• Anesthesiology · May 2020

    Randomized Controlled Trial

    Prophylactic Intrathecal Morphine and Prevention of Post-Dural Puncture Headache: A Randomized Double-blind Trial.

    Prophylactic intrathecal morphine does not reduce the incidence or severity of post-dural puncture headache.

    pearl
    • Feyce M Peralta, Cynthia A Wong, Nicole Higgins, Paloma Toledo, Mary Jane Jones, and Robert J McCarthy.
    • From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (F.M.P., N.H., P.T., M.J.J.) Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa (C.A.W.) Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois (R.J.M.).
    • Anesthesiology. 2020 May 1; 132 (5): 1045-1052.

    BackgroundProphylactic 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.MethodsParturients 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.ResultsSixty-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%).ConclusionsThe 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.

      Pubmed     Full text   Copy Citation  

      Add institutional full text...

    Notes

    pearl
    1

    Prophylactic intrathecal morphine does not reduce the incidence or severity of post-dural puncture headache.

    Daniel Jolley  Daniel Jolley
     
    Do you have a pearl, summary or comment to save or share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…

Want more great medical articles?

Keep up to date with a free trial of metajournal, personalized for your practice.
988,657 articles already indexed!

We guarantee your privacy. Your email address will not be shared.