An audit of single dose epidural diamorphine during elective caesarean section at a district general hospital

Mothers receiving combined spinal-epidural (CSE) anaesthesia for elective caesarean section (n = 188) were audited. A single dose of epidural diamorphine (2-3 mg) was given during surgery. Unless contraindicated, diclofenac 100 mg was given per rectum at the end of surgery. Postoperative analgesia was provided as oral Co-dydramol and diclofenac. All mothers were premedicated with ranitidine 150 mg and metoclopramide 10 mg orally. Observations were recorded for 24 h postoperatively. Pain, nausea, sedation and itching were assessed on a scale of 0 (nil), 1 (mild), 2 (moderate) or 3 (severe). All mothers were reviewed during the second postoperative day. Epidural supplements during surgery and administration of naloxone, systemic opiates and anti-emetics after surgery were recorded. Postoperative analgesia was prolonged and excellent. Over 92% of pain scores were mild or less. Two mothers complained of severe pain, which was resolved with oral Co-dydramol. Postoperative morphine was not used. Itching was common but not troublesome; mild (54%), moderate (16%), severe (3%); 7% of mothers received naloxone. Nausea was uncommon: mild (19%), moderate (10%), severe (2%); 16% of mothers received anti-emetics. Itching was less than previous reports with subarachnoid diamorphine. Single dose epidural diamorphine can be used during elective caesarean section rendering systemic opiates unnecessary.