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Randomized Controlled Trial Clinical Trial
Is the clinical efficacy of epidural diamorphine concentration-dependent when used as analgesia for labour?
- G A McLeod, B Munishankar, and M O Columb.
- Department of Anaesthetics, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. g.a.mcleod@dundee.ac.uk
- Br J Anaesth. 2005 Feb 1;94(2):229-33.
BackgroundThe physicochemical properties of diamorphine (3,6-diacetylmorphine) enhance its bioavailability compared with more lipid-soluble opioids when administered into the epidural space. However, the influence of concentration, volume or mass on the clinical efficacy of diamorphine is not known.MethodIn this double-blind, randomized, prospective study, 62 women in active labour and ResultsThere was no significant difference in EC50 for diamorphine between the groups: the difference was 15.0 microg ml(-1) (95% CI -40.3 to 10.3). The EC50 for group A was 237.5 microg ml(-1) (95% CI 221.2 to 253.8) and the EC50 for group B was 252.5 microg ml(-1) (95% CI 232.2 to 272.8). The EC50 ratio was 0.95 (95% CI 0.87 to 1.06). The groups exhibited parallelism (P=0.98). The overall EC50 for all data was 244.2 microg ml(-1) (95% CI 230.8 to 257.2).ConclusionWe conclude that diamorphine provides analgesia in labour by a concentration-dependent effect.
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