The Effect of Neuraxial Morphine (Duramorph) on Pain Control
The Effect of Neuraxial Morphine (Duramorph) on Pain Control
With the rise of the opioid epidemic, it is important for physicians to be more mindful of
 the amount of narcotic prescriptions that are being written every day. In the early
 postpartum period, pain and fatigue are the most common problems reported by women. Untreated
 pain has negative consequences on the amount of opioid narcotics used, postpartum depression,
 and the potential development of persistent chronic pain. While pain can interfere with a
 woman's ability to adequately take care of her newborn, narcotic abuse can lead to excessive
 maternal drowsiness and increased infant mortality in the new breastfeeding mother. The most
 common sources of pain after a vaginal delivery include breast engorgement, uterine
 contractions and perineal lacerations. Perineal lacerations are immediate postpartum
 complications of the vaginal birth process, defined as injury that involves the
 bulbocavernosum muscle complex (second degree), and may involve the anal sphincter complex
 (third degree) or the anal epithelium (fourth degree). Prevention of chronic and severe
 postpartum pain, especially after a cesarean delivery has been extensively studied, however,
 much paucity in research exists for the management of postpartum pain from perineal tears.
 Compared to patients with first degree tears or intact perineum, women with severe perineal
 lacerations (second degree or greater) have increased analgesic requirement up to the fifth
 postpartum day. . Epidural morphine has been accepted by anesthesiologists as treatment for
 acute pain. In obstetrics, 2-3 mg of epidural morphine was found to be sufficient to provide
 post-episiotomy analgesia. Neuraxial morphine has been used for analgesic management after a
 cesarean section, especially to reduce the amount of oral pain medications used in the first
 24 hours, but limited data exists on the use of neuraxial morphine after a severe perineal
 laceration repair in the setting of a vaginal delivery. Niv et al (1994) studied the effect
 of epidural morphine and monitored its timing of administration in post-epiostomy pain onset.
 They noted that if epidural morphine is administered before the onset of pain in an
 episiotomy repair it is much more effective than if given after the onset. This study hopes
 to take the prior 1994 study a step further and incorporates it's data to investigate whether
 neuraxial morphine given after a severe perineal laceration repair mitigates postpartum pain.
Inclusion Criteria:

 -  Patients with a second degree, third degree, or fourth degree perineal tear identified
 in the immediate postpartum period.

 -  Pregnant patients who received neuraxial anesthesia during their labor course

 -  Women >18 yo

 Exclusion Criteria:

 -  Unwillingness to participate in the study

 -  Allergy to morphine

 -  Women with history of polysubstance abuse/narcotic abuse

 -  Women <18 yo