A comparison of epidural diamorphine with intravenous patient‐controlled analgesia using the Baxter infusor following Caesarean section

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Abstract
Summary: In a randomised study of analgesia following Caesarean section, we compared the efficacy and side effects of on‐demand epidural diamorphine 2.5 mg with intravenous patient‐controlled analgesia using diamorphine from the Baxter infusor system. Pain scores fell more rapidly in the epidural group, but by the fourth hour, and thereafter, both techniques had a similar analgesic effect. The patient‐controlled analgesia group used significantly more diamorphine (p < 0.001), median 62 mg (range 18–120 mg) compared to the epidural group, median 10 mg (range 2.5–20 mg), over a significantly longer time period (p < 0.001), median 54.25 h (range 38–68 h) compared to the epidural group, median 40.75 h (range 6–70 h). The frequency and severity of nausea, vomiting and pruritus were similar in the two groups, however the patient‐controlled analgesia group were more sedated during the first postoperative day. This reached statistical significance (p < 0.05) between 9–24 h. Overall satisfaction scores (0–100) were high, but the patient‐controlled analgesia group scored significantly higher: mean 85.5 (SD 12.2) compared to mean 77.0 (SD 11.7) in the epidural group.