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Electronic Letters to:

Clinical Investigation:
A. Vasudevan, C. E. Snowman, S. Sundar, T. W. Sarge, and P. E. Hess
Intrathecal morphine reduces breakthrough pain during labour epidural analgesia
Br. J. Anaesth. 2007; 0: ael346v1-5 [Abstract] [Full text] [PDF]
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Electronic letters published:

[Read E-letter] Intrathecal morphine for labour epidural analgesia
J.A. Khan, M. Rafi   (16 February 2007)
[Read E-letter] headache after inta-thecal opioids for labour analgesia
J Robert Sneyd   (26 January 2007)

Intrathecal morphine for labour epidural analgesia 16 February 2007
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J.A. Khan
Russells Hall Hospital, Dudley DY1 2HQ, UK,
M. Rafi

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Re: Intrathecal morphine for labour epidural analgesia

We read with interest the study by A. Vasudevan and colleagues and also appreciate the use of intrathecal Morphine as an adjunct for breakthrough pain during labour. The authors did mention the severe nausea and pruritus, but the incidence of actual vomiting in the patients was not clear. Also there is no comment on the number of patients having a Caesarean section or instrumental delivery, or APGAR scores of the newborns, having recieved intrathecal morphine with the ones who had not recieved it. These data are required to make an informed decision.

Conflict of Interest:

None declared
headache after inta-thecal opioids for labour analgesia 26 January 2007
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J Robert Sneyd,
Professor of Anaesthesia
Peninsula Medical School, Plymouth, UK

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Re: headache after inta-thecal opioids for labour analgesia

I read with interest the description of morphine as an adjunct to labour epidural analgesia.The reported side effects included nausea, pruritis and sedation but there was no mention of headache. Our own experience of using intrathecal diamorphine (heroin) was of immediate and effective analgesia with a high incidence of headache (6/13 patients). [1] We found that diamorphine (heroin) alone provided effective analgesia for 8/13 patients which is consistent with this report that morphine reduces break through pain. Given that we used a 26 g needle whereas Vasudevan et al used a 24 g needle, the lack of headaches seems surprising. Was there any inquiry about headache or were these not recorded?

[1]. Sneyd JR, Meyer-Witting M. Intrathecal diamorphine (heroin) for obstetric analgesia. Int J Obstet Anesth 1992;1:153-5

Conflict of Interest:

None declared