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Intrathecal Morphine Chloride (with Sodium Edetate) for Post Cesarean Section Analgesia
Abstract Number: F4D-6
Abstract Type: Original Research
Introduction: Preservative free morphine sulfate (MS) has been available in USA since 1984. Unfortunately, MS is not available many places. Morphine chloride with sodium edetate (MCE) is available in many low and middle income countries. Using data from two institutions in Serbia we aimed to determine the safety and efficacy of MCE in patients undergoing cesarean delivery (CD) under spinal anesthesia (SAB).
Method: The Institutional Review Boards of Opsta Bolnica Sremska Mitrovica (OBSM) and Klinicki Centar, Novi Sad (KC) gave permission for prospective observational study comparing standard practices in these hospitals. CD at OBSM is routinely performed under SAB with 12 mg bupivacaine, 20 ug fentanyl and 0.1 mg MCE (Group 1). CD at KC is routinely performed under GA and under SAB with the same drugs without MCE (Groups 2, 3). Demographic, obstetric, intraoperative analgesic administration, verbal rating scale for pain 12 and 24 hours after CD, and NSAID/tramadol administration data were obtained and morphine dose equivalents were calculated. Two questions were asked at 24 hours to screen for new onset neurologic symptoms: 1. Do you have new onset back pain with radiation down your legs? 2. Do you have leg numbness/weakness since delivery? Positive responses prompted a neurologic examination. If positive, the patient was followed until symptoms resolved. If the rate of new transient neurologic deficit is assumed at 6%, 275 patients in each group have an 80% chance of detecting a 50% reduction at 0.05 alpha. Chi square, rank sum, and ANOVA testing were used to compare groups.
Results: Data from 1250 patients were obtained (Table 1). The incidence of new neurological symptoms was low and not different between groups. No patient had an abnormality on neurological examination or when followed up 1 month after delivery. Two patients experienced traumatic nerve injury from IM injection of methylergonovine in gluteal region; their data were excluded. Less intraoperative sedation/analgesics were administered in Group 1 compared to Group 3.
Discussion: The incidence of temporary neurologic deficit was lower in our study than that reported elsewhere.(1) We showed no difference in new onset transient radicular symptoms or low back pain. The upper 95% confidence interval for neurologic abnormality with MCE is no more than 0.5% (3/N rule). The improvement in block with the addition of MCE needs further investigation.
1.Dahlgren et al. A&A1997;85:1288