SUBARACHNOID MEPERIDINE-MORPHINE COMBINATION - AN EFFECTIVE PERIOPERATIVE ANALGESIC ADJUNCT FOR CESAREAN DELIVERY

Background and Objectives. Low-dose subarachnoid morphine provides eff ective perioperative analgesia but may be associated with a transient period of inadequate pain relief between the regression of local anest hetic block and the onset of morphine's analgesic effect. We hypothesi zed that this period of suboptimal analgesia could be avoided by addin g meperidine, a rapid-acting, intermediate-duration opioid. Methods. I n a double-blind, randomized trial, 49 patients scheduled for elective cesarean delivery received subarachnoid 0.75% bupivacaine, 12 mg in 8 .25% dextrose, with either meperidine 10 mg, morphine 0.15 mg, or mepe ridine 10 mg plus morphine 0.15 mg. Visual analog scale scores for pai n and satisfaction were obtained at skin incision, delivery, uterine e xteriorization, on arrival in the postanesthesia care unit, and 2, 4, 6, 12, and 24 hours after drug administration. Neonatal Apgar scores a nd adverse effects were also noted. Postoperative intravenous patient- controlled analgesia (PCA) requirements were recorded for 24 hours. Th e data were analyzed by chi-square analysis Fisher's exact test, the W ilcoxon rank sum test, and analysis of variance with Tukey's adjustmen t for multiple comparisons. Results. There were no significant differe nces in the incidence and severity of side effects, including nausea, vomiting, pruritus, and sedation. Respiratory depression was not obser ved. Patients treated with morphine alone were least comfortable (P < .006), expressed the lowest satisfaction scores at early observations (P < .002), and required more PCA meperidine (P < .001) than any other group. Patients treated with meperidine alone were comfortable at ear ly observations but required the greatest total amount of PCA meperidi ne over the first 24 hours (P < .05). Patients in the meperidine-morph ine combination group reported the lowest pain scores and highest sati sfaction scores at 4-hour and 6-hour observations (P < .03) and requir ed the least total amount of PCA meperidine. Conclusion. The subarachn oid combination of meperidine-morphine provided more uniform analgesia , higher satisfaction, and a lower requirement for intravenous narcoti c supplementation than either morphine or meperidine alone in patients recovering from cesarean delivery.