“Comparison between the use of intrathecal morphine and intravenous/subcutaneous/intramuscular morphine in the management of post-Caesarean section pain in University Teaching Hospital of Kigali and Muhima District Hospital”

Abstract

Background Adequate pain management is one of the most important factors that contribute to a good outcome following surgery. Administration of morphine via different routes is a common practice for post-operative pain management including Cesarean section. Intrathecal administration of morphine may be an effective route for better results. Aim and Objectives. This study aims to compare the outcome of analgesia provided by Intrathecal morphine to IV/Sc/IM Morphine with the following objectives: • To determine the quality of analgesia provided by Intrathecal and IV/ Sc/IM Morphine administration. • To determine the incidence of side effects of Morphine administered via Intrathecal and IV/ Sc/IM Morphine. Methodology This is a prospective cohort study conducted on parturient women who gave birth by Cesarean section under spinal anesthesia at University Teaching Hospital of Kigali and Muhima District Hospital. Results Two hundred and fifty women participated in the study, divided into two groups. The IV/Sc/IM morphine group had higher pain scales with a median pain scale of 3.0 (1.0-6.0), 5.0 (1.0-7.0) and 2.0 (1.0-5.0) at 3 hours, 6 hours and 24 hours respectively after administration of morphine IV/Sc/IM; compared to the intrathecal morphine group that had a median pain scale of 2.0 (1.0-4.0), 3.0 (1.0-6.0) and 2.0 (1.0-4.0) at 3 hours, 6 hours and 24 hours respectively with P value <0.001. The intrathecal morphine group demonstrated better ability for ambulation (Ability to sit up 3 hours after morphine administration (94.4% Vs 64.8%, P value<0.001) and to walk easily with help 6 hours and 24 hours after morphine administration (48.0% Vs 23.2% and 87.2% Vs 60.0% respectively) and a longer duration of analgesia (Median period of 24 hours vs 5 hours, P value <0.001). Itching was the most frequent side effect and it was highly associated with intrathecal morphine administration at 40.8% compared to 6.4% for IV/Sc/IM morphine administration. The need for treatment of side effect was 4.8% for intrathecal morphine vs 0.8% of IV/Sc/IM morphine. Conclusion Intrathecal morphine provides a better analgesia for post Cesarean section pain management compared to IV/Sc/IM morphine with no significant severe side effects associated.