Kondo Hiroaki, Hyuga Shunsuke, Tomoda Yoshinori, Fujita Tomoe, Adachi Mariko, Okutomi Toshiyuki
Division of Obstetric Anesthesia, Center for Perinatal Care, Child Health and Development, Kitasato University Hospital, 1-15-1 Kitasato Minami-Ku, Sagamihara City, Kanagawa, 252-0375, Japan.
Laboratory of Clinical Pharmacokinetics, Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, 5-9-L Shirokane, Minato-Ku, Tokyo, 108-8641, Japan.
JA Clin Rep. 2025 Sep 26;11(1):51. doi: 10.1186/s40981-025-00818-4.
Epidural morphine administration following vaginal delivery reduces postpartum pain; however, side effects may occur. We investigated whether a lower dose could achieve pain relief without increasing the incidence and severity of side effects.
Eighty women treated with combined spinal-epidural analgesia received 0.75 mg epidural morphine (morphine group) or normal saline (normal saline group) after delivery. The primary outcome was the area under the curve (AUC) of the visual analog scale score assessing perineal and contraction pain for 24 h following delivery. Secondary outcomes were time until initial request for additional analgesics, number of analgesic medications, and side effects incidence and severity.
The morphine group did not show lower mean AUCs for postpartum perineal (290, interquartile range [IQR]: 90-580 vs 450, IQR: 265.6-760; P = 0.07) or contraction pain (18.8, IQR: 0-105 vs 156.3, IQR: 11.5-300; P = 0.004). The time until the initial request for additional analgesics was longer in the morphine group (530 min, 95% confidence interval [CI]: 365 to 915 min vs 268 min, 95% CI: 230 to 385 min; P = 0.001). The median (IQR) number of analgesic medications within 24 h were 2 (0.5-3) and 2.5 (2-3) in the morphine and saline groups, respectively (P = 0.007). There were no differences in the incidence of side effects between the groups.
Epidural morphine following vaginal delivery reduces contraction pain but not perineal pain and prolongs the time until initial request for additional analgesia without increasing side effects.
The University Hospital Medical Information Network Clinical Trials Registry (registration number: UMIN000039351).
阴道分娩后硬膜外注射吗啡可减轻产后疼痛；然而，可能会出现副作用。我们研究了较低剂量是否能在不增加副作用发生率和严重程度的情况下实现疼痛缓解。
80名接受腰麻-硬膜外联合镇痛的女性在分娩后接受0.75毫克硬膜外吗啡（吗啡组）或生理盐水（生理盐水组）。主要结局是评估分娩后24小时会阴和宫缩疼痛的视觉模拟量表评分的曲线下面积（AUC）。次要结局是首次要求追加镇痛药的时间、镇痛药的使用数量以及副作用的发生率和严重程度。
吗啡组产后会阴疼痛的平均AUC（290，四分位间距[IQR]：90-580 vs 450，IQR：265.6-760；P = 0.07）或宫缩疼痛的平均AUC（18.8，IQR：0-105 vs 156.3，IQR：11.5-300；P = 0.004）并无降低。吗啡组首次要求追加镇痛药的时间更长（530分钟，95%置信区间[CI]：365至915分钟 vs 268分钟，95%CI：230至385分钟；P = 0.001）。吗啡组和生理盐水组24小时内镇痛药的中位数（IQR）分别为2（0.5-3）和2.5（2-3）（P = 0.007）。两组间副作用的发生率无差异。
阴道分娩后硬膜外注射吗啡可减轻宫缩疼痛，但不能减轻会阴疼痛，并延长首次要求追加镇痛的时间，且不增加副作用。
大学医院医学信息网络临床试验注册库（注册号：UMIN000039351）。
