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Patient-controlled Analgesia After Cesarean Delivery: Epidural Sufentanil versus Intravenous Morphine
  1. Jeffrey A. Grass, M.D.,
  2. Rhonda L. Zuckerman, M.D.,
  3. Neal T. Sakima, M.D. and
  4. Andrew P. Harris, M.D.
  1. From the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland
  1. Reprint requests: Dr. Grass, Johns Hopkins Hospital, 600 N. Wolfe St., Osler 304, Baltimore, MD 21205.

Abstract

Background and Objectives. The authors studied the efficacy of sufentanil patient-controlled epidural analgesia (PCEA) for postoperative analgesia after cesarean delivery and compared these results to a morphine intravenous-patient-controlled-analgesia (IV-PCA) regimen.

Methods. Fifty patients were randomized into two groups to receive sufentanil PCEA or morphine IV-PCA after cesarean delivery under epidural anesthesia. Visual-analog-scale pain scores (0-100 mm: 0 mm = no pain, 100 mm = worst pain), sedation, side effects, recovery times, and patient satisfaction were assessed through 4 p.m. on postoperative day (POD) 2.

Results. Analgesia was similar in the two groups, except following the initial physician-administered loading dose when pain was rated significantly lower by patients in the PCEA group at 30 minutes (6 ± 2 mm versus 38 ± 6 mm; P < .0.1) and at 2 hours (7 ± 2 mm versus 27 ± 5 mm; P < .05). Sedation was rated lower by patients in the PCEA group at 2 hours (P < .05). The incidence of nausea and vomiting was similar in both groups. The incidence of pruritus requiring treatment was greater in the PCEA group (57% versus 12%; P < .01). Length of hospitalization was not different. Patients were equally satisfied in both groups.

Conclusions. Although sufentanil PCEA provided satisfactory sustained postoperative analgesia, sufentanil PCEA appears to offer no clear advantage over morphine IV-PCA beyond the effects of the initial physician-administered loading dose.

  • analgesics
  • sufentanil
  • morphine
  • anesthetic techniques
  • epidural
  • obstetric
  • patient-controlled analgesia
  • patient-controlled epidural analgesia
  • spinal opioids

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Footnotes

  • This clinical study was conducted in the Department of Anesthesiology and Critical Care Medicine at the Johns Hopkins Hospital, Baltimore, Maryland.

    Supported in part by a grant from Janssen Research Foundation.

    Presented at the 66th Congress of the International Anesthesia Research Society in San Francisco, California on March 14, 1992.

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