Appropriate Dose Of Morphine For Epidural Analgesia After Cesarean Section

Objective: To observe analgesic effect of different doses of epidural morphine and incidence of adverse reactions after cesarean section.Method: Ninety patients undergoing cesarean section in the lower uterus from January 2018 to September 2018 were randomly divided into three groups: groupM1,groupM2,and groupM3.The morphine dose was divided into group M1(1 mg morphine);group M2(2 mg morphine)and group M3(3 mg morphine).Each group had 30 patients(n=30).All patients were received combined spinal and epidural anesthesia(CSEA),spinal anesthesia 0.75% ropivacaine hydrochloride 1.6 to 1.8 ml.Different doses of morphine were diluted to 6ml with normal saline and injected into the epidural space 15 minutes before the end of operation.Palonosetron 0.25 mg were injected intravenously before the end of surgery to prevent postoperative nausea and vomiting.The visual analogue scale(VAS),sedation score(Ramsay),postoperative analgesic remedy,nausea and vomiting,skin itching,other adverse reactions and milking at 2h,4h,8h,24 h,48h after cesarean section were observed and recorded.Results: There were no significant differences in the age,body mass index,gestational age,ASA,and operation time among the three groups(P>0.05).Compared with M1 group,the VAS score of M2 group and M3 group at 2h,4h,8h,24 h,48h were significantly decreased(P<0.05).Compared with M2 group,the VAS score of M3 group at 2h,24 h were significantly decreased(P<0.05),and at 4h,8h,48 h were significantly increased(P<0.05).The incidence of requirement for rescue analgesia in M1 group was 26%.M2 group and M3 group were no incidence of requirement for rescue analgesia.The incidence of moderate pain in M1 group was 33%,in M2 group was 3%,and in M3 group was no incidence of moderate pain.There were significant differences in the incidence of requirement for rescue analgesia and moderate pain among the three groups(P<0.05).The scored 1 of Ramsay sedation scores in M1 group was 7%,the scored 2 was 93%.In M2 group and M3 group were all the scored 2 of Ramsay sedation scores.There were no significant differences in the Ramsay sedation scores among the three groups(P>0.05).There was no significant differences in the incidence of posto-perative nausea and vomiting among the three groups(P>0.05).The incide-nce of skin itching did not occur in M1 group and M2 group,and the incidence rate in M3 group was 57%.Compared with M1 group and M2 group,the incidence rate of skin itching was significant increased in group M3(P<0.05).There were no significant differences in the time of initiation of feeding among three groups.Conclusion: 2 mg morphine in the epidural space is used for analgesia after first pregnancy cesarean section.The analgesic effect is good,moderate sedation,the incidence of nausea and vomiting is low,and no skin itching occurs.It is a good choice for postoperative analgesia after cesarean section.