Low-dose intrathecal morphine versus intrathecal fentanyl for post-caesarean analgesia in a resource-constrained setting: a pragmatic randomised trial
Abstract
Background: Intrathecal morphine is recommended for post-caesarean analgesia, but its implementation remains inconsistent in resource-constrained obstetric services, where short-acting intrathecal fentanyl is often favoured instead because of familiarity and perceived simplicity of use. We compared two low doses of intrathecal morphine with intrathecal fentanyl in women undergoing caesarean delivery under spinal anaesthesia in a South African public-sector hospital.
Methods: This was a single-centre, participant- and outcome-assessor-blinded, parallel-group pragmatic randomised trial. Women undergoing caesarean delivery under single-shot spinal anaesthesia were allocated to hyperbaric bupivacaine 0.5% 1.8 ml mixed with intrathecal morphine 100 µg (M100), intrathecal morphine 50 µg (M50), or intrathecal fentanyl 25 µg (F25). All participants received postoperative intravenous (IV) morphine patient-controlled analgesia (PCA) and rectal indomethacin. The primary outcome was cumulative 24-hour IV PCA morphine consumption. Secondary outcomes were morphine consumption for 0-12 h and 12-24 h, pain numerical rating scale (NRS) scores at rest and with cough at 12 and 24 h, perceived pain relief over 24 h, and whether participants wanted more analgesic treatment. The prespecified primary analysis was per protocol, with a supportive intention-to-treat analysis.
Results: One hundred women were randomised. Ninety-three comprised the per-protocol efficacy cohort (M100 n = 32, M50 n = 29,…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 32 participants or records.
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