Comparison of Three Different Doses of Intrathecal Morphine for Analgesia After Cesarean Section
Condition: Cesarean Section; Spinal Anesthesia; Postoperative Analgesia
MeSH terms: Agnosia
Study type: Interventional

Summary: 
      In our study, It was aimed to determine the dose of morphine that provides the most effective
      analgesia with the least incidence of side effects in the postoperative period.
    

Detailed description: 
      Spinal anesthesia is a widely used method in cesarean section operations. It has become a
      popular practice to add opioids to local anesthetic agents to improve the quality and prolong
      the duration of intraoperative and postoperative analgesia. Morphine and fentanyl are
      commonly used opioids for this purpose. In cesarean sections, intrathecal morphine (ITM) is
      preferred for postoperative analgesia due to its slow onset and long-term analgesia, and
      intrathecal fentanyl is preferred for intraoperative analgesia due to its faster onset of
      action.

      ITM can cause side effects such as nausea, vomiting, itching, sedation and respiratory
      depression. The quality of analgesia and the incidence of side effects may vary depending on
      the ITM dose used. There are studies indicating that reducing the dose of ITM results in good
      quality, long-term analgesia with a low incidence of side effects. However, the ideal dose of
      ITM providing optimal postoperative analgesia with the lowest incidence of side effects for
      cesarean section has not been determined yet in the literature. For this purpose, in this
      study it was compared the postoperative analgesia efficiency and incidence of side effects of
      three different ITM doses in order to contribute to the literature.

      Patients were divided into three groups:

      Group 1: 10 mg hyperbaric bupivacaine + 20 mcg fentanyl+ 80 mcg intrathecal morphine was
      administered.

      Group 2: 10 mg hyperbaric bupivacaine + 20 mcg fentanyl+ 120 mcg intrathecal morphine was
      administered.

      Group 3: 10 mg hyperbaric bupivacaine + 20 mcg fentanyl+ 160 mcg intrathecal morphine was
      administered.

      All patients received iv Patient Controlled Analgesia (PCA) prepared with fentanyl
      postoperatively.
    

Intervention name(s): 80 mcg intrathecal morphine; 120 mcg intrathecal morphine; 160 mcg intrathecal morphine
Intervention type(s): Drug; Drug; Drug
Intervention description(s): İntraoperative Management:
Spinal anesthesia was administered to each patient in a sitting position, after aseptic conditions were achieved with a midline approach. A 25 gauge pencil point spinal needle was placed in the L3-4 or L4-5 space. Upon aspiration of clear cerebrospinal fluid (CSF), 10 mg of hyperbaric bupivacaine, 20 mcg of fentanyl and 80 micrograms of morphine were injected into the intrathecal space together with the determined morphine doses.
Postoperative analgesia management:
Diclofenac sodium 2 × 75 mg was administered intramuscularly to all patients. All patients received iv Patient Controlled Analgesia (PCA) prepared with fentanyl postoperatively. For patients with pain VAS score of 5 or more, meperidine was administered at a rate of 25 mg each time and with a total daily dose of 200 mg.; İntraoperative Management:
Spinal anesthesia was administered to each patient in a sitting position, after aseptic conditions were achieved with a midline approach. A 25 gauge pencil point spinal needle was placed in the L3-4 or L4-5 space. Upon aspiration of clear cerebrospinal fluid (CSF), 10 mg of hyperbaric bupivacaine, 20 mcg of fentanyl and 120 micrograms of morphine were injected into the intrathecal space together with the determined morphine doses.
Postoperative analgesia management:
Diclofenac sodium 2 × 75 mg was administered intramuscularly to all patients. All patients received iv Patient Controlled Analgesia (PCA) prepared with fentanyl postoperatively. For patients with pain VAS score of 5 or more, meperidine was administered at a rate of 25 mg each time and with a total daily dose of 200 mg.; İntraoperative Management:
Spinal anesthesia was administered to each patient in a sitting position, after aseptic conditions were achieved with a midline approach. A 25 gauge pencil point spinal needle was placed in the L3-4 or L4-5 space. Upon aspiration of clear cerebrospinal fluid (CSF), 10 mg of hyperbaric bupivacaine, 20 mcg of fentanyl and 160 mcg of morphine were injected into the intrathecal space together with the determined morphine doses.
Postoperative analgesia management:
Diclofenac sodium 2 × 75 mg was administered intramuscularly to all patients. All patients received iv Patient Controlled Analgesia (PCA) prepared with fentanyl postoperatively. For patients with pain VAS score of 5 or more, meperidine was administered at a rate of 25 mg each time and with a total daily dose of 200 mg.
Intervention MeSH terms: Morphine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The patients were randomly divided into three groups of 50patients each. In the system where computer generated random numbers (SPSS v23.0, IBM,- Page 2 of 6 [DRAFT] -NewYork, USA) were used,
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Postoperative pain; Intrathecal morphine