The effect of intratecal usage of different doses of morphine in caesarian with spinal anesthesia on head pain after dural punction: Randomized, double-blind, controlled study

Aim of Study: In this study, we aimed to investigate the effect of intrathecal administration of different doses of morphine on headache after dural puncture (PDPH) in pregnant women who underwent cesarean section (C / S) with spinal anesthesia. Method: A total of 80 ASA I-II pregnant women between the ages of 18-40 were included in the study. After the patients were taken to the operating room, they were monitored in a standard way. Pregnant women who underwent elective CS under spinal anesthesia were randomly divided into 4 groups. Group F25; 2 ml hyperbaric bupivacaine + 25 µg fentanyl intrathecal Group M100; 2 ml hyperbaric bupivacaine + 100 µg morphine intrathecal, Group M150; 2 ml hyperbaric bupivacaine + 150 µg morphine intrathecal, Group M200; 2 ml hyperbaric bupivacaine + 200 µg morphine were administered intrathecally. Demographic characteristics and vital signs (pulse, blood pressure and saturation) of the patients, operation times, intraoperative blood loss and intraoperative transfusion amount, APGAR (Activity-Pulse-Grimace-Appearence-Respiration) 1 and 5 minutes scores of infants were recorded. Postoperative headache, PDPH development, epidural blood patch (EBP) requirement, EBP count, length of hospital stay, possible side effects (drug allergy, nausea, vomiting, itching, apnea, desaturation) that may occur within the first 24 hours were followed. After the operation, all patients were evaluated with the visual analog scale (VAS) score for the next 7 days. Results: While PDPH was most prevalent in the fentanyl group, it was least seen in Group M200 patients. Other groups did not show a significant difference in terms of PDPH frequency. There was no difference between VAS values in the first 4 days postoperatively and on the 6th and 7th days. The rate of nausea-vomiting and itching in Group F25 was significantly lower than Group M100, Group M150 and Group M200; The rate of nausea-vomiting and itching did not differ significantly between Group M100, Group M150 and Group M200. Conclusion: PDPH was significantly lower in the group receiving 200 µg intrathecal morphine. The incidence of side effects (nausea-vomiting, pruritus) was found to be significantly higher in the groups receiving morphine compared to the fentanyl group, regardless of the dose.