Neuraxial morphine after unintentional dural puncture is not associated with reduced postdural puncture headache in obstetric patients.
Adult
Analgesia, Epidural
/ adverse effects
Analgesia, Obstetrical
/ adverse effects
Analgesics, Opioid
/ administration & dosage
Cohort Studies
Delivery, Obstetric
Dura Mater
Female
Humans
Labor, Obstetric
Morphine
/ administration & dosage
Post-Dural Puncture Headache
/ etiology
Pregnancy
Punctures
Retrospective Studies
Risk Factors
Epidural
Morphine
Postdural puncture headache
Spinal
Journal
Journal of clinical anesthesia
ISSN: 1873-4529
Titre abrégé: J Clin Anesth
Pays: United States
ID NLM: 8812166
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
received:
31
07
2018
revised:
23
08
2018
accepted:
08
09
2018
pubmed:
15
9
2018
medline:
30
5
2019
entrez:
15
9
2018
Statut:
ppublish
Résumé
To examine the relationship between neuraxial morphine exposure after unintentional dural puncture and the risk for postdural puncture headache in obstetric patients. Retrospective cohort study. Obstetrical unit at a tertiary care referral center. Parturients receiving labor epidural analgesia with recognized unintentional dural puncture. Cases in which neuraxial morphine was given for any reason were compared to cases in which it was not for the outcome of postdural puncture headache. Development of postdural puncture headache, headache severity, number of epidural blood patches, hospital length of stay. Of the 80 cases that were included, 38 women received neuraxial morphine and 42 did not. There was no significant difference in the incidence of headache between the two morphine groups (Headache present: Morphine: 27/56 [48.2%], No morphine: 29/56 [51.8%]; Headache free: Morphine: 11/24 [45.8%], No morphine: 13/24 [54.2%], P = 0.84). There was no difference in the need for epidural blood patch (Morphine: 24/42 [57.1%], No morphine: 18/38 [47.4%], P = 0.50) and headache severity (mean headache pain score: Morphine: 7.9 ± 1.8 vs. No morphine: 7.3 ± 2.4, P = 0.58). Hospital length of stay was higher in the morphine group (4.4 ± 2.9 days vs. 3.0 ± 1.5 days respectively, P = 0.008). Using logistic regression, morphine did not affect headache risk after controlling for covariates (morphine vs. no morphine: adjusted OR 1.24 [0.75]; P = 0.72; pre-eclampsia vs. no pre-eclampsia: adjusted OR 0.56 [0.41], P = 0.42; cesarean vs. normal spontaneous vaginal delivery: adjusted OR 0.97 [0.67]; P = 0.96). In cases of unintentional dural puncture, exposure to neuraxial morphine for any reason may not be protective against the risk of postdural puncture headache. Although an overall protective effect of neuraxial morphine was not observed in this study, its role in specific subsets of patients remains to be investigated.
Identifiants
pubmed: 30216925
pii: S0952-8180(18)30922-X
doi: 10.1016/j.jclinane.2018.09.009
pmc: PMC6251736
mid: NIHMS1506447
pii:
doi:
Substances chimiques
Analgesics, Opioid
0
Morphine
76I7G6D29C
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
58-62Subventions
Organisme : NICHD NIH HHS
ID : K12 HD043441
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000005
Pays : United States
Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.
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