Morphine in the spinal cuts headaches after caesarean, at a price in nausea and itch
A randomised trial in Van compared fentanyl with three morphine doses in 80 women having a caesarean section.
Spinal anaesthesia is the usual choice for caesarean sections, but the needle puncture sometimes leaves a severe headache that worsens on sitting up and can last for days.
Anaesthetists at Van Yüzüncü Yıl University randomly gave 80 women one of four spinal mixtures: the local anaesthetic bupivacaine with either 25 micrograms of fentanyl or 100, 150 or 200 micrograms of morphine. The double-blind trial was published in The Ulutas Medical Journal in 2021.
Headaches needing treatment became rarer as the morphine dose rose: 55% of women in the fentanyl group, then 35%, 25% and finally 10% in the highest-dose morphine group. Peak pain scores were also lowest with 200 micrograms.
The trade-off was side effects. Nausea or vomiting affected 75% of the 200-microgram group against 5% with fentanyl, and itching 75% against none.
Caveat: each group had only 20 women, all from one hospital, which is too few to judge rare complications.
Source: Hilmi Yetkin et al. The Effect of Intrathecal Administration of Different Doses of Morphine on Headache after Dural Puncture in Cesarean Sections Under Spinal Anesthesia: A Randomized Double-Blind Controlled Study. Ulutas Med J 2021. doi:10.5455/umj.20210203101035.
Image: Figure 3 of the article, CC BY-NC 4.0.
