For post-Cesarean analgesia, the investigators will compare the efficacy of single-shot epidural preservative free morphine with a continuous epidural fentanyl infusion. The investigators will be comparing the patient's pain level and satisfaction with the two techniques, as well as the side effects that the patients experience, such as itching, nausea, back pain and respiratory depression.
Included in the study will be all healthy (ASA I or II) woman having elective Cesarean sections who are candidates for regional anesthesia. Exclusion criteria include morbid obesity (BMI \> 40), age less that 18 years, history of sleep apnea, and abuse of or intolerance to opioid analgesics. All patients will also receive 100 micrograms of fentanyl once epidurally during the Cesarean section, and they will receive ibuprofen every six hours for the first 24 hours after the Cesarean section. The patients will be visited twice a day postoperatively for two days. The epidural morphine will be expected to last only approximately 20 hours, while the fentanyl infusion will be kept in place for two days after the procedure. Additional analgesics, such as intravenous morphine or PO oxycodone and tylenol, will be available for breakthrough pain.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
2
3mg given epidurally during the Cesarean section.
An infusion of epidural fentanyl started during the Cesarean section. It will be given on a patient controlled analgesia basis, with a basal rate of 60 micrograms, a demand dose of 16 micrograms, and a lockout of 15 mins.
University Hospitals Case Medical Center
Cleveland, Ohio, United States
Postsurgical Pain
Participants will be asked to rate their pain on a 10 point Numerical Rating Pain Scale, where zero is no pain and ten is the most intense pain possible.
Time frame: At 8, 24 36 and 48 hours after the Cesarean section
Number of Participants Who Responded Yes to Having Nausea or Vomiting
The patient will be asked whether she has nausea or vomiting (yes=1, no=0).
Time frame: At 8, 24, 36 and 48 hours after the Cesarean section
Patient Satisfaction
Participants will be asked to rate their satisfaction on a 10 point Numerical Rating Scale (0=worst, 10=best).
Time frame: At 8, 24, 48 and 36 hours after Cesarean section
Number of Participants Who Responded Yes to Having Back Pain
Participants will be asked whether they have back pain (Yes=1, No=0)
Time frame: At 8, 24, 36 and 48 hours after the Cesarean section
Number of Participants Who Responded Yes to Having Pruritis
Participants will be asked whether they have pruritis (Yes=1, No=0)
Time frame: At 8, 24, 36 and 48 hours after Cesarean section
Number of Participants Who Were Observed by Their Nurse to Have Urinary Retention
Participant's nurse will be asked whether \>400ml was obtained by straight cath (Y=1, No=0)
Time frame: At 8, 24, 36 and 48 hours after Cesarean section
Number of Participants Who Were Observed by Their Nurse to Have Respiratory Depression
Participant's chart will be examined to determine whether the respiratory rate was \<8 per minute (Yes=1, No=0)
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Time frame: At 8, 24, 36 and 48 hours after the Cesarean section