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2‐chloroprocaine antagonism of epidural morphine analgesia
Author(s) -
KARAMBELKAR D. J.,
RAMANATHAN S.
Publication year - 1997
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.1997.tb04782.x
Subject(s) - medicine , morphine , anesthesia , analgesic , analysis of variance , lidocaine
Background: 2‐chloroprocaine (2‐CP) used for lumbar epidural anesthesia (LEA) reportedly decreases the efficacy of epidural morphine (EM) administered for post‐cesarean section (CS) analgesia. The amount of supplemental i.v. morphine self‐administered by the patient via the patient‐controlled analgesia device (PCA) is used to study the interaction between EM and 2‐CP. Methods: Forty‐two patients scheduled for elective CS were randomly divided into 3 equal groups, and received 2‐CP, 2‐CP+epinephrine (Epi, 5 μg ml ‐1 ) or 2% lidocaine (Lido) with Epi for LEA. All patients received 5 mg EM and i.v. PCA morphine for postoperative pain. Cumulative amount of i.v. morphine used in the first 24 hours as well as the amount of the drug used during each 2‐h period were noted. Nonparametric analysis of variance and Chi‐squared analysis were used for statistical comparisons. Results: The mean cumulative 24‐h i.v. PCA morphine requirement in the 2‐CP, 2‐CP+Epi and Lido+Epi groups respectively was 20.5±24, 33.1.5±27 and 4.07±6.3 (mean±SD). The Lido+Epi group used significantly less morphine ( P = 0.01) compared to either of the 2‐CP groups with no significant difference between the 2‐CP groups. The maximum i.v. PCA morphine use occurred in the first 4 hours following surgery in all three groups. Conclusion: Analgesic efficacy of EM is decreased when 2‐CP is used for LEA compared to when Lido+Epi is used.