A randomised, double-blind comparison of subarachnoid and epidural diamorphine for elective caesarean section using a combined spinal-epidural technique

We have compared the quality of analgesia and incidence of side-effects fro m subarachnoid and epidural diamorphine for caesarean section, as part of a combined spinal-epidural technique. Sixty patients were studied in a rando mised, double-blind, double-dummy assessment. The doses of diamorphine refl ect current practice in our hospital and are close to optimal. All patients received 13.25 mg subarachnoid bupivacaine and 37.5 mg epidural bupivacain e. In addition, patients in group 1 received 0.3 mg subarachnoid diamorphin e and patients in group 2 received 3 mg epidural diamorphine. All patients were premedicated with ranitidine 150 mg and metoclopramide 10 mg and after surgery received diclofenac regularly and co-dydramol as needed. The durat ion and quality of analgesia, assessed by verbal rating score, was the same in the two groups. The incidence and severity of pruritus were higher (P < 0.005) in group 1. Postoperative nausea and vomiting were uncommon; 83% of patients in group 1 and 77% in group 2 had none. Subarachnoid and epidural diamorphine provided similar quality analgesia with a low incidence of eme tic symptoms. However pruritus was more common and more severe after subara chnoid diamorphine. (C) 2000 Harcourt Publishers Ltd.