SMALL DOSES OF INTRATHECAL MORPHINE COMBINED WITH SYSTEMIC DICLOFENACFOR POSTOPERATIVE PAIN CONTROL AFTER CESAREAN DELIVERY

Postoperative pain control after cesarean delivery under spinal anesth esia is effectively obtained with morphine 0.1-0.3 mg intrathecally, a lthough there may be dose-dependent side effects. We evaluated the qua lity of analgesia and the incidence of side effects with smaller doses of intrathecal morphine combined with intramuscular (IM) diclofenac. One hundred-twenty pregnant patients were allocated into six groups, w hich received the following treatments: Groups 1, 3, and 5 received 0. 1, 0.05, and 0.025 mg of intrathecal morphine, respectively, plus 75 m g of IM diclofenac every 8 h; Groups 2, 4, and 6 received 0.1, 0.05, a nd 0.025 mg of intrathecal morphine, respectively, plus IM diclofenac on demand. Spinal anesthesia was performed with 15 mg of 0.5% hyperbar ic bupivacaine. Pain scores and side effects were evaluated hourly for the first 24 h. Groups 1 and 2 had lower pain scores than Groups 3, 4 , 5, and 6. However, only patients in Groups 2, 4, and 6 requested add itional analgesics. Severe pruritus was more frequent in Groups 1 and 2. No patient experienced respiratory depression. We conclude that the re is no advantage in using doses larger than 0.025 mg of intrathecal morphine if they are combined with systemic diclofenac. Implications: A multimodal approach to pain control may provide good quality analges ia while reducing drug-related side effects. In this study, a very sma ll dose of intrathecal morphine, in association with intramuscular dic lofenac, proved effective for controlling pain after cesarean delivery , with a low incidence of morphine-induced pruritus.