Effect of Epidural Morphine, Morphine with Droperidol and Morphine with Nalbuphine after a Cesarean Section

Kim, Tong Il; Kim, Hye Ja; Lee, Jung Un

Abstract

BACKGROUND
A number of recent reports have described the usefullness of the epidural injection of narcotics for the relief of postoperative pain. Morphine, an micro-receptor agonist, produces strong analgesic effects with side effects. Nalbupine, a micro-antagonist and kappa-agonis, has an analgesic effect comparable to morphine with little side effects. The comparison of side effects and analgesic effects of epidural morphine alone and a combination of nalbuphine and droperidol respectively to morphine were sutudied in cesarean section patients.
METHODS
We divided 45 patients into 3 groups utilizing a two-day Boxter infusor in normal saline 100 ml at 2.0 ml/hr: Group M (n = 15) initially a 1 mg bolus 2 mg/day of maintenance morphine. Group M D (n = 15): initially received a 1 mg bolus 2 mg/day of maintenance morphine 1.25 mg/day of maintenance droperidol. Group M N (n = 15): initially received a 1 mg morphine bolus 2 mg/day of maintenance morphine 5 mg/day of maintenance nalbupine. The Analgesic effect was evaluated by a visual analogue scale (0 10) at 30 min, 4 hr, 12 hr and 24 hr postoperatively and the incidence of side effects was observed too.
RESULTS
The average VAS scores are below 3 in all groups. In addition, there are no significant changes between groups. There are no significant differences in side effects between groups except sedation of patients is significantly (P< 0.05) high in group M D.
CONCLUSIONS
We concluded that the analgesic effect of epidural morphine, morphine with nalbuphine and morphine with droperidol are good in all patients and there is no significant difference even though there is a belief that a combination of nalbuphine or droperidol increases analgesic effects of morphine. Comparing the incidence of side effects in the three groups, the sedative effect of morphine with droperidol is increased significantly over the other two groups.intubation.