• D Niv, I Wolman, T Yashar, G Varrassi, V Rudick, and E Geller.
• Pain Control Unit, Ichilov Hospital, Tel Aviv, Israel.
• Clin J Pain. 1994 Dec 1;10(4):319-23.

Objective/DesignA randomized double-blind controlled study was conducted on two groups of 45 parturients to evaluate the importance of the timing of epidural morphine administration for the relief of postepisiotomy pain. Both groups had preemptive analgesia by continuous lumbar epidural bupivacaine blockade. Upon completion of the episiotomy repair and before the onset of pain, the patients received epidural injections of 3 ml saline with or without 2 mg morphine in groups A and B respectively. When pain appeared, group A patients received an epidural injection of 3 ml saline while group B patients received 2 mg morphine in 3 ml saline. Postepisiotomy pain level was evaluated by a visual analogue scale.ResultsThe incidence of pain in group B women following epidural morphine administration was 68.6%. This was significantly higher than that of group A at 15.6% (p < 0.01). Furthermore, group B showed that the rate of effective pain relief after 2 mg epidural morphine significantly decreases as the level of pain intensity rises (p < 0.01).ConclusionEpidural morphine for postepisiotomy pain is much more effective if administered before the onset of pain.

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