EPIDURAL OPIOID ANALGESIA AFTER CESAREAN-SECTION - A COMPARISON OF PATIENT-CONTROLLED ANALGESIA WITH MEPERIDINE AND SINGLE BOLUS INJECTION OF MORPHINE

The quality of analgesia, patient satisfaction and incidence of side e ffects following a single bolus of epidural morphine were compared wit h patient-controlled epidural analgesia (PCEA) with meperidine during the first 24 hr after elective Caesarean section. Seventy-five women w ere randomly assigned to three equal groups. Group 1 received 30 mg ep idural meperidine after deliver and PCEA with meperidine; Group 2 rece ived 3 mg epidural morphine after delivery and PCEA with saline in a d ouble-blind fashion. Group 3 received 3 mg epidural morphine after del iver without saline PCEA. Visual analogue pain scores (VAS) were highe r with PCEA meperidine from 8-16 hr postoperatively (P < 0.05) than in both epidural morphine groups. Two patients in Group 1 and one in Gro up 3 required supplemental parenteral analgesia. The incidence of naus ea was 16% in Group 1, compared with 52% in Group 2 and 56% in Group 3 (P < 0.001). Forty-six percent of patients in Group 1 were very satis fied with pain management, compared with 77% in Group 2 and 79% in Gro up 3. Nurse workload was higher in the PCEA study groups than in Group 3 (P < 0.05). A single bolus of epidural morphine provides superior a nalgesia and satisfaction at low cost, but with a higher incidence of nausea and pruritus than PCEA with meperidine.