POSTCESAREAN ANALGESIA WITH BOTH EPIDURAL MORPHINE AND INTRAVENOUS PATIENT-CONTROLLED ANALGESIA - NEUROBEHAVIORAL OUTCOMES AMONG NURSING NEONATES

Among nursing parturients after cesarean delivery, intravenous patient -controlled analgesia (PCA) with meperidine is associated with signifi cantly more neonatal neurobehavioral depression than PCA with morphine . A single dose of epidural morphine (4 mg) decreases postcesarean opi oid analgesic requirements and may reduce or prevent neonatal neurobeh avioral depression associated with PCA meperidine. Prospectively, 102 term parturients underwent cesarean delivery with epidural anesthesia, 2% lidocaine and epinephrine 1:200,000. After umbilical cord clamping , each patient received epidural morphine 4 mg and was randomly alloca ted to receive either PCA meperidine or PCA morphine. Initial neonatal characteristics, included gestational age, Apgar scores, weight, and umbilical cord gas partial pressures. Brazelton Neonatal Behavioral As sessment Scale (NBAS) examinations were performed on each of the first 4 days of life. Nursing infants (n = 47) were grouped according to ma ternal PCA opioid in breast milk (meperidine [n = 24] or morphine [n = 23]); bottle-fed infants (n = 56) served as the control group. The th ree infant groups were equivalent with respect to initial characterist ics and NBAS scores on the first 2 days of life. On the third day of l ife, infants in the morphine group were significantly more alert and o riented to animate human cues compared with infants in the meperidine or control group. On the fourth day of life, infants in the morphine g roup remained significantly more alert and oriented to animate human a uditory cues than infants in the meperidine group. Average PCA opioid consumption through 48 h postpartum was equivalent (0.54 mg/kg morphin e and 4.7 mg/kg meperidine); however, even with these small doses, mep eridine was associated with significantly poorer neonatal alertness an d orientation than morphine. Morphine is the PCA opioid of choice for postcesarean analgesia among nursing parturients. Implications: Among nursing parturients after cesarean delivery, intravenous patient-contr olled analgesia with meperidine is associated with more neonatal neuro behavioral depression than patient-controlled analgesia with morphine. In this study, we found that nursing infants exposed to morphine were more alert and oriented to animate human cues than those exposed to m eperidine.