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On-line version ISSN 1806-907X
Rev. Bras. Anestesiol. vol.54 no.4 Campinas July/Aug. 2004
LETTERS TO THE EDITOR
Reply - Effects of low spinal morphine doses associated to intravenous and oral ketoprofen in patients submitted to cesarean sections
With regards to Prof. Itagyba Martins Miranda Chaves comments, I would like to explain that the association of spinal morphine to local anesthetics to provide postoperative analgesia in patients submitted to Cesarean section has been routinely used for years by members of the Anesthesiology Department and that care has been taken1 to prevent possible side-effects of this technique.
As from the publication of a study2 showing that the association of anti-inflammatory (diclofenac) to spinal opioids has been effective to prevent pain in patients submitted to Cesarean section, even when low morphine doses were used, it has been proposed in our service to decrease spinal morphine dose and associate it to ketoprofen, which is the standard anti-inflammatory drug in our hospital. Major objective was to decrease the incidence of side effects, in addition to induce analgesia.
I would also stress that by that time, some physicians in our department were already using lower morphine doses associated to ketoprofen in Cesarean sections with satisfactory results. However, to make our observations scientifically reliable, we have proposed the above-mentioned research to validate our observations.
The study was started on late 1999 and inclusion criteria were physical status ASA I patients with healthy fetuses. Research was slowly developed since we work in a hospital of tertiary level obstetric service (complicated gestations, hypertensive, diabetic, cardiac disease, patients with fetal malformation).
During this study were been collected a systematic review was published and showed that the best morphine dose by subarachonoidal injection was 0.1 mg when used how single analgesic agent in postoperative period of cesarean section3.
Since our proposal was the association of opioid to the anti-inflammatory drug, our objective was to observe the behavior of lower morphine doses.
To conclude, results obtained are product of a strictly applied method and so they could not have been masked or manipulated for being different of what has been reported in the literature.
Eliana Marisa Ganem, TSA, M.D.
Address: Anesthesiology Dept, FMB - UNESP
ZIP: 18618-970 City: Botucatu, Brazil
01. Ganen EM, Módolo NSP, Ferrari F et al - Efeitos da associação entre pequenas doses subaracnóideas de morfina e cetoprofeno venoso e oral em pacientes submetidas à cesariana. Rev Bras Anestesiol, 2003;53:431;439.
02. Cardoso MM, Carvalho JC, Amaro A et al - Small doses of intrathecal morphine combined with systemic diclofenac for postoperative pain control after cesarean delivery. Anesth Analg, 1998;86:538-541.
03. Dahl JB, Jeppersen IS, Jorgensen H et al - Intraoperative e postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal anesthesia: a qualitative and quantificative systematic review of randomized controlled trials. Anesthesiology, 1999;91: 1919-1927.