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235 Eight mg of epidural morphine: how much should we worry?
  1. R Rodrigues Oliveira,
  2. A Vasconcelos Pereira,
  3. R Mendes de Carvalho and
  4. M Azevedo Coutinho
  1. Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal


Background and Aims Currently, administering a bolus of 2 to 3 mg of epidural morphine for cesarean section postoperative pain management is widely recommended. Assuming that by using higher doses the increased side effects incidence will outweight any possible benefits in analgesic outcome, there is actually a lack of literature reporting higher dose regimens. We present a case of a patient who accidentally received a dose of 8 mg.

Methods A twenty-six-year-old, ASA II female underwent a cesarean section under epidural block due to fetopelvic disproportion. The epidural catheter was previously placed and used for labor analgesia. At the end of the surgery, a bolus of 8 mg of epidural morphine was mistakenly administered instead of 2 mg.

The patient was kept in the postoperative care unit for 18 hours and subsequently transferred to the ward. Ondansetron 4 mg 8/8h was prescribed for nausea and vomiting prophylaxis.

Results During the 24h after the administration, adverse effects such as sedation, nausea, vomiting, pruritus, or urinary retention did not occur. She had no ventilatory depression and was hemodynamically stable throughout the day. Analgesia was optimal without the need of rescue analgesics.

Conclusions Despite the need of adequate monitoring, administering an higher dose of epidural morphine provided optimal analgesia without any adverse effects and allowed for an otherwise normal postoperative period. More studies might be needed in order to determine the actual safety of higher dose epidural morphine and its possible benefits for selected cases.

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