Prophylactic Intrathecal Morphine and Prevention of Post-Dural Puncture Headache : A Randomized Double-blind Trial
BACKGROUND: Prophylactic epidural morphine administration after unintentional dural puncture with a large-bore needle has been shown to decrease the incidence of post-dural puncture headache. The authors hypothesized that prophylactic administration of intrathecal morphine would decrease the incidence of post-dural puncture headache and/or need for epidural blood patch after unintentional dural puncture.
METHODS: Parturients with an intrathecal catheter in situ after unintentional dural puncture with a 17-g Tuohy needle during intended epidural catheter placement for labor analgesia were enrolled in this randomized, double-blind trial. After delivery, subjects were randomized to receive intrathecal morphine 150 µg or normal saline. The primary outcome was the incidence of post-dural puncture headache. Secondary outcomes included onset, duration, and severity of post-dural puncture headache, the presence of cranial nerve symptoms and the type of treatment the patient received.
RESULTS: Sixty-one women were included in the study. The incidence of post-dural puncture headache was 21 of 27 (78%) in the intrathecal morphine group and 27 of 34 (79%) in the intrathecal saline group (difference, -1%; 95% CI, -25% to 24%). There were no differences between groups in the onset, duration, or severity of headache, or presence of cranial nerve symptoms. Epidural blood patch was administered to 10 of 27 (37%) of subjects in the intrathecal morphine and 11 of 21 (52%) of the intrathecal saline group (difference 15%; 95% CI, -18% to 48%).
CONCLUSIONS: The present findings suggest that a single prophylactic intrathecal morphine dose of 150 µg administered shortly after delivery does not decrease the incidence or severity of post-dural puncture headache after unintentional dural puncture. This study does not support the clinical usefulness of prophylactic intrathecal morphine after an unintentional dural puncture.
| Errataetall: | |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:132 |
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| Enthalten in: |
Anesthesiology - 132(2020), 5 vom: 15. Mai, Seite 1045-1052 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Peralta, Feyce M [VerfasserIn] |
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| Links: |
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| Themen: |
76I7G6D29C |
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| Anmerkungen: |
Date Completed 14.07.2020 Date Revised 14.07.2020 published: Print ErratumIn: Anesthesiology. 2020 May 26;:. - PMID 32472801 Citation Status MEDLINE |
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| doi: |
10.1097/ALN.0000000000003206 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM307009378 |
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| 245 | 1 | 0 | |a Prophylactic Intrathecal Morphine and Prevention of Post-Dural Puncture Headache |b A Randomized Double-blind Trial |
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| 500 | |a Date Revised 14.07.2020 | ||
| 500 | |a published: Print | ||
| 500 | |a ErratumIn: Anesthesiology. 2020 May 26;:. - PMID 32472801 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Prophylactic epidural morphine administration after unintentional dural puncture with a large-bore needle has been shown to decrease the incidence of post-dural puncture headache. The authors hypothesized that prophylactic administration of intrathecal morphine would decrease the incidence of post-dural puncture headache and/or need for epidural blood patch after unintentional dural puncture | ||
| 520 | |a METHODS: Parturients with an intrathecal catheter in situ after unintentional dural puncture with a 17-g Tuohy needle during intended epidural catheter placement for labor analgesia were enrolled in this randomized, double-blind trial. After delivery, subjects were randomized to receive intrathecal morphine 150 µg or normal saline. The primary outcome was the incidence of post-dural puncture headache. Secondary outcomes included onset, duration, and severity of post-dural puncture headache, the presence of cranial nerve symptoms and the type of treatment the patient received | ||
| 520 | |a RESULTS: Sixty-one women were included in the study. The incidence of post-dural puncture headache was 21 of 27 (78%) in the intrathecal morphine group and 27 of 34 (79%) in the intrathecal saline group (difference, -1%; 95% CI, -25% to 24%). There were no differences between groups in the onset, duration, or severity of headache, or presence of cranial nerve symptoms. Epidural blood patch was administered to 10 of 27 (37%) of subjects in the intrathecal morphine and 11 of 21 (52%) of the intrathecal saline group (difference 15%; 95% CI, -18% to 48%) | ||
| 520 | |a CONCLUSIONS: The present findings suggest that a single prophylactic intrathecal morphine dose of 150 µg administered shortly after delivery does not decrease the incidence or severity of post-dural puncture headache after unintentional dural puncture. This study does not support the clinical usefulness of prophylactic intrathecal morphine after an unintentional dural puncture | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
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| 650 | 7 | |a Morphine |2 NLM | |
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| 700 | 1 | |a Wong, Cynthia A |e verfasserin |4 aut | |
| 700 | 1 | |a Higgins, Nicole |e verfasserin |4 aut | |
| 700 | 1 | |a Toledo, Paloma |e verfasserin |4 aut | |
| 700 | 1 | |a Jones, Mary Jane |e verfasserin |4 aut | |
| 700 | 1 | |a McCarthy, Robert J |e verfasserin |4 aut | |
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