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Intrathecal Morphine Administration for Spinal Anesthesia for Cesarean Delivery
Abstract Number: F-23
Abstract Type: Original Research
Background: Intrathecal morphine (ITM) provides optimal analgesia following cesarean delivery (CD). (1) Recent data from Israel suggest that ITM is frequently not administered. (2) We investigated factors associated with ITM administration for women undergoing CD under spinal anesthesia in a both a community and tertiary medical center in Jerusalem, Israel.
Methods: Women who had CD from 02/2007 to 11/2015 were identified from an anesthesia information management system (AIMS) (Metavision, iMDsoft, Tel-Aviv, Israel). We identified all women who received spinal anesthesia including combined-spinal anesthesia, and women who underwent conversion to general anesthesia. We used logistic regression to identify factors associated with ITM administration for spinal anesthesia.
Results: Within the study cohort, 10,674 women had CD; 7, 686 (72%) received spinal anesthesia. ITM was administered to 5,909 (77%) of women in the study cohort. In our multivariate model, emergency surgery (aOR = 0.27; 95% CI = 0.25 – 0.29) was associated with decreased likelihood of ITM administration during spinal anesthesia for CD. CD in the tertiary center (aOR = 1.36, 95% CI = 1.25-1.48), and ASA 1 or 2 (aOR = 2.58; 95% CI = 1.91 – 3.49) were independently associated with increased likelihood of ITM administration during spinal anesthesia for CD. Maternal body weight above 70 kg (aOR 0.97, 95% CI = 0.89-1.07), resident only anesthesia provider (aOR = 1.26, 95% CI = 1.16-1.38), and CD during weekend shifts (aOR 1.10, 95% CI = 0.97 – 1.26) did not impact the likelihood of ITM administration.
Conclusion: In our study cohort, almost one-quarter of women who had spinal anesthesia for CD did not receive ITM. Findings provide an insight into factors associated with decreased likelihood of ITM administration, and will help facilitate strategies to help increase ITM use e.g. pre-made ITM for use during emergency CD; clinician education initiatives for non-obstetric anesthesia specialists in community practices. Our analysis also shows the utility of AIMS for quality improvement projects within and across medical institutions.
1. Weiniger CF. Isr Med Assoc J 2014;16:171-2
2. Orbach-Zinger S. Isr Med Assoc J 2014;16:153-6.