Author: Eric Ramos
Neuraxial morphine reduced inpatient opioid consumption in the first 6 hours after caesarean delivery, and >72 hours after delivery, according to a study presented at the 2020 Virtual Meeting of the American Society of Anesthesiologists (ASA).
“Currently, caesarean delivery is the most common inpatient surgery in the United States, with an average of 1.3 million procedures per year,” said Daniel D. Kim, MD, Cleveland Clinic Foundation, Cleveland, Ohio. “Several publications have shown an excessive prescription of opioids after caesarean deliveries. One of the strategies to reduce post-operative pain, and therefore opioid consumption, is an addition of a hydrophilic opioid, such as morphine in the neuraxial anaesthesia.”
For the study, the researchers conducted a retrospective analysis of 3,277 women who had a caesarean delivery between January 2017 and March 2020. Of the women, 3,143 received neuraxial morphine and 134 did not.
Overall, inpatient opioid consumption was lower in the neuraxial morphine group compared with the control group, with a mean difference of 10 oral morphine equivalents.
Opioid consumption in the first 24 hours after delivery was numerically lower in the neuraxial morphine group at all time points assessed, but the differences were not statistically significant, except for the first 6 hours after caesarean section. Opioid consumption in the first 72 hours was similar between groups, except after day 3 (>72 hours), where the neuraxial morphine group showed a significantly lower opioid consumption.
“Opioid consumption was also lower in the neuraxial morphine group within 6 hours after delivery, with a mean difference of 3 oral morphine equivalents [mg],” said Dr. Kim. “And after postoperative day 3, the mean difference was 6 oral morphine equivalents.”
Although inpatient opioid consumption was reduced, “the overall mean difference of 10 oral morphine equivalents, which represents less than 50% of total inpatient opioid consumption was not relevant,” said Dr. Kim.