Abstract
A 32-year-old G3P1 female with a body mass index (BMI) of 40 % for elective, repeat cesarean delivery. The patient denies other comorbidities, but her husband states that she snores loudly at night and notes pauses in her nighttime breathing. The patient reports that after her previous cesarean delivery, the epidural catheter impeded her ability to interact with the baby. Her right leg was numb and weak, and she could not get up to go to the bathroom. The skin around the catheter insertion remained red, swollen, and painful for a few days. Overall, it was “very uncomfortable.” As a consequence, she asks you if it would be possible to have the catheter removed immediately after surgery.
Keywords
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Hamilton BE, Martin JA, Ventura SJ. Births: preliminary data for 2012. Natl Vital Stat Rep. 2013;62(3):1–20.
Witt WP, Wisk LE, Cheng ER, Mandell K, Chatterjee D, Wakeel F, et al. Determinants of cesarean delivery in the US: a lifecourse approach. Matern Child Health J. 2015;19(1):84–93.
Kotelko DM, Dailey PA, Shnider SM, Rosen MA, Hughes SC, Brizgys RV. Epidural morphine analgesia after cesarean delivery. Obstet Gynecol. 1984;63(3):409–13.
Kumarasamy S, Choy YC. Epidural morphine for postoperative analgesia after caesarean section. Acute Pain. 2008;10(3–4):117–21.
Youssef N, Orlov D, Alie T, Chong M, Cheng J, Thabane L, Paul J. What epidural opioid results in the best analgesia outcomes and fewest side effects after surgery?: a meta-analysis of randomized controlled trials. Anesth Analg. 2014;119(4):965–7.
Bonnet MP, Mignon A, Mazoit JX, Ozier Y, Marret E. Analgesic efficacy and adverse effects of epidural morphine compared to parenteral opioids after elective caesarean section: a systematic review. Eur J Pain. 2010;14(9):894.e1–9.
Gambling D, Hughes T, Martin G, Horton W, Manvelian G. A comparison of Depodur, a novel, single-dose extended-release epidural morphine, with standard epidural morphine for pain relief after lower abdominal surgery. Anesth Analg. 2005;100(4):1065–74.
Martin R, Lamarche Y, Tétrault JP. Epidural and intrathecal narcotics. Can Anaesth Soc J. 1983;30(6):662–73.
Rosen MA, Hughes SC, Shnider SM, Abboud TK, Norton M, Dailey PA, Curtis JD. Epidural morphine for the relief of postoperative pain after cesarean delivery. Anesth Analg. 1983;62(7):666–72.
Finkel KJ, Searleman AC, Tymkew H, Tanaka CY, Saager L, Safer-Zadeh E, et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med. 2009;10:753–8.
Hai F, Porhomayon J, Vermont L, Frydrych L, Jaoude P, El-Solh AA. Postoperative complications in patients with obstructive sleep apnea: a meta-analysis. J Clin Anesth. 2014;26(8):591–600.
Lee LA, Caplan RA, Stephens LS, Posner KL, Terman GW, Voepel-Lewis T, Domino KB. Postoperative opioid-induced respiratory depression: a closed claims analysis. Anesthesiology. 2015;122(3):659–65.
American Society of Anesthesiologists Task Force on Neuraxial Opioids, Horlocker TT, Burton AW, Connis RT, Hughes SC, Nickinovich DG, Palmer CM, et al. Practice guidelines for the prevention, detection, and management of respiratory depression associated with neuraxial opioid administration. Anesthesiology. 2009;110(2):218–30.
Vercauteren M, Vereecken K, La MM, Coppejans H, Adriaensen H. Cost-effectiveness of analgesia after Caesarean section. A comparison of intrathecal morphine and epidural PCA. Acta Anaesthesiol Scand. 2002;46(1):85–9.
Francis C. Prophylaxis for thromboembolism in hospitalized medical patients. N Engl J Med. 2007;356:1438–44.
Tepper NK, Boulet SL, Whiteman MK, Monsour M, Marchbanks PA, Hooper WC, et al. Postpartum venous thromboembolism: incidence and risk factors. Obstet Gynecol. 2014;123(5):987–96.
Gadsen J, Hart S, Santos AC. Post-cesarean delivery analgesia. Anesth Analg. 2005;101(5 Suppl):S62–9.
Yuan H, Zuo Z, Yu K, Lin W, Lee H, Chan K. Bacterial colonization of epidural catheters used for short-term postoperative analgesia. Anesthesiology. 2008;108:130–7.
Dawson S. Epidural catheter infections. J Hosp Infect. 2001;47(1):3–8.
Brooks K, Pasero C, Hubbard L, Coghlan RH. The risk of infection associated with epidural analgesia. Infect Control Hosp Epidemiol. 1995;16(12):725–8.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Voiculescu, L.D., Eydlin, O., Largi, J.T. (2017). Single-Dose Epidural Morphine or Patient-Controlled Epidural Analgesia (PCEA) for Post-Cesarean Pain Control?. In: Scher, C., Clebone, A., Miller, S., Roccaforte, J., Capan, L. (eds) You’re Wrong, I’m Right. Springer, Cham. https://doi.org/10.1007/978-3-319-43169-7_87
Download citation
DOI: https://doi.org/10.1007/978-3-319-43169-7_87
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-43167-3
Online ISBN: 978-3-319-43169-7
eBook Packages: MedicineMedicine (R0)