The impact of nalmefene on side effects due to intrathecal morphine at cesarean section

J. E. Pellegrini*, S. L. Bailey, J. Graves, J. A. Paice, S. Shott, M. Faut-Callahan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Nalmefene is a long-acting opioid antagonist that provides long-term belief from side effects of intrathecal morphine sulfate. A randomized, double-blind, placebo-controlled study was conducted to determine whether prophylactic nalmefene could decrease side effects of intrathecal morphine given during cesarean section, without affecting analgesia. Sixty porturients were given 0.25 mg of intrathecal morphine, 12.5 μg of fentanyl, and 11.25 to 15 mg of bupivacaine. A dose of 0.25 μg/kg of nalmefene or placebo was given by intravenous piggyback immediately after delivery of the neonate. Nausea, vomiting, pruritis, and level of sedation were assessed for a 24-hour period using a 4-point ordinal scoring system. Pain was assessed by using a 0- to 10-point verbal analogue scale. A 5-point analgesic satisfaction survey also was completed. Subjects who received nalmefene required supplemental analgesia at a median of 6.00 hours after intrathecal morphine, compared with 14.12 hours in the placebo group (P = .037). No differences were found between the groups in the incidence of pruritis, nausea and vomiting, level of sedation, or analgesic satisfaction. We concluded that nalmefene at a dose of 0.25 μg/kg does not decrease the incidence of side effects but increases the need for supplemental analgesics.

Original languageEnglish (US)
Pages (from-to)199-205
Number of pages7
JournalJournal of the American Association of Nurse Anesthetists
Issue number3
StatePublished - Aug 11 2001


  • Cesarean section
  • Intrathecal opioids
  • Nalmefene
  • Neuraxial side effects of morphine
  • Obstetrical anesthesia

ASJC Scopus subject areas

  • Medical–Surgical
  • Advanced and Specialized Nursing
  • Anesthesiology and Pain Medicine


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