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Sökning: onr:"swepub:oai:DiVA.org:uu-341815" > Perioperative analg...

Perioperative analgesia after intrathecal fentanyl and morphine or morphine alone for cesarean section : A randomized controlled study

Weigl, Wojciech (författare)
Uppsala universitet,Anestesiologi och intensivvård,Med Univ Warsaw, Dept Anesthesiol & Intens Care 1, Warsaw, Poland
Bierylo, Andrzej (författare)
Med Univ Warsaw, Dept Anesthesiol & Intens Care 1, Warsaw, Poland.
Wielgus, Monika (författare)
Med Univ Warsaw, Dept Anesthesiol & Intens Care 1, Warsaw, Poland.;Gruca Orthoped & Trauma Teaching Hosp, Ctr Postgrad Med Educ, Dept Anesthesiol & Intens Care, Otwock, Poland.
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Krzemien-Wiczynska, Swietlana (författare)
Med Univ Warsaw, Dept Anesthesiol & Intens Care 1, Warsaw, Poland.
Kolacz, Marcin (författare)
Med Univ Warsaw, Dept Anesthesiol & Intens Care 1, Warsaw, Poland.
Dabrowski, Michal J. (författare)
Polish Acad Sci, Inst Comp Sci, Jana Kazimierza 5, PL-01248 Warsaw, Poland.
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 (creator_code:org_t)
LIPPINCOTT WILLIAMS & WILKINS, 2017
2017
Engelska.
Ingår i: Medicine (Baltimore, Md.). - : LIPPINCOTT WILLIAMS & WILKINS. - 0025-7974 .- 1536-5964. ; 96:48
  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
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  • Objectives: Intrathecal morphine is used in the postoperative management of pain after caesarean section (CS), but might not be optimal for intraoperative analgesia. We hypothesized that intrathecal fentanyl could supplement intraoperative analgesia when added to a local anesthetic and morphine without affecting management of postoperative pain.Methods: This prospective, randomized, double-blind, parallel-group study included 60 parturients scheduled for elective CS. Spinal anesthesia consisted of bupivacaine with either morphine 100 mu g (M group), or fentanyl 25 mu g and morphine 100 mu g (FM group). The frequency of intraoperative pain and pethidine consumption in the 24 hours postoperatively was recorded.Results: Fewer patients in the FM group required additional intraoperative analgesia (P < .01, relative risk 0.06, 95% confidence interval [CI] 0.004-1.04). The FM group was noninferior to the M group for 24-hour opioid consumption (95% CI -10.0 mg to 45.7 mg, which was below the prespecified boundary of 50 mg). Pethidine consumption in postoperative hours 1 to 12 was significantly higher in the FM group (P=.02). Postoperative nausea and vomiting (PONV) were more common in the FM group (P=.01). Visual analog scale scores, effective analgesia, Apgar scores, and rates of pruritus and respiratory depression were similar between the groups.Conclusions: Intrathecal combination of fentanyl and morphine may provide better perioperative analgesia than morphine alone in CS and could be useful when the time from anesthesia to skin incision is short. However, an increase in PONV and possible acute spinal opioid tolerance after addition of intrathecal fentanyl warrants further investigation using lower doses of fentanyl.

Nyckelord

acute opioid tolerance
hydrophilic and lipophilic opioids
patient-controlled analgesia (PCA)
post-caesarean pain management
spinal anesthesia
spinal opioids
superiority and noninferiority trial

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