Comparison of epidural oxycodone and epidural morphine for post-caesarean section analgesia: A randomised controlled trial.

Autor: Sng BL; Department of Women's Anaesthesia, KK Women's and Children's Hospital, Bukit Timah, Singapore., Kwok SC; Department of Women's Anaesthesia, KK Women's and Children's Hospital, Bukit Timah, Singapore., Mathur D; Department of Women's Anaesthesia, KK Women's and Children's Hospital, Bukit Timah, Singapore., Ithnin F; Department of Women's Anaesthesia, KK Women's and Children's Hospital, Bukit Timah, Singapore., Newton-Dunn C; Department of Women's Anaesthesia, KK Women's and Children's Hospital, Bukit Timah, Singapore., Assam PN; Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore., Sultana R; Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore., Sia AT; Department of Women's Anaesthesia, KK Women's and Children's Hospital, Bukit Timah, Singapore.
Jazyk: angličtina
Zdroj: Indian journal of anaesthesia [Indian J Anaesth] 2016 Mar; Vol. 60 (3), pp. 187-93.
DOI: 10.4103/0019-5049.177877
Abstrakt: Background and Aims: Epidural morphine after caesarean section may cause moderate to severe pruritus in women. Epidural oxycodone has been shown in non-obstetric trials to reduce pruritus when compared to morphine. We hypothesised that epidural oxycodone may reduce pruritus after caesarean section.
Methods: A randomised controlled trial was conducted in pregnant women at term who underwent caesarean section with combined spinal-epidural technique initiated with intrathecal fentanyl 15 μg. Women received either epidural morphine 3 mg or epidural oxycodone 3 mg via the epidural catheter after delivery. The primary outcome was the incidence of pruritus at 24 h after caesarean section. The secondary outcomes were the pruritus scores, treatment for post-operative nausea and vomiting (PONV), pain scores and maternal satisfaction.
Results: One hundred women were randomised (group oxycodone O = 50, morphine M = 50). There was no difference between Group O and M in the incidence of pruritus (n [%] 28 [56%] vs. 31 [62%], P = 0.68) and the worst pruritus scores (mean [standard deviation] 2.6 (2.8) vs. 3.3 [3.1], P = 0.23), respectively. Both groups had similar pain scores at rest (2.7 [2.3] vs. 2.0 [2.7], P = 0.16) and sitting up (5.0 [2.3] vs. 4.6 [2.4], P = 0.38) at 24 h. Pruritus scores were lower at 4-8, 8-12 and 12-24 h with oxycodone, but pain scores were higher. Both groups had a similar need for treatment of PONV and maternal satisfaction with analgesia.
Conclusion: There was no difference in the incidence of pruritus at 24 h between epidural oxycodone and morphine. However, pruritus scores were lower with oxycodone between 4 and 24 h after surgery with higher pain scores in the same period.
Databáze: MEDLINE
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