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

Prabowo Wicaksono Yuwono Putro

Abstract


Background:. Intrathecal morphine proved to be effective caesarean section with possible side effect delayed respiratory depression, nausea vomiting and pruritus. Fentanyl continuous infusion fixed base infusion rate with disposable elastomeric pump is an alternative to intrathecal morphine. However,  the effectiveness has not been proven. Objective: to compare effectiveness between fentanyl continuous infusion fixed base infusion rate using disposable elastomeric pump and intrathecal morphine.

Methods: RCT with 56 patients who met the inclusion criteria, divided into two groups: group Morphine (n=28): spinal anesthesia 10 mg Bupivacaine Heavy 0.5% + 100 mcg morphine; group Fentanyl (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 of the fetus. Data analysis: Mann-Whitney test level of significance p < 0.05.

Results: Analgesic effect of Fentanyl group was as effective as Morphine group. NRS score difference significantly only in measurement taken 6 hours after surgery (p=0.034). Mean NRS score group Morphine (0.68±1.02) and mean NRS score group Fentanyl (1.11±0.832). Both group were effective in preventing increased cortisol level measured 6 hours after surgery, mean value group Morphine (15.053±8.664) and mean value group Fentanyl (12.162±8.623); no statistical significant difference between group (p=0.114). Side effects revealed no significant difference.

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


Keywords


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

Full Text:

PDF

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, 144-7.

CARVALHO FAE & TENORIO SB 2013. Comparative study between doses of intrathecal morphine for analgesia after caesarean. Rev Bras Anestesiol, 63, 492-498.

CHOI SH, KOO BN, NAM SH, LEE SJ, KIM KJ & KIL HK 2008. 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, 109-17.

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 concentration-analgesic response relationship in the treatment of postoperative pain. Anesth Analg, 67, 329-37.

IRAWAN H, WAHYUDI & HISBULLAH 2014. Perbandingan kadar kortisol dan efek analgesia pascabedah anestesi spinal kombinasi bupivakain hiperbarik 0.5% 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 2014].

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.

VADIVELU N, MITRA S & NARAYAN D 2010. Recent advances in postoperative pain management. Yale Journal of Biology and Medicine 83, 11-25.

VERCAUTEREN M 2009. Analgesia after Caesarean section: are neuroaxila techniques outdated? Jurnalul Roman de Anestezie Terapie Intensiva, 16, 129-133.

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 2014].




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

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM

Refbacks

  • There are currently no refbacks.


Copyright (c) 2018 Sains Medika

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.
Based on a work at http://jurnal.unissula.ac.id/index.php/sainsmedika.

site
stats View My Stats.