Epidural Morphine Versus Epidural Fentanyl Infusion Following Cesarean Section

Not Applicable

Terminated

Brief Summary: For post-Cesarean analgesia, the investigators will compare the efficacy of single-shot epidural preservative free morphine with a continuous epidural fentanyl infusion. The investigators will be comparing the patient's pain level and satisfaction with the two techniques, as well as the side effects that the patients experience, such as itching, nausea, back pain and respiratory depression.

Detailed Description: Included in the study will be all healthy (ASA I or II) woman having elective Cesarean sections who are candidates for regional anesthesia. Exclusion criteria include morbid obesity (BMI \> 40), age less that 18 years, history of sleep apnea, and abuse of or intolerance to opioid analgesics.

All patients will also receive 100 micrograms of fentanyl once epidurally during the Cesarean section, and they will receive ibuprofen every six hours for the first 24 hours after the Cesarean section. The patients will be visited twice a day postoperatively for two days. The epidural morphine will be expected to last only approximately 20 hours, while the fentanyl infusion will be kept in place for two days after the procedure. Additional analgesics, such as intravenous morphine or PO oxycodone and tylenol, will be available for breakthrough pain.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Preservative free morphine	Preservative free morphine	This group will receive 3mg of preservative free morphine epidurally during the procedure.
Fentanyl infusion	Fentanyl	This group will receive an epidural infusion of fentanyl (60 micrograms per hour), which will be started during the Cesarean section and which will continue for the next two days.

Primary Outcome Measures

Name	Time	Method
Postsurgical Pain	At 8, 24 36 and 48 hours after the Cesarean section	Participants will be asked to rate their pain on a 10 point Numerical Rating Pain Scale, where zero is no pain and ten is the most intense pain possible.

Secondary Outcome Measures

Name	Time	Method
Number of Participants Who Responded Yes to Having Nausea or Vomiting	At 8, 24, 36 and 48 hours after the Cesarean section	The patient will be asked whether she has nausea or vomiting (yes=1, no=0).
Number of Participants Who Were Observed by Their Nurse to Have Urinary Retention	At 8, 24, 36 and 48 hours after Cesarean section	Participant's nurse will be asked whether \>400ml was obtained by straight cath (Y=1, No=0)
Number of Participants Who Were Observed by Their Nurse to Have Respiratory Depression	At 8, 24, 36 and 48 hours after the Cesarean section	Participant's chart will be examined to determine whether the respiratory rate was \<8 per minute (Yes=1, No=0)
Patient Satisfaction	At 8, 24, 48 and 36 hours after Cesarean section	Participants will be asked to rate their satisfaction on a 10 point Numerical Rating Scale (0=worst, 10=best).
Number of Participants Who Responded Yes to Having Back Pain	At 8, 24, 36 and 48 hours after the Cesarean section	Participants will be asked whether they have back pain (Yes=1, No=0)
Number of Participants Who Responded Yes to Having Pruritis	At 8, 24, 36 and 48 hours after Cesarean section	Participants will be asked whether they have pruritis (Yes=1, No=0)