Combination of Low-Dose Epidural Morphine and Intramuscular Diclofenac Sodium in Postcesarean Analgesia

• Published in: Anesthesia and analgesia Vol. 75; no. 1; pp. 64 - 68
• Main Authors: Sun, Hsiao-Lun, Wu, Chi-Chen, Lin, Min-Shung, Chang, Ching-Feng, Mok, Martin S.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01-07-1992; Lippincott
• Subjects: Adult; Analgesia; Analgesics; Analysis of Variance; Biological and medical sciences; Cesarean Section; Diclofenac - administration & dosage; Diclofenac - adverse effects; Diclofenac - therapeutic use; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Injections, Epidural; Injections, Intramuscular; Medical sciences; Morphine - administration & dosage; Morphine - adverse effects; Morphine - therapeutic use; Neuropharmacology; Pain Measurement; Pain, Postoperative - drug therapy; Pain, Postoperative - physiopathology; Pharmacology. Drug treatments; Uterine Contraction; Human; Postoperative; Drug combination; Low dose; Morphine; Opiates; Narcotic analgesic; Non steroidal antiinflammatory agent; Cramp; Chemotherapy; Pain; Treatment; Surgery; Cesarean section
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/00000539-199207000-00012

Epidural morphine is used for postcesarean analgesia, and nonsteroidal antiinflammatory drugs are frequently administered to relieve uterine cramps after vaginal delivery. To assess the efficacy of a combination of low-dose epidural morphine and intramuscular diclofenac sodium in postcesarean analgesia, a double-blind, randomized study was conducted. Epidural anesthesia was given to 120 parturients who were randomly allocated into four treatment groupsgroup A received normal saline solution, 10 mL epidurally and 3 mL intramuscularly (IM); group B received 10 mL of epidural saline solution and 75 mg (3 mL) of diclofenac IM; group C received 2 mg of morphine in 10 mL of epidural saline solution and 3 mL of saline solution IM; and group D received 2 mg of morphine in 10 mL of epidural saline solution and 75 mg of diclofenac IM. Epidural injections were given after delivery of the placenta, and IM injections were given on arrival in the recovery room. Verbal analogue pain scores were recorded at 2, 4, 8, 12, 18, and 24 h after epidural injection. Subjective scores of overall pain relief were also recorded at 24 h. Results showed that scores of overall pain relief were significantly better in group D compared with group A, B, or C (P < 0.05). Groups A and B required more supplemental meperidine than groups C and D. None of the subjects in group D requested supplemental analgesia. Compared with the other three groups, group D experienced a better analgesic effect for both wound pain and uterine cramping pain from 4 to 18 h (P < 0.05). Incidence of nausea or vomiting, or both, and pruritus occurred more frequently in groups C and D compared with group A or B (P < 0.05). No bradypnea was observed during the study period. Diclofenac alone was not effective in postcesarean analgesia. We conclude that combining low-dose (2 mg) epidural morphine and IM diclofenac enhances analgesic efficacy in the treatment of both wound pain and uterine cramps after cesarean section.