Analgesia after caesarian section: intermittent intramuscular morphine injection versus subcutaneous morphine boluses

Recent studies have demonstrated that subcutaneous rout for opioid administration is a useful way for management of postoperative pain. The aim of this study was to compare the analgesic efficacy and adverse effects of intermittent intramuscular injection and subcutaneous morphine boluses after cesarean section. Sixty patients, aged 16 to 45, scheduled for caesarian section were randomly assigned to receive analgesia via either intramuscular (intramuscular group, 0.15 mg/kg) or subcutaneous injections of morphine (subcutaneous group, 0.15 mg/kg). Postoperative pain was assessed at rest and walking, using a visual analogue scale (VAS) every 4 hours. A Mini Mental Status examination was used to assess cognitive functions before surgery, at 2, 24 and 48 hours after surgery and at hospital discharge. Side effects were also recorded systematically during the first 48 hours after surgery. At rest, pain and overall analgesia satisfaction scores were not significantly different between the two groups. During mobilization, the subcutaneous group had lower pain score and it was significant at 12 hour, 16 hour, and 20 hour after operation (p<0.05). There was no inter-group difference in postoperative Mini Mental Status scores. The incidence of side effects was similar in two groups. It was concluded that subcutaneous morphine is a satisfactory alternative to intramuscular morphine after cesarean section.