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Combined Intrathecal Morphine and Bupivacaine for Cesarean Section

Abouleish, Ezzat MD; Rawal, Narinder MD; Fallen, Kevin PhD; Hernandez, Deirdre RN
Anesthesia & Analgesia: April 1988

The effects of adding 0,2 mg preservative-free morphine sulfate in 0.2 ml solution to hyperbaric spinal bupivacaine were evaluated in a double-blind randomized prospective study of 34 patients undergoing elective repeat cesarean section. In the control patients (n = 17), 0.2 ml saline instead of morphine was added to bupivacaine. The intrathecal morphine significantly improved intra- and postoperative analgesia, e.g., 82% of patients given morphine compared with 41% of the control patients did not require analgesic supplementation to the spinal anesthesia during surgery; postoperatively, the former patients did not request additional analgesia for 27 ± 0.7 hours (mean ± SEM) compared with 2 ± 0.3 hours in the control patients. Neonatal condition was not adversely affected by this small dose of morphine administered 11 ± 1 minutes before delivery. Combining 0.2 mg morphine with hyperbaric spinal bupivacaine for cesarean section is a safe and effective method of improving intraoperative pain relief and providing adequate prolonged postoperative analgesia.

Address correspondence to Dr. Abouleish, University of Texas Health Science Center, Department of Anesthesiology, 6431 Fannin, MSMB 5.020, Houston, TX 77030.

© 1988 International Anesthesia Research Society