Labor Analgesia when Neuraxial Anesthesia is Relatively Contraindicated: Comparison of Patient-Controlled Fentanyl and Intermittent Nalbuphine Boluses

Nguyen T-At,Izquierdo M,Bolden N,Wang Xf,Wagner K

doi:10.16966/2470-9956.138

Abstract

Labor Analgesia when Neuraxial Anesthesia is Relatively Contraindicated: Comparison of Patient-Controlled Fentanyl and Intermittent Nalbuphine Boluses

Highlights

Neuraxial analgesia is the gold standard for providing maternal pain relief during labor [1]
While the majority of patients in the United States opt for neuraxial analgesia for labor pain relief [2], there are a number of distinct circumstances that are considered an absolute or relative contraindication to the performance of neuraxial anesthesia [3]
The primary goal of this study is to identify any increased risk for adverse events to the laboring patient or her fetus associated with the implementation of our fentanyl patient-controlled analgesia (PCA) protocol

Summary

Introduction

Neuraxial analgesia is the gold standard for providing maternal pain relief during labor [1]. We implemented a fentanyl patient-controlled analgesia (PCA) protocol at our institution in 2009 to help guide obstetricians and standardize the care for patients who were unable to receive epidural analgesia due to relative contraindications to neuraxial anesthesia. The number of patients at our institution that elect not to receive either neuraxial analgesia or IV opioid therapy for labor pain relief is almost nil. The primary goal of this study is to identify any increased risk for adverse events to the laboring patient or her fetus associated with the implementation of our fentanyl PCA protocol. The primary outcome studied was maternal/fetal adverse events associated with fentanyl PCA use during labor. The primary goal of this study is to identify any increased risk for adverse events to the mother or fetus associated with our fentanyl PCA protocol. Secondary outcomes studied included verbal pain score (VPS) during labor and incidence for adherence to the specified protocol

Objectives

Methods

Results

Conclusion