What would be the best way to do c-section?
Spinal is better than general—-no risk of aspiration .
But what is the best way for post op pain. Literature says —-intrathecal morphine. But it works only 12 hours (reliably), maybe up to 24 hours(not in real life). What about 2nd day and 3rd day? Patient stays in the hospital for 3 days post c-section.
Little story–I was doing spinal with bupivacaine and 0,2mg intrathecal morphine,(and it was much better than PCA pump) and following patient for next day, woman said : “Why 2nd day is much worse than 1st day?”
“WHY SECOND DAY IS WORSE THAN FIRST DAY ?”
I started thinking —this does not make sense , 2nd day should be easier……uh? Whats the difference between 1st and second day? Intrathecal Morphine. So we need to repeat it. How? We need to leave epidural catheter for 2nd and 3rd day and give 2mg of Morphine every 12 Hours. (you can look up in Chestnut ”Obstetric anesthesia”—its a regular practice in Yale)
and i started doing it. Its the best
Epidural Morphine 2mg q 12 h(or Dilaudid 0,5 mg q 12h) —-no pain, you can not get high on it. Nothing compares to it for pain relief.
Who else does it? Pain management for untreatable pancreatic cancer —they put intrathecal morphine pump—-no sedation , no pain. Its a standard of care for years in that field.
Look at video of our patient in “Cases :after c-section”