Comparison of 0.1 and 0.05mg Intrathecal Morphine for Post-cesarean Analgesia.

Study Overview
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Brief Summary
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The purpose of this study is to determine the ideal dose of spinal morphine for use in Cesarean section. Spinal anesthesia (single injection in the lower back to numb patients from the waist down) is commonly used in Cesarean section to provide numbness and pain relief during the surgery, and adding morphine to the spinal anesthetic provides long lasting pain relief for up to 24 hours after surgery. The ideal dose of spinal morphine, when given with other types of pain medications such as nonsteroidal anti-inflammatories and acetaminophen, has not been determined. In addition, spinal morphine can have side effects such as nausea and itching, so using a lower dose of morphine may decrease these side effects while providing the same amount of postoperative pain relief. Study participants will be divided into two groups. Group 1 will receive the standard dose of spinal morphine (0.1mg) while Group 2 will receive a lower dose of spinal morphine (0.05mg). Both groups will receive the standard dose of spinal bupivacaine (numbing medication) and spinal fentanyl (short acting pain medication). The additional pain medications (IV Toradol and oral acetaminophen) will be given to both groups after surgery. Pain control and morphine side effects will be compared between the two groups in order to determine the best dose of spinal morphine for cesarean section.

Official Title
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Comparison of 0.1 and 0.05mg Intrathecal Morphine When Administered With a Multimodal Pain Regimen for Post-cesarean Analgesia

Conditions
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Cesarean Section

Intervention / Treatment
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* Drug: receiving 0.1 mg IT morphine
* Drug: recieving 0.05 mg IT morphine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: any parturient 18 years of age or older undergoing elective cesarean delivery under spinal anesthesia able to consent to the study and participate in the follow-up. Exclusion Criteria: any known allergy to morphine general anesthesia urgent or emergent cases any bleeding diathesis or other coagulopathy known G6PD deficiency any known liver disease known alcohol abuse or dependence HELLP syndrome thrombocytopenia or known platelet dysfunction history or active gastrointestinal bleeding acute kidney injury or chronic renal insufficiency contraindication/refusal to spinal anesthestic chronic pain chronic narcotic use illicit drug use allergy to any study related medications

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: This study will be conducted as a randomized controlled single-blinded clinical trial with patients being randomized to receive either 0.1 or 0.05 mg of IT morphine.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: receiving 0.1 mg IT morphine<br>Patients will receive the standard of care dose 0.1 mg of intrathecal morphine | Drug: receiving 0.1 mg IT morphine<br>* Patients will receive the standard of care dose 0.1 mg of intrathecal morphine<br>|
| Experimental: recieving 0.05 mg IT morphine<br>Patients will receive 0.05 mg of intrathecal morphine | Drug: recieving 0.05 mg IT morphine<br>* Patients will receive 0.05 mg of intrathecal morphine<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to first narcotic rescue dose in the first 24 hours posto cesarean delivery. |  | 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| time to first ambulation |  | up to 48 hours | 
| opiate consumption |  | 24 and 48 hours | 
| subjective pain rating using visual analogue scales (VAS) |  | 24 hours post operatively | 
| presence of opiate side effects (nausea, vomiting, and pruritus) |  | 24 hours post operavtively | 
| overall patient satisfaction with pain control |  | 48 hours |