Acute Pain
Volume 9, Issue 4 , Pages 215-219, December 2007

Postoperative analgesia after caesarean section: Intermittent intramuscular versus subcutaneous morphine boluses

  • Mohammadreza Safavi

      Affiliations

    • Department of Anesthesiology and Intensive Care, School of Medical Science, Isfahan University, Isfahan, Iran
    • Anesthesiology Department, Alzahra Medical Center, Isfahan University of Medical Sciences, Isfahan, Iran
    • Corresponding Author InformationCorresponding author at: Alzahra Medical Center, Street SOFEH, Isfahan University, Isfahan 817465731/81744, Iran. Tel.: +98 9133152416; fax: +98 3117751182.
    • ,
  • Azim Honarmand

      Affiliations

    • Department of Anesthesiology and Intensive Care, School of Medical Science, Isfahan University, Isfahan, Iran
    • Anesthesiology Department, Alzahra Medical Center, Isfahan University of Medical Sciences, Isfahan, Iran

Received 16 April 2007; received in revised form 24 July 2007; accepted 16 August 2007.

Summary 

Background

Several recent studies have demonstrated that the subcutaneous route of morphine administration is effective for the management of postoperative pain. The injection of morphine via an indwelling subcutaneous cannula results in blood concentrations that are comparable to those arising from intramuscular injection. The aim of this study was to compare the analgesic efficacy and adverse effect profile of intermittent intramuscular and subcutaneous morphine boluses after caesarean section.

Methods

Sixty patients, aged 16–45 years, scheduled for elective caesarean section (CS) were randomly assigned to receive analgesia via either intramuscular (IM group, 0.15mg/kg) or s.c. injections of morphine (SC group, 0.15mg/kg). Postoperative pain was assessed at rest and when moving, using a visual analogue scale (VAS) every 4h. A Mini Mental Status (MMS) examination was used to assess cognitive functions before surgery, at 2h, 24h and 48h after surgery, and at hospital discharge. Side-effects were also recorded systematically during the first 48h after surgery.

Results

The SC group showed lower pain scores and higher overall analgesia satisfaction score than the IM group at rest but it was not significant statistically (P>0.05). During mobilization, the SC group had lower pain scores and it was significant at 12h, 16h and 20h postoperatively (P<0.05). There was no inter-group difference in postoperative MMS scores. The incidence of side-effects was similar in both groups.

Conclusion

SC morphine is a satisfactory alternative to IM morphine after CS.

Keywords: Morphine, Analgesia, Pain, Postoperative, Caesarean section

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PII: S1366-0071(07)00149-0

doi:10.1016/j.acpain.2007.08.023

Acute Pain
Volume 9, Issue 4 , Pages 215-219, December 2007

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