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2025, Number 3

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Acta Med 2025; 23 (3)

Identification of the use of analgesic rescue for pain control in obstetric patients after the use of subarachnoid morphine

Chávez DJ, Pérez PMA, Rendón MAA, Berrón PSA, Sánchez CMGG, Gutiérrez RKI, Martínez FA

Language: Spanish
References: 37
Page: 248-253
PDF size: 250.62 Kb.


ABSTRACT

Introduction: cesarean section often involves significant postoperative pain, which is effectively mitigated by multimodal analgesia, including the use of intrathecal morphine. Objective: to explore post-surgical pain management in patients undergoing cesarean section, assessing whether variations in morphine dosages significantly impact the additional use of tramadol beyond the standard treatment with nonsteroidal anti-inflammatory drugs (NSAIDs). Material and methods: an analytical and observational study on post-cesarean pain management was conducted, including women aged 18-39, classified as ASA II and III, using neuro-axial anesthesia and NSAID-based analgesia. Results: this study reviewed 165 cesarean patient records, selecting 50 between the ages of 16 and 39, predominantly healthy and first-time mothers, who received postoperative pain management with intrathecal morphine and NSAIDs, demonstrating effective pain mitigation. Conclusion: intrathecal morphine and individually tailored multimodal analgesia are effective. Limitations include its retrospective nature and sample size, with opportunities to explore morphine alternatives that could reduce costs and environmental pollution, and additional considerations for breastfeeding patients who no longer have access to broad-spectrum opioids. Nonetheless, these strategies have improved maternal comfort and reduced hospital stays.


REFERENCES

  1. Gámez BH, Habib AS. Predicting severity of acute pain after cesarean delivery: a narrative review. Anesth Analg. 2018; 126 (5): 1606-1614.

  2. Betran AP, Torloni MR, Zhang JJ, Gülmezoglu AM; WHO Working Group on Caesarean Section. WHO statement on caesarean section rates. BJOG. 2016; 123 (5): 667-670.

  3. Orbach-Zinger S, Aviram A, Fireman S, Kadechenko T, Klein Z, Mazarib N et al. Severe pain during local infiltration for spinal anaesthesia predicts post-caesarean pain. Eur J Pain. 2015; 19 (9): 1382-1388.

  4. Chandrakantan A, Glass PS. Multimodal therapies for postoperative nausea and vomiting, and pain. Br J Anaesth. 2011; 107 Suppl 1: i27-i40.

  5. Eblen-Zajjur. Neurofisiología de la nocicepción. Gac Méd Caracas. 2005; 113 (4): 466-473.

  6. Singh SI, Rehou S, Marmai KL, Jones APM. The efficacy of 2 doses of epidural morphine for postcesarean delivery analgesia: a randomized noninferiority trial. Anesth Analg. 2013; 117 (3): 677-685.

  7. Rivera-Ordoñez A. Dolor agudo postoperatorio. Rev Mex Anest. 2016; 39 (1): S174-S177.

  8. Sutton CD, Carvalho B. Optimal pain management after cesarean delivery. Anesthesiol Clin. 2017; 35 (1): 107-124.

  9. Barash P, Cullen B, Stoelting R, Cahalan M, Stock C, Ortega R et al. Anestesia clínica. 8ª ed. Philadelphia, EUA: Wolters Kluwer; 2018.

  10. Miller R, Cohen N, Eriksson L, Fleisher L, Wiener-Kronish J, Young W. Miller anestesia. 8ª ed. Barcelona, España: Elsevier; 2016.

  11. Weigl W, Bierylo A, Wielgus M, Krzemien-Wiczynska S, Kolacz M, Dabrowski MJ. Perioperative analgesia after intrathecal fentanyl and morphine or morphine alone for cesarean section: A randomized controlled study. Medicine (Baltimore). 2017; 96 (48): e8892.

  12. Mitchell KD, Smith CT, Mechling C, Wessel CB, Orebaugh S, Lim G. A review of peripheral nerve blocks for cesarean delivery analgesia. Reg Anesth Pain Med. 2019: rapm-2019-100752.

  13. Lugo RA, Kern SE. Clinical pharmacokinetics of morphine. J Pain Palliat Care Pharmacother. 2002; 16 (4): 5-18.

  14. Bujedo BM. Spinal opioid bioavailability in postoperative pain. Pain Pract. 2014; 14 (4): 350-364.

  15. Wang JK, Nauss LA, Thomas JE. Pain relief by intrathecally applied morphine in man. Anesthesiology. 1979; 50 (2): 149-151.

  16. Sakurada T, Komatsu T, Sakurada S. Mechanisms of nociception evoked by intrathecal high-dose morphine. Neurotoxicology. 2005; 26 (5): 801-809.

  17. Domke P, Contreras-Domínguez V, Contreras Chassin-Trubert F, Carbonell-Bellolio P. Manejo del dolor agudo postoperatorio en operación cesárea. Rev Chil Obstet Ginecol. 2018; 83 (6): 635-642.

  18. Cummings A, Orgill BD, Fitzgerald BM. Intrathecal morphine. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. Available in: https://www.ncbi.nlm.nih.gov/books/NBK499880/

  19. Rathmell JP, Lair TR, Nauman B. The role of intrathecal drugs in the treatment of acute pain. Anesth Analg. 2005; 101 (5S): S30-S43.

  20. Shafer SL, Eisenach JC. Location, location, location. Anesthesiology. 2000; 92 (3): 641-643.

  21. Ummenhofer WC, Arends RH, Shen DD, Bernards CM. Comparative spinal distribution and clearance kinetics of intrathecally administered morphine, fentanyl, alfentanil, and sufentanil. Anesthesiology. 2000; 92 (3): 739-753.

  22. Samii K, Chauvin M, Viars P. Postoperative spinal analgesia with morphine. Br J Anaesth. 1981; 53 (8): 817-820.

  23. Sultan P, Halpern SH, Pushpanathan E, Patel S, Carvalho B. The effect of intrathecal morphine dose on outcomes after elective cesarean delivery: a meta-analysis. Anesth Analg. 2016; 123 (1): 154-164.

  24. Sviggum HP, Arendt KW, Jacob AK, Niesen AD, Johnson RL, Schroeder DR et al. Intrathecal hydromorphone and morphine for postcesarean delivery analgesia: determination of the ED90 using a sequential allocation biased-coin method. Anesth Analg. 2016; 123 (3): 690-697.

  25. Bailey PL, Rhondeau S, Schafer PG, Lu JK, Timmins BS, Foster W et al. Dose-response pharmacology of intrathecal morphine in human volunteers. Anesthesiology. 1993; 79 (1): 49-59; discussion 25A.

  26. Booth JL, Harris LC, Eisenach JC, Pan PH. A randomized controlled trial comparing two multimodal analgesic techniques in patients predicted to have severe pain after cesarean delivery. Anesth Analg. 2016; 122 (4): 1114-1119.

  27. Sharpe EE, Molitor RJ, Arendt KW, Torbenson VE, Olsen DA, Johnson RL et al. Intrathecal morphine versus intrathecal hydromorphone for analgesia after cesarean delivery: a randomized clinical trial. Anesthesiology. 2020; 132 (6): 1382-1391.

  28. Karri J, Singh M, Modi DJ, Orhurhu V, Seale C, Saulino M et al. Combination intrathecal drug therapy strategies for pain management. Pain Physician. 2021; 24 (8): 549-569.

  29. Roofthooft E, Joshi GP, Rawal N, Van de Velde M; PROSPECT Working Group1 of the European Society of Regional Anaesthesia and Pain Therapy and supported by the Obstetric Anaesthetists' Association. PROSPECT guideline for elective caesarean section: updated systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2021; 76 (5): 665-680.

  30. Oberlander TF, Robeson P, Ward V, Huckin RS, Kamani A, Harpur A et al. Prenatal and breast milk morphine exposure following maternal intrathecal morphine treatment. J Hum Lact. 2000; 16 (2): 137-142.

  31. Nicholas TA 4th, Robinson R. Multimodal analgesia in the era of the opioid epidemic. Surg Clin North Am. 2022; 102 (1): 105-115.

  32. Duan G, Bao X, Yang G, Peng J, Wu Z, Zhao P et al. Patient-controlled intravenous tramadol versus patient-controlled intravenous hydromorphone for analgesia after secondary cesarean delivery: a randomized controlled trial to compare analgesic, anti-anxiety and anti-depression effects. J Pain Res. 2018; 12: 49-59.

  33. Chi X, Li M, Mei W, Liao M. Comparison of patient-controlled intravenous analgesia with sufentanil versus tramadol in post-cesarean section pain management and lactation after general anesthesia - a prospective, randomized, double-blind, controlled study. J Pain Res. 2017; 10: 1521-1527.

  34. Schnapp SC, Sepúlveda ES, Robert JA. Operación cesárea. Rev Med Clin Condes. 2014; 25 (6): 987-992.

  35. Rivera Dommarco J, Barrientos Gutiérrez T, Oropeza Abúndez C. Síntesis sobre políticas de salud. Propuestas basadas en evidencia. Cuernavaca, México: Instituto Nacional de Salud Pública; 2022. pp. 68-72.

  36. Cardoso MM, Carvalho JC, Amaro AR, et al. Small doses of intrathecal morphine combined with systemic diclofenac for postoperative pain control after cesarean delivery. Anesth Analg. 1998;86:538-541.

  37. Ramos-Rangel G, Ferrer-Zaccaro L, Mojica-Manrique V, Rotta M. Manejo analgésico durante el postoperatorio de cesárea: estrategias farmacológicas. Rev. Colomb. Anestesiol. 2017;45(4):327-334.




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