Newly Published
Perioperative Medicine  |   February 2020
Prophylactic Intrathecal Morphine and Prevention of Post–Dural Puncture Headache: A Randomized Double-blind Trial
Author Notes
  • From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (F.M.P., N.H., P.T., M.J.J.); Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa (C.A.W.); Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois (R.J.M.).
  • Submitted for publication September 5, 2019. Accepted for publication January 22 2020.
    Submitted for publication September 5, 2019. Accepted for publication January 22 2020.×
  • Correspondence: Address correspondence to Dr. Peralta: Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, 251 E. Huron Street, Feinberg 5-704, Chicago, Illinois 60611. feyce.peralta@northwestern.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Central and Peripheral Nervous Systems / Pain Medicine / Pharmacology / Opioid
Perioperative Medicine   |   February 2020
Prophylactic Intrathecal Morphine and Prevention of Post–Dural Puncture Headache: A Randomized Double-blind Trial
Anesthesiology Newly Published on February 25, 2020. doi:https://doi.org/10.1097/ALN.0000000000003206
Anesthesiology Newly Published on February 25, 2020. doi:https://doi.org/10.1097/ALN.0000000000003206
Abstract

Background: Prophylactic epidural morphine administration after unintentional dural puncture with a large-bore needle has been shown to decrease the incidence of post–dural puncture headache. The authors hypothesized that prophylactic administration of intrathecal morphine would decrease the incidence of post–dural puncture headache and/or need for epidural blood patch after unintentional dural puncture.

Methods: Parturients with an intrathecal catheter in situ after unintentional dural puncture with a 17-g Tuohy needle during intended epidural catheter placement for labor analgesia were enrolled in this randomized, double-blind trial. After delivery, subjects were randomized to receive intrathecal morphine 150 µg or normal saline. The primary outcome was the incidence of post–dural puncture headache. Secondary outcomes included onset, duration, and severity of post–dural puncture headache, the presence of cranial nerve symptoms and the type of treatment the patient received.

Results: Sixty-one women were included in the study. The incidence of post–dural puncture headache was 21 of 27 (78%) in the intrathecal morphine group and 27 of 34 (79%) in the intrathecal saline group (difference, −1%; 95% CI, −25% to 24%). There were no differences between groups in the onset, duration, or severity of headache, or presence of cranial nerve symptoms. Epidural blood patch was administered to 10 of 27 (37%) of subjects in the intrathecal morphine and 11 of 21 (52%) of the intrathecal saline group (difference 15%; 95% CI, −18% to 48%).

Conclusions: The present findings suggest that a single prophylactic intrathecal morphine dose of 150 µg administered shortly after delivery does not decrease the incidence or severity of post–dural puncture headache after unintentional dural puncture. This study does not support the clinical usefulness of prophylactic intrathecal morphine after an unintentional dural puncture.

Editor’s Perspective:

What We Already Know about This Topic:

  • Epidural morphine has been suggested to be effective for preventing post–dural puncture headache, but the effects of intrathecal morphine in reducing the incidence of this complication is unknown

What This Article Tells Us That Is New:

  • In a single-center, randomized, double-blind study, there was no evidence that intrathecal morphine prevented post–dural puncture headache