Join now to get access to this content and more.
Become a SOAP member and have access to our benefits.
- For Review: SOAP Consensus Statement on Neuraxial Procedures in Thrombocytopenic Parturients
- Sample Centers of Excellence Applications
- ASA Corner
- SOAP Policy and Procedure Manual (P&P Manual)
- SOAP Expert Opinions
- SOAP's Learning Modules
- 2019 Annual Meeting Lecture Videos
- December 2018 - SOAP Unofficial Guide to ASA Committees Webinar
- Submit a Position
- View Job Postings
- Previous Meeting Archives
- Previous Meeting Abstract Search
- CMS Guidelines
- Member Benefits
- Newsletter Clinical Articles
- ACOG Documents
- Search our Patient Safety Archive
- Ask SOAP a Question
- Global Health Opportunities
- And more…
Intrathecal versus Epidural Morphine for Post-Cesarean Delivery Analgesia
Abstract Number: T1A-3
Abstract Type: Original Research
While morphine is commonly administered as part of the neuraxial anesthetic during cesarean delivery (1), whether intrathecal vs. epidural administration offer better pain control is unclear (2,3). The aim of this study was to compare the analgesic efficacy of intrathecal vs. epidural morphine. Our hypothesis was that parturients who receive epidural morphine might have better pain control.
We performed an IRB-approved retrospective review of all parturients who underwent cesarean delivery for any indication in a single academic institution from April 2016 through March 2017. We compared those who received intrathecal 0.2mg morphine vs. epidural 3mg morphine, excluding those who received a different dose. The primary outcome was median duration from administration of neuraxial morphine to first opioid in the postoperative period. Secondary outcomes included median pain scores and the proportion of patients who received opioid in the first 18 hours postoperatively, as well as rates of side effects. Student’s T test and Mann-Whitney U test were used to analyze continuous variables, and Chi-squared test and Fisher’s exact test for categorical variables.
A total of 378 parturients underwent cesarean delivery. Of the 328 who received neuraxial morphine, 178 (54.3%) received intrathecal 0.2mg morphine and 132 (40.2%) received epidural 3mg morphine. Baseline demographic data were similar between the groups. There was no difference in median number of hours [25-75% range] from administration of neuraxial morphine to first opioid post-operatively between the intrathecal vs. epidural groups (19.2 [18.3, 20.6] vs. 18.9 [18.1, 20.5], mean difference 0.2 [95% CI -0.2 to 0.7], p=0.76) (Fig. 1). During the first 18 hours after receiving intrathecal vs. epidural morphine, there was no difference in incidence of postoperative opioid use (16% vs. 21%, OR 0.7, [95% CI 0.4 to 1.3], p=0.29) or median pain numeric rating scores (3.7 [2.8, 4.8] vs. 3.7 [2.7, 4.5], mean difference 0.0 [95% CI -0.3 to 0.5], p=0.58). The proportion of patients requiring medication to counteract side effects in the first 18 hours post-operatively was similar between the two groups (83% vs. 75%, OR 1.6 [95% CI 0.9 to 2.8], p=0.10) .
Intrathecal and epidural administration of morphine offer similar analgesic efficacy and demonstrate a similar side effect profile.
1. Beatty, NC. JCA. (2013).
2. Duale, C. BJA. (2003).
3. Sarvela, J. A&A. (2002).