolong the time to first request for additional analgesia, and have fewer side effects.

Keywords: Perineal trauma; Perineal pain, Epidural morphine

 

Author: 

Mao Mao, MD, MSc