Epidural opioids in UK obstetric anaesthetic practice

Abstract

Units using epidural opioids 62 units used epidural opioids for caesarean sections and 40 units also used them during labour. 20000 women per year at these units had caesarean sections using epidural anaesthesia and 2 500 women per year had been given epidural opioids during labour. Diamorphine and fentanyl were the commonest drugs used (77% of units). Other drugs used included morphine, alfentanil, phenoperidine, pethidine, methadone and buprenorphine. Twelve per cent of units gave more than one dose down the epidural catheter. Postnatal care took place on the general ward after up to 1 h in recovery in 52% of units. Only 6 units had a High Dependency Unit where patients were nursed for between 12 and 24 h. Respiratory rate was the commonest form of postnatal monitoring. Nine units used pulse oximeters and 9 units used no extra monitoring. Six units had written protocols. An estimated 100 000 women will have had epidural opioids in these units. There were only 4 reports of respiratory depression: one patient had a respiratory rate of 1 I; one had a respiratory rate of less than 10; one other patient was given 50 mg diamorphine in error and had to be ventilated and a fourth one had respiratory depression after having a chlormethiazole infusion in addition to epidural morphine.