Single-dose, sustained-release epidural morphine in the management of postoperative pain after elective cesarean delivery: results of a multicenter randomized controlled study.

In this multicenter, randomized, controlled study, we compared the analgesic efficacy and safety profile of a new single-dose extended-release epidural morphine (EREM) formulation (DepoDur) with that of epidural morphine sulfate for the management of postoperative pain for up to 48 h after elective cesarean delivery. ASA physical status I or II parturients (n = 75) were anesthetized with a combined spinal/epidural technique. Parturients received intrathecal bupivacaine 12-15 mg and fentanyl 10 mug for spinal anesthesia and a single epidural injection of either 5 mg of standard (conventional preservative-free) morphine or 5, 10, or 15 mg of extended-release morphine after cord clamping for postoperative pain control. Single-dose EREM 10 and 15 mg groups significantly decreased total supplemental opioid medication use and improved functional ability scores for 48 h after surgery compared with those receiving 5 mg of standard morphine. Visual analog scale pain scores at rest and with activity at 24 to 48 h after dosing were significantly better in the 10- and 15-mg single-dose EREM groups versus the standard morphine group. There were no significant differences between the two 5 mg (single-dose EREM and standard morphine) groups. Single-dose EREM was well tolerated, and most adverse events were mild to moderate in severity. Single-dose EREM is a potentially beneficial epidural analgesic for the management of post-cesarean delivery pain and has particular advantages over standard morphine for the period from 24 to 48 h after surgery.

Intrathecal hyperbaric bupivacaine dose response in postpartum tubal ligation patients.

BACKGROUND AND OBJECTIVES: Because of its short duration, hyperbaric lidocaine has been a popular intrathecal drug to provide anesthesia for postpartum tubal ligation (PPTL). However, reports of transient symptoms associated with its use have prompted the search for alternative intrathecal local anesthetics for short procedures. Hyperbaric bupivacaine is rarely associated with transient neurologic symptoms, and we designed this study to determine the optimal dose of bupivacaine for PPTL that assures adequate sensory block and allows the patient the shortest recovery time. METHODS: Forty American Society of Anesthesiologists (ASA) I-II patients undergoing spinal anesthesia for PPTL were randomly assigned to receive 5.0, 7.5, 10.0, or 12.5 mg hyperbaric bupivacaine in the right lateral position. RESULTS: Despite sensory block above T-8 in all groups, 4 of the 5 patients in the 5-mg group developed blocks insufficiently dense for surgery and required general anesthesia. Failed spinals occurred evenly in the remaining groups. Motor regression was significantly more rapid with decreasing doses of bupivacaine. Time in the postanesthesia care unit (PACU) was shorter in the 7.5-mg group. CONCLUSIONS: Hyperbaric bupivacaine 7.5 mg injected in the lateral position provides adequate surgical anesthesia for PPTL with a minimal duration of motor block and recovery time.