Comparison of opioid local anesthetic combination regimens using the number of self-administrated boluses in patient-controlled epidural analgesia after cesarean section A retrospective single-center study

The aim of this study was to assess the efficacy of combined opioids by comparing four regimens of patient-controlled epidural analgesia (PCEA) after cesarean section. Parturient patients who underwent elective or emergent cesarean section under combined spinal and epidural anesthesia from April 2013 to March 2016 were retrospectively analyzed. Based on PCEA, they were assigned to one of 4 groups: local anesthetic alone (LA), epidural single morphine administration during surgery followed by local anesthetic alone (M), local anesthetic combined with fentanyl 10 mu g/h (F10), or local anesthetic combined with fentanyl 20 mu g/h (F20). The primary outcome was the number of PCEA boluses used. Secondary outcomes included the use of rescue analgesia, postoperative nausea and vomiting, and postoperative pruritus. A total of 250 parturients were analyzed. Whereas the number of PCEA boluses in the LA group was significantly higher than in the other combined opioid groups on the day of surgery and postoperative day 1 (LA: 3 [1-6] and 7 [4-9] vs M: 2 [0-4] and 4 [0-7] vs F10: 1 [0-4] and 3 [0-6] vs F20: 1 [0-3] and 2 [0-8], P = .012 and 0.010, respectively), within the combined opioid groups, the number was not significantly different. Significantly fewer patients in the F20 group required rescue analgesia on postoperative day 1 and 2 (25 and 55%) than those in the M (66 and 81%) and F10 (62 and 66%) groups (P P = .007, respectively). Postoperative nausea and vomiting and pruritus were significantly higher in the M group (P P = .024, respectively). The results of the present study suggest that local anesthetic alone after a single administration of morphine, or local anesthetic combined with fentanyl 10 mu g/h would generally be adequate for PCEA, whereas local anesthetic combined with fentanyl 20 mu g/h would be suitable for conventional epidural analgesia.

Automated summary

The study showed that combining fentanyl 10 mcg/h after single morphine administration or using local anesthetic alone post-operatively is generally effective for patient-controlled epidural analgesia (PCEA) after cesarean section, while combining fentanyl 20 mcg/h is more suitable for conventional epidural analgesia.