Morphine versus Fentanyl Used Spinally for Post Cesarean Section Analgesia: A Randomized Clinical Trial

Background: Finding appropriate analgesic for cesarean section with maximum pain relief and minimal untoward effects is very important to aid mother's recovery. So, this study was carried out to compare morphine and fentanyl given spinally in patients undergoing cesarean section. Methods: Hundred and twenty one patients (aged 18-43 years) undergoing either elective or emergency lower-segment cesarean section were enrolled in this randomised, unmasked, parallel-group controlled trial, at Al Helal Al Emirati Hospital, Rafah, Gaza Strip, occupied Palestinian territory. Using manual-blocks formation based on the rolling of a die, women were randomly assigned into two groups. Morphine group (n=59) received 0.2mg preservative-free morphine combined with 2ml of 0.5% hyperbaric bupivacaine while Fentanyl Group (n=62) received 20μg fentanyl combined with 2ml of 0.5% hyperbaric bupivacaine for spinal anesthesia. Visual analogue scales (VAS; range 0–10, 0=no pain and 10=pain as bad as it could be) were used to record the pain 1 h after the after the end of surgical procedure and then at 6 h, 12 h, 18h and 24 h. Time from induction of spinal anesthesia to the first demand of other analgesia and the total amounts and types of analgesics used in 24 hours, were recorded (primary outcomes). The secondary outcomes were nausea and vomiting scores (NVS 0–3; 0=no nausea or vomiting and 3=severe, unresponsive to antiemetic drugs), sedation scores (SS 0–3; 0=patient awake and 3=severe sedation, patient difficult to rouse, unrousable) and pruritis scores {PS 0-2; 0= no pruritis, 2= severe pruritis (treatment required).