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Intrathecal morphine does not prevent chronic postsurgical pain after elective Caesarean delivery: a randomised controlled trial
Background: Morphine is frequently added to spinal anaesthesia for Caesarean delivery. We aimed to determine whether
intrathecal morphine for spinal anaesthesia decreases the risk of chronic postsurgical pain (CPSP).
Methods: In this randomised, double-blind, placebo-controlled trial, 290 healthy parturients undergoing elective
Caesarean delivery were randomly assigned in a 1:1 ratio to receive either intrathecal morphine 100 mg (n 145) or normal
saline (control; n 145) as a part of spinal anaesthesia. Anaesthetic care and postoperative pain management were
standardised in all patients. The primary outcome was the incidence of CPSP at 3 months. Secondary outcomes included
CPSP at 6 months, pain severity, and pain interference, measured by the Brief Pain Inventory questionnaire using an 11-
point numeric rating scale, at...
Show moreBackground: Morphine is frequently added to spinal anaesthesia for Caesarean delivery. We aimed to determine whether
intrathecal morphine for spinal anaesthesia decreases the risk of chronic postsurgical pain (CPSP).
Methods: In this randomised, double-blind, placebo-controlled trial, 290 healthy parturients undergoing elective
Caesarean delivery were randomly assigned in a 1:1 ratio to receive either intrathecal morphine 100 mg (n 145) or normal
saline (control; n 145) as a part of spinal anaesthesia. Anaesthetic care and postoperative pain management were
standardised in all patients. The primary outcome was the incidence of CPSP at 3 months. Secondary outcomes included
CPSP at 6 months, pain severity, and pain interference, measured by the Brief Pain Inventory questionnaire using an 11-
point numeric rating scale, at 3 and 6 months after the surgery.
Results: Two hundred and seventy-six patients completed the 3-month follow-up, 139 in the morphine group and 137 in
the placebo group. The incidences of CPSP at 3 months were 19% (27 of 139) in the morphine group and 18% (25 of 137) in
the placebo group (odds ratio, 1.08; 95% confidence interval, 0.59e1.97; P 0.803). At 6 months, CPSP was present in 23 of
139 (16%) morphine group patients compared with 19 of 137 (14%) in the placebo group (odds ratio, 1.23; 95% confidence
interval, 0.63e2.38; P 0.536). Brief Pain Inventory questionnaire scores for pain severity and pain interference at 3 and 6
months were similar between groups.
Conclusions: Administration of morphine 100 mg as a component of spinal anaesthesia for elective Caesarean delivery
failed to reduce the incidence of chronic pain at 3 and 6 months after surgery.
Show less- All authors
- Subedi, A.; Schyns-van den Berg, A.M.J.V.; Thapa, P.; Limbu, P.M.; Trikhatri, Y.; Poudel, A.; Dhakal, Y.; Bhandari, S.
- Date
- 2022-04-05
- Journal
- British Journal of Anaesthesia
- Volume
- 128
- Issue
- 4
- Pages
- 700 - 707