Comparison Between The Efficacy of Fentanyl Continuous Infusion and Intratechal Morphine for Pain After Cesarean Section

Prabowo Wicaksono Yuwono Putro, Taufiqurrachman Nasihun

Abstract


Background: Intrathecal morphine has been shown to be effective for pain after cesarean section with possible side effect including delayed respiratory

depression, nausea vomiting and pruritus. Fentanyl continuous infusion fixed base infusion rate with disposable elastomeric pump is an alternative to

intrathecal morphine but has not been been widely studied.

 

Objective: to compare the effectiveness between fentanyl continuous infusion fixed base infusion rate using disposable elastomeric pump and intrathecal morphine.

 

Methods: in a Randomized Controlled Trial (RCT), 56 patients meeting the inclusion criteria were divided into two groups: Morphine group (n=28):

spinal anesthesia 10 mg Bupivacaine Heavy 0.5% + 100 mcg morphine; Fentanyl group (n=28): spinal anesthesia 10 mg Bupivacaine Heavy 0.5% +

fentanyl continuous infusion 0.5 mcg/kg BW/hour using disposable elastomeric pump after delivery. Data analysis: Mann-Whitney test at the level of

significance p<0.05.

 

Results: Analgesic effect of Fentanyl group was as effective as that of Morphine group. NRS score difference was significant only in measurement taken 6

hours after surgery (p=0.034). Mean NRS score for Morphine and Fentanyl were 68±1.02 and 1.11±0.832, respectively. Both group were effective in preventing increased cortisol level measured 6 hours after surgery, mean value group Morphine and Fentanyl were 15.053±8.664 and12.162±8.623,

respectively.There were no statistical significant difference between groups (p=0.114). No significant difference in side effect between the groups was found.

 

Conclusion:

Fentanyl continuous infusion 0.5 mcg/kg BW/hour using disposable elastomeric pump is as effective as intrathecal morphine 100 mcg/kg BW/hour


Keywords


Pain; cpain, caesarean section, intrathecal morphine, fentanyl continuous infusion, disposable elastomeric pump, NRS, OOAPS, cortisolaesarean section; intrathecal morphine, fentanyl continuous infusion, disposable elastomeric pump; NRS; OOAPS; cortisol.

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References


Aoki Y, Hatakeyama N, Yamada M, Matsuda N

& Yamazaki M 2009. Postoperative pain

management by continuous intravenous infusion

of fentanyl using the single -use continuous

infusion device. Masui, 58, 1424-9.

Burton D, Nicholson G & Hall G 2004. Endocrine

and metabolic response to surgery. Continuing

education in anesthesia, critical care & pain, 4,

-7.

Carvalho Fae & Tenorio SB 2013. Comparative study

between doses of intrathecal morphine for

analgesia after caesarean. Rev Bras Anestesiol,

, 492-498.

Choi SH, Koo BN, Nam SH, Lee SJ, Kim KJ & Kil HK

Comparison of remifentanil and fentanyl

for postoperative pain control after abdominal

hysterectomy. Yonsei Med J, 49.

Coll AM, Ameen JR & Mead D 2004. Postoperative

pain assessment tools in day surgery: literature review. J Adv Nurs, 46, 124-33.

Dahl JB & Moiniche S 2004. Pre-emptive analgesia.

British Medical Bulletin, 71, 13-27.

Desborough JP 2000. The stress response to trauma

and surgery. British Journal of Anaesthesia, 85,

-17.

Desousa KA & Chandran R 2014. Intrathecal morphine

for postoperative analgesia: current trends. Worl

J Anesthesiol, 27, 191-202.

Escamilla RP, Radovan IM & Dewey KG 1996. The

association between caesarean delivery and

breast-feeding outcomes among Mexican women.

Am J Public Health 86, 832-836.

Gourlay GK, Kowalski SR, Plummer JL, Cousins MJ &

Armstrong PJ 1988. Fentayl blood concentrationanalgesic

response

relationship

in

the

treatment

of

postoperative pain. Anesth Analg, 67, 329-

Irawan H, Wahyudi & Hisbullah 2014. Perbandingan

kadar kortisol dan efek analgesia pascabedah

anestesi spinal kombinasi bupivakain hiperbarik

5% 8 mg dan klonidin 30 mcg dengan

bupivakain hiperbarik 0,5% 8 mg dan morfin 0,1

mg pada pasien yang menjalani prosedur seksio

sesarea. Anstesia & Critical Care, 22, 111-8.

Kim JY, Park SY, Chang HS, Nam SK & Min SK 2013.

The efficacy of the time-scheduled decremental

continuos infusion of fentanyl for postoperative

patient-controlled analgesia after total intravenous

anesthesia. Korean J Anesthesiol, 65, 544-551.

Man, A. 2014. Management of Postoperative Pain

[Online]. Hongkong: Department of Anesthesia

& Intensive Care The Chinese University of

Hong Kong Prince of Wales Hospital. Available:

http://www.cuhk.edu.hk/med/ans/pain/Pain

Nausea and vomiting.doc [Accessed 2014.4.14

.

Morrison, R., Magaziner, J., Mclaughlin, M., Orosz,

G., Silberzweig, S., Koval, K. & SIU, A. 2003.

The impact of postoperative pain on outcomes

following hip fracture. Pain, 103, 303-11.

Presseau EV, Martel MO, Mathieu R, Caron E, Albouy

G, Marin MF, Plante I, Sullivan MJ, Lupien SJ

& Rainville P 2013. Acute stress contibutes to

individual differences in pain and pain-ralated

brain activity in healthy and chronic pain patients.

The Journal of Neuroscience, 33, 6826-33.

Shafer SL, Varvel JR, Aziz N & Scott JC 1990.

Pharmacokinetics of fentanyl administered

by computer-controlled infusion pump.

Anesthesiology, 73, 1091-102.

Vercauteren M 2009. Analgesia after Caesarean section:

are neuroaxila techniques outdated? Jurnalul

Roman de Anestezie Terapie Intensiva, 16, 129133.

Verstraete S & Velde Mvd 2012. Post-caesarean section

analgesia. Acta Anaesth. Belg, 63, 147-167.

Weinger M 2007. Dangers of postoperative opioids.

APFS Newsletter, 21, 61-68.

Wong JY, Carvalho B & Riley ET 2013. Intrathecal

morpine 100 and 200 mcg for post cesarean

delivery analgesia: a trade off between analgesic

effecacy and side effects. International Journal

of Obstetric Anesthesia, 22, 36-41.

Zichterman A. 2007. Opioid Pharmacology and

Considerations in Pain Management [Online].

U.S. Pharmacist. Available: http://www.

uspharmacist.com/continuing_education/

ceviewtest/lessonid/105473/ [Accessed 4.19

.




DOI: http://dx.doi.org/10.26532/sainsmed.v8i2.1842

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