Intrathecal morphine for postpartum tubal ligation postoperative analgesia

Intrathecal morphine (ITM) provides effective postoperative cesarean delive ry analgesia but has not been reported for postoperative postpartum tubal l igation (PPTL) analgesia. We designed this prospective, randomized, double- blinded study to determine the efficacy of 100 mug ITM for postoperative PP TL analgesia. Sixty-six women received spinal anesthesia with 60 mg (1.2 mL ) of 5% hyperbaric lidocaine, 10 mug (0.2 mL) of fentanyl, and either 0.2 m L of 0.9% saline (normal saline; NS) or 100 mug (0.2 mL) of morphine (morph ine sulfate, MS). Postoperative analgesia was limited to patient-controlled IV analgesia morphine. Six women (three NS and three MS) were excluded bec ause of major protocol violations. Twenty-four-hour patient-controlled IV a nalgesia morphine use vas (mean +/- SD) 39.6 +/- 19.6 mg in the NS group an d 1.1 +/- 2.5 mg in the MS group (P < 0.0000001). Visual analog scale score s for crampy and incisional pain (rest and movement) were significantly hig her in the NS group compared with the MS group at 4, 8, 12, and 24 h (P < 0 .001). The adverse effect profile was similar between groups. Visual analog scale satisfaction scores (mean +/- SD) were 96.6 +/- 16.0 in the MS group and 84.2 +/- 23.6 in NS group (P < 0.05). The results of this study indica te that women experience significant postoperative pain after PPTL surgery, and this pain is effectively obviated by 100 mug ITM.