Authors: Thiruselvi Subramaniam, Shu Ning Kong, Shi Ting Tee, Muhammad Faiz Bin Ismail, Joanne Sue James, Hamitra Gandhi.
ABSTRACT
Background: Side effects of intra-thecal (IT) morphine in lower caesarean section (LSCS) can be dangerous hence they are co-managed by the anesthesia pain team for a minimum of 24 hours. The aim of this study was to identify the side effects and consider the possibility of earlier discharge from the pain team to the parent team.
Methods: A prospective observational study was conducted on 323 patients who received IT morphine for LSCS. An interviewer-centered questionnaire was used to obtain data on the side effects.
Results: Side effects were experienced by 80% (n=259) of the patients, and none developed respiratory depression. Side effects occurred in first 6 hours in 94% (n=244) of the patients, 5% (n=13) within 6 to 12 hours and 1% (n=2) within 12 to 24 hours. Pruritus was the most common side effect (88%; n=227) and 93% (n=210) experienced it within the first 6 hours. Nausea and vomiting occurred in 54% (n=139) of the patients with side effects and 70% (n=97) of them experienced them within the first 6 hours. Kruskal-Wallis H test showed that Malays experienced more side effects, χ2(2) = 3.363, p = 0.004. No difference in pain scores was noted between races at 0-6 hours and 12-24 hours. However, Indians had higher scores at 6-12 hours (χ2(1) =4.31, p = 0.031).
Conclusion: The most common side effect was pruritus, then nausea and vomiting with no respiratory depression. Most occurred in the first 12 hours suggesting possibility of earlier discharge by the pain team to the parent team. However, further research is needed as guidelines suggest 24 hours, fearing respiratory depression. Side effects in Malays and increased pain perception among Indians need exploration.
Keywords: Caesarean Sections, Drug side effects, Intrathecal morphine, Race, Respiratory depression.
Citation: IeJSME 2021 15 (3): 37-45
