This was a prospective randomised, controlled, single-blind study done to determine the effect of intrathecal morphine 0.1 mg as compared with intrathecal fentanyl 25 microg in terms of analgesia and duration for postoperative pain relief after Caesarean section. Sixty ASA I or II parturients were randomised into two groups. Group 1 (n=33) received 1.8 ml of 0.5% hyperbaric bupivacaine combined with 0.1 mg morphine while Group 2 (n=27) received 1.8 ml of 0.5% hyperbaric bupivacaine combined with 25 microg fentanyl for spinal anaesthesia. Postoperatively, all patients were provided with patient controlled analgesia (PCA) morphine. Pain was assessed using visual analogue score (VAS) at 6, 12, 18 and 24 hours. Time to first demand of PCA morphine, cumulative PCA morphine requirement and opioid side effects were documented. The VAS for pain and the cumulative PCA morphine requirement were both significantly lower in Group 1 (p < 0.05) during the 24 hours study period. The time to first demand was also significantly longer in Group 1 (p < 0.05). Overall, there were no significant difference between the two groups in side effects, except for a high incidence of nausea and vomiting requiring treatment in Group B in the first six hours. In conclusion the addition of 0.1 mg morphine for spinal anaesthesia provided superior and longer postoperative analgesia after Caesarean section.
Morphine ; Pain management ; intrathecal ; Passive Cutaneous Anaphylaxis ; Fentanyl

BACKGROUND: The addition of morphine to intrathecal or epidural anesthesia provides an effective, long-lasting postoperative analgesia. However, a common side effect is pruritus which occurs in up to 80 percent of subjects. This study was designed to determine the minimal effective dose of nalbuphine HCI in the treatment and amelioration of morphine-induced pruritus. METHODS: In a prospective, blinded study, 50 patients, 18 to 65 years old who developed pruritus after administration of morphine (intrathecal and epidural) were randomly assigned into 2 groups, Group A received nalbuphine 1 mg/IV every five minutes until pruritus was relieved while Group B received diphenhydramine 50 mg/IV for pruritus. Pruritus scores before and after administration of the drugs were recorded. Data gathered were analyzed using descriptive statistics, students t-test, linear regression and determination of ED50. RESULTS: There was no significant difference between the quality of pain relief between groups A and B. ED50 was noted to occur at 5 mg/IV (the dose in which 50 percent of subjects responded). No significant difference was noted with regards to the ability to relieve pain and the ability to antagonize morphine and its analgesic property. In conclusion, the minimum effective dose of Nalbuphine HCI for amelioration of morphine-induced pruritus is 5 mg per IV. (Author)
Human ; ANESTHESIA ; EPIDURAL, ANESTHESIA ; INTRATHECAL, ANESTHESIA ; ANALGESIA ; ANESTHESIOLOGY ; PRURITUS ; NALBUPHINE HYDROCHLORIDE ; MORPHINE

Sixty subjects who were to undergo elective cesarean section were randomized into two groups which received spinal anesthesia with 0.2 mg morphine for abdominal delivery. The Nalbuphine group received 10 mg IV Nalbuphine (Nubain) every 6 hours postoperatively while the patients in the control group were given saline. Pain, nausea and vomiting, pruritus and the incidence of respiratory depression were assessed in both groups for the first 24 hours and then compared and analyzed. Both the subjects and the investigators were blinded The severity of nausea was significantly lower in the Nalbuphine group than in the Control groups while pruritus and pain scores failed to show any significant differences. None of the patients had any episodes of respiratory depression. (Author)
Human ; Female ; Adult ; INTRAVENOUS ; INTRATHECAL MORPHINE ; NALBUPHINE ; MORPHINE ; CESAREAN SECTION ; ANESTHESIA, SPINAL