Analgesic efficacy and adverse effects of epidural morphine compared to parenteral opioids after elective caesarean section: A systematic review

Aims: Obstetric anesthesia presents a challenge to the anesthesiologist. The effective pain management allows the parturient adequate degree of comfort and promotes physical recovery and a sense of well being. Methods: This randomized controlled study was designed to assess the analgesic efficacy and side effects of single dose direct epidural morphine (Group 1) versus intermittent 12 hourly epidural morphine with bupivacaine (Group2) for postoperative analgesia in lower segment caesarean section cases. Results: Each group consisted of 36 patients. Demographic characteristics of two groups were comparable and differences among them were not statistically significant. Mean duration of analgesia was significantly longer in group one patients (16.5 ± 2.5) in comparison to group two patients (11.5 ± 1.5). Mean highest visual analogue scales (VAS scale) was significantly lower (3.2± 0.9) in group one patients in comparison of group two (6.7±0.8) patients. Only 43% patient in group one required supplementary analgesic (Inj Paracetamole/ Diclofenac) and 71% required Inj epidural Morphine / Inj bupivacaine in group two. Mean number of supplementary analgesic required in group one was 0.7 and it was 1.8 in group two. There was no significant difference in nausea, vomiting, itching and pruritis in two groups of patients. Conclusions: our study showed that the use of single dose epidural morphine was associated with lower pain scores at rest and movement when compared to intermittent epidural morphine with bupivacaine in post-caesarean section analgesia. Single dose epidural morphine was found more convenient, less cumbersome and less costly as compared to intermittent epidural morphine for post-caesarean section analgesia. Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 1 / Issue 13 / Jan- June, 2012 / 41-44 DOI: http://dx.doi.org/10.3126/njog.v7i1.8835

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Active warming after caesarean section to prevent neonatal hypothermia: a systematic review

British Journal of Midwifery ◽

10.12968/bjom.2020.28.12.829 ◽

2020 ◽

Vol 28 (12) ◽

pp. 829-837

Author(s):

Aliona Vilinsky-Redmond ◽

Maria Brenner ◽

Linda Nugent ◽

Margaret McCann

Keyword(s):

Systematic Review ◽

Caesarean Section ◽

Elective Caesarean Section ◽

Evidence Base ◽

Current Evidence ◽

Skin Contact ◽

Current Evidence Base ◽

Randomised Controlled ◽

Skin To Skin ◽

Neonatal Hypothermia

There is a lack of evidence on the effects of perioperative warming on maternal and neonatal outcomes in women undergoing elective caesarean section who are performing at-birth skin-to-skin contact. This study aimed to provide a systematic review of the current evidence base on the effects of perioperative warming versus no warming. Inclusion criteria included randomised controlled trials involving pregnant women ≥18 years old undergoing an elective caesarean section at term under regional anaesthesia and who initiated at-birth neonatal skin-to-skin contact. Studies investigated active warming versus no active warming interventions. Three studies were included, with a total of 286 participants. Active warming of women resulted in significantly less occurrence of neonatal hypothermia, with no difference in maternal hypothermia. Perioperative active warming of mothers and newborns who had skin-to-skin contact may be beneficial. The quality of the included studies was low, so the review findings should be interpreted with caution. High quality studies with larger sample sizes need to be undertaken.

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