Decreased Neuraxial Morphine After Cesarean Delivery

NCT ID: NCT04279054

Last Updated: 2025-03-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

EARLY_PHASE1

Total Enrollment

87 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-09-09

Study Completion Date

2023-07-05

Brief Summary

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The purpose of this study is to compare 50mcg to 150mcg morphine in epidural for the goal of decreasing side effects of medication with lower dose in patients who receive a QL block

Detailed Description

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Regional anesthesia has been associated with reduced opioid consumption after surgery. Cesarean delivery is one of the most commonly performed surgeries worldwide and women undergoing cesarean delivery are often young, opioid-naïve, and motivated to recover quickly in an effort to better care for their newborn. However, approximately 1 in 300 opioid naïve women become persistent prescription opioid users following cesarean delivery . Hence, it is important to optimize post-cesarean pain control while limiting exposure to opioids. Currently, standard therapy includes the use of neuraxial morphine (NM) in combination with a multi-modal regime in an effort to limit excessive opioid use after cesarean delivery. The current typical dose of NM that is given prior to cesarean delivery at the investigator's center is 150 mcg. Importantly, NM doses as low as 100 mcg have been shown to provide comparable analgesia while reducing side effects such as itching. The side-effect profile associated with NM includes up to 87% of patients experiencing pruritus and up to 70% experiencing urinary retention. Nausea and vomiting also lead to significant discomfort for a new mother trying to provide acute infant care.

Adjunctive Peripheral Nerve Blockade has recently been introduced to reduce postoperative pain and opioid use. Studies have assessed the usefulness of the transversus abdmoninis plane (TAP) block after cesarean delivery. Another ultrasound-guided injection of local anesthetic in the fascial plane (truncal block) that is available at UAB and within the standard of care for patients undergoing abdominal surgery is the quadratus lumborum (QL) block. Because of its more posterior and caudal location, it is more likely to anesthetize the nerve fibers associated with pain from cesarean delivery.

This study will compare the use of 50mcg to 150mcg morphine for the goal of decreasing side effects of medication with lower dose in all patients who receive a QL block

Conditions

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Anesthesia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Group A: 150 mcg morphine

Patients in this group will receive 150mcg of morphine in their neuraxial block

Group Type ACTIVE_COMPARATOR

Morphine Sulfate 150 mcg

Intervention Type DRUG

Use of 150mcg of morphine sulfate for neuraxial block (dosing difference)

Group B: 50 mcg morphine

Patients in this group will receive 50mcg of morphine in their neuraxial block

Group Type EXPERIMENTAL

Morphine Sulfate 50mcg

Intervention Type DRUG

Use of 50mcg of morphine sulfate for neuraxial block (dosing difference)

Interventions

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Morphine Sulfate 150 mcg

Use of 150mcg of morphine sulfate for neuraxial block (dosing difference)

Intervention Type DRUG

Morphine Sulfate 50mcg

Use of 50mcg of morphine sulfate for neuraxial block (dosing difference)

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* All women presenting for scheduled cesarean delivery who desire a QL block

Exclusion Criteria

* Women with pregnancies complicated by preeclampsia
* Women with pregnancies complicated by insulin-treated diabetes
* Women with pregnancies complicated by placental abnormalities
* Women with pregnancies complicated by a history of opioid use disorder
Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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University of Alabama at Birmingham

OTHER

Sponsor Role lead

Responsible Party

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Ayodeji Sanusi

Principal Investigator/ Assistant Professor Maternal Fetal Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ayodeji Sanusi, MD

Role: PRINCIPAL_INVESTIGATOR

University of Alabama at Birmingham

Locations

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UAB Women and Infants Center

Birmingham, Alabama, United States

Site Status

Countries

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United States

References

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Reference Type BACKGROUND
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Bateman BT, Franklin JM, Bykov K, Avorn J, Shrank WH, Brennan TA, Landon JE, Rathmell JP, Huybrechts KF, Fischer MA, Choudhry NK. Persistent opioid use following cesarean delivery: patterns and predictors among opioid-naive women. Am J Obstet Gynecol. 2016 Sep;215(3):353.e1-353.e18. doi: 10.1016/j.ajog.2016.03.016. Epub 2016 Mar 17.

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Girgin NK, Gurbet A, Turker G, Aksu H, Gulhan N. Intrathecal morphine in anesthesia for cesarean delivery: dose-response relationship for combinations of low-dose intrathecal morphine and spinal bupivacaine. J Clin Anesth. 2008 May;20(3):180-5. doi: 10.1016/j.jclinane.2007.07.010.

Reference Type BACKGROUND
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McMorrow RC, Ni Mhuircheartaigh RJ, Ahmed KA, Aslani A, Ng SC, Conrick-Martin I, Dowling JJ, Gaffney A, Loughrey JP, McCaul CL. Comparison of transversus abdominis plane block vs spinal morphine for pain relief after Caesarean section. Br J Anaesth. 2011 May;106(5):706-12. doi: 10.1093/bja/aer061.

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Reference Type BACKGROUND
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Ng SC, Habib AS, Sodha S, Carvalho B, Sultan P. High-dose versus low-dose local anaesthetic for transversus abdominis plane block post-Caesarean delivery analgesia: a meta-analysis. Br J Anaesth. 2018 Feb;120(2):252-263. doi: 10.1016/j.bja.2017.11.084. Epub 2017 Dec 5.

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Reference Type BACKGROUND
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Committee Opinion No. 666: Optimizing Postpartum Care. Obstet Gynecol. 2016 Jun;127(6):e187-e192. doi: 10.1097/AOG.0000000000001487.

Reference Type BACKGROUND
PMID: 27214194 (View on PubMed)

Abdallah FW, Laffey JG, Halpern SH, Brull R. Duration of analgesic effectiveness after the posterior and lateral transversus abdominis plane block techniques for transverse lower abdominal incisions: a meta-analysis. Br J Anaesth. 2013 Nov;111(5):721-35. doi: 10.1093/bja/aet214. Epub 2013 Jun 27.

Reference Type BACKGROUND
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Blanco R, Ansari T, Riad W, Shetty N. Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Postoperative Pain After Cesarean Delivery: A Randomized Controlled Trial. Reg Anesth Pain Med. 2016 Nov/Dec;41(6):757-762. doi: 10.1097/AAP.0000000000000495.

Reference Type BACKGROUND
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Hirabayashi M, Doi K, Imamachi N, Kishimoto T, Saito Y. Prophylactic Pentazocine Reduces the Incidence of Pruritus After Cesarean Delivery Under Spinal Anesthesia With Opioids: A Prospective Randomized Clinical Trial. Anesth Analg. 2017 Jun;124(6):1930-1934. doi: 10.1213/ANE.0000000000002060.

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Aly M, Ibrahim A, Farrag W, Abdelsalam K, Mohamed H, Tawfik A. Pruritus after intrathecal morphine for cesarean delivery: incidence, severity and its relation to serum serotonin level. Int J Obstet Anesth. 2018 Aug;35:52-56. doi: 10.1016/j.ijoa.2018.02.004. Epub 2018 Feb 16.

Reference Type BACKGROUND
PMID: 29544720 (View on PubMed)

Other Identifiers

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UL1TR003096

Identifier Type: NIH

Identifier Source: secondary_id

View Link

IRB00000196

Identifier Type: -

Identifier Source: org_study_id

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