A two‐dose epidural morphine regimen for cesarean section patients: therapeutic efficacy

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Abstract
A single dose of epidural morphine (EM) usually produces 24 h of post‐cesarean section (CS) analgesia and patients require supplemental analgesics beyond this period. This study assesses if a second dose of EM administered 24 h after the first one offers superior therapeutic efficacy compared to conventional analgesics. Patients (n = 100) were randomized to receive one or two doses of epidural morphine. In all patients, EM 5 mg was administered after delivery. After 24 h patients received epidurally either normal saline (n = 50, Group 1) or morphine 5 mg (n = 50, Group 2). An independent observer used a visual analogue scale to assess nausea, itching, and analgesia 24 h after each injection. Results were expressed as mean ± 1 s.e. mean and analyzed using nonparametric methods. The second dose of EM produced a significantly lower incidence and severity of nausea and itching than did the first dose (PP<0.01). No serious complications were noted. In summary, the use of a second dose of EM for post‐CS analgesia produces better analgesia and reduces the need for oral analgesics. The second dose produced fewer side‐effects, probably due to acute tolerance to morphine.