{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T02:49:55Z","timestamp":1788922195032,"version":"build-2803163510"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Perioper Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>To compare the analgesic and side effect profiles of three intrathecal morphine doses as part of an enhanced recovery protocol in obstetric patients undergoing caesarean section.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A prospective cohort study including ASA 2 females, over 18\u00a0years old having repeat elective caesarean sections. Primary outcomes include total oral morphine equivalents (mg) at 24 and 48\u00a0h, proportion of opioid free patients (24 and 48\u00a0h), and frequency of ITM-related side-effects. Secondary outcome measures include duration of analgesia, pain scores at 24\u00a0h, FAS at 24\u00a0h and length of stay.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Five hundred seventy-four patients were divided into 150\u00a0mcg (190 patients), 125\u00a0mcg (191 patients) and 100\u00a0mcg (193 patients) intrathecal morphine groups. Effective analgesia was provided by all doses of ITM with a dose-dependent increase in side-effects. The median opioid consumption at 24\u00a0h was 10\u00a0mg in the 150\u00a0mcg group and 20\u00a0mg in the 125\u00a0mcg and 100\u00a0mcg groups. At 48\u00a0h, the median opioid consumption was 30\u00a0mg in the 150\u00a0mcg group and 45\u00a0mg in the 125\u00a0mcg and 100\u00a0mcg groups. The proportion of opioid-free patients at 24 and 48\u00a0h decreased with decreasing dose of ITM; 41% in 150\u00a0mcg group, 31% in the 125\u00a0mcg group and 28% in the 100\u00a0mcg group at 24\u00a0h. At 48\u00a0h, this reduces to 24% in the 150\u00a0mcg group, 15% (37.5% reduction in the 125\u00a0mcg group, and 13% (45.8% reduction) in the 100\u00a0mcg group. This designates analgesic inferiority of both 125\u00a0mcg and 100\u00a0mcg ITM doses compared to 150\u00a0mcg dosing. There was no significant difference between 125 and 100\u00a0mcg dosing. The duration of analgesia was greater in 150\u00a0mcg dosing (median duration 21\u00a0h) compared to 125\u00a0mcg (13\u00a0h) and 100\u00a0mcg (12\u00a0h) groups. No significant difference in pain scores was noted between doses. FAS scores demonstrated a trend towards functional limitation in 125\u00a0mcg and 100\u00a0mcg dosing compared to 150\u00a0mcg. There was no difference between the 125\u00a0mcg and 100\u00a0mcg groups. Increased pruritus was seen in the 150\u00a0mcg and 125\u00a0mcg groups (41%) compared to the 100\u00a0mcg group (32%). Increased nausea and vomiting was seen in the 150\u00a0mcg (49%) and 125\u00a0mcg (42%) groups compared to the 100\u00a0mcg group (24%). No difference in LOS was noted between doses (median difference 1.1\u00a0h).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>All doses of ITM provide effective analgesia with 100\u00a0mcg dosing providing the best trade-off between analgesic efficacy and side effect profile.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s13741-025-00555-3","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T14:57:18Z","timestamp":1760453838000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Enhanced recovery after caesarean section: an intrathecal morphine dosing study"],"prefix":"10.1186","volume":"14","author":[{"given":"Rian","family":"Crandon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Storr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Parker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramil","family":"Nair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Pietrobuono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Hughes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"issue":"5","key":"555_CR1","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1007\/s40264-015-0386-5","volume":"39","author":"S Armstrong","year":"2016","unstructured":"Armstrong S, Fernando R. 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