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Published Jun 20, 2017

Mao Mao

Zhaohui Wang

Caijuan Li

Nan Wang

Shanwu Feng

Shiqin Xu

Xiaofeng Shen

Xian Wang  

Abstract

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.

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Keywords

Perineal Trauma, Perineal Pain, Epidural Morphine

References
1. Temtanakitpaisan T, Bunyacejchevin S, Koyama M. Obstetrics anal sphincter injury and repair technique: a review. J Obstet Gynaecol Res 2015; 41:329-333.

2. Wang X, Shen J, Feng SW. Xue X, Xu SQ. A prospective stydy of perineal pain after vagi-nal delivery. Chin J Pain Med 2014; 20: 490-493.

3. Wong CA. Advances in labor analgesia. Int J Womens Health 2009; 1:139-154.

4. Wang X, Xu S, Feng S. Postpartum perineal pain in the absence of obstetric anal sphinc-ter injuries: a prospective observational study. Sci Insigt 2013; 4:69-74.

5. Macarthur A, Macarthur C. Incidence, severity and determinants of postpartum perineal pain: a prospective cohort study. Am J Obstet Gynecol 2004; 191:1199-1204.

6. Leeman L, Rogers R, Borders N, Teaf D, Qualls C. The Effect of Perineal Lacerations on Pelvic Floor Function and Anatomy at 6 Months Postpartum in a Prospective Cohort of Nulliparous Women. Birth 2016; 43:293-302.

7. Dichtwald S, Ben HM, Papismedov L, Hazan S, Cattan A, Matot L. Intrathecal morphine versus intravenous opioid administration to impact postoperative analgesia in hepato-pancreatic surgery: a randomized controlled trial. J Anesth 2017; 31:237-245.

8. Sultan P, Gutierrez MC, Carvalho B. Neuraxial morphine and respiratory depression: find-ing the right balance. Drugs 2011; 71:1807-1819.

9. Capdevila X, Moulard S, Plasse C, Peshaud JL, Molinari N, Dadure C, Bringuier S. Effec-tiveness of Epidural Analgesia, Continuous Surgical Site Analgesia, and Patient-Controlled Analgesic Morphine for Postoperative Pain Management and Hyperalgesia, Rehabilitation, and Health-Related Quality of Life After Open Nephrectomy: A Prospective, Randomized, Controlled Study. Anesth Analg 2017; 124: 336-345.

10. Tan EC, Lim Y, Teo YY, Goh R, Law HY, Sia AT. Ethnic differences in pain perception and patient-controlled analgesia usage for postoperative pain. J Pain 2008; 9:849-855.

11. Apfelbaum JL, Horlocker TT, Agarkar M, Connis RT, Hebl JR, Nickinovich DG, Palmer CM, Rathmell JP, Rosenquist RW, Wu CL. Practice Guidelines for the Prevention, Detec-tion, and Management of Respiratory Depression Associated with Neuraxial Opioid Admin-istration:An Updated Report by the American Society of Anesthesiologists Task Force on Neuraxial Opioids and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology 2016; 124:535-55.

12. Crowgey TR, Dominguez JE, Peterson LC, Allen TK, Muir HA, Habib AS. A retrospective assessment of the incidence of respiratory depression after neuraxial morphine admin-istration for postcesarean delivery analgesia. Anesth Analg 2013; 117:1368-1370.
How to Cite
Mao, M., Wang, Z., Li, C., Wang, N., Feng, S., Xu, S., Shen, X., & Wang, X. (2017). Effectiveness of A Single Dose of Epidural Morphine for Postpartum Perineal Pain: A Randomized Controlled Trial. Science Insights, 2017(5), 1–6. https://doi.org/10.15354/si.17.ar062
Section
Original Article