The Use of Combined Spinal-Epidural Analgesia Utilizing Intrathecal Morphine for Labor Pain in a Community Hospital

Alexander G Shilkrut Elena V Kuklina

doi:10.4172/2155-6148.1000356

Abstract

Purpose: To assess the incidence of adverse outcomes in pre-selected laboring patients who received low dose intrathecal morphine as part of the regional technique for labor analgesia. Methods: Retrospective observational study of 205 laboring patients who delivered at a large community hospital between January 2007 and December 2010. All patients received Duramorph, 250 μg, and fentanyl, 25 μg intrathecally. The primary adverse outcome was delayed maternal respiratory depression. Secondary adverse outcomes included high pain scores, low Apgar scores, and postpartum hemorrhage. Results: No cases of respiratory depression requiring naloxone administration were reported during the study. No infants had Apgar scores 4. Conclusion: This study demonstrates that regional analgesia utilizing low doses of intrathecal morphine and fentanyl in selected laboring patients is safe and effective.

Highlights

In the US, 50-60% of eligible pregnant women receive regional analgesia as a part of labor pain management [1]
The purpose of this study was to evaluate the incidence of respiratory depression, high pain scores, low Apgar scores, and postpartum hemorrhage with the use of low-dose intrathecal morphine as part of planned combined spinal-epidural analgesia in laboring patients
There were no cases of respiratory depression resulting in bradypnea, oxygen saturation (SpO2) 4 at any point after the neuraxial anesthesia was administered (Table 2)

Summary

Introduction

In the US, 50-60% of eligible pregnant women receive regional (neuraxial) analgesia as a part of labor pain management [1]. Combined Spinal-Epidural (CSE) analgesia is a well-established modality of pain control. It includes a single injection of local anesthetic and/or opiate into the cerebrospinal fluid (spinal analgesia, SA) in addition to insertion of an epidural catheter (epidural analgesia, EA). CSE shows a faster onset of pain relief and provides more reliable analgesia with fewer operative vaginal births and less urinary retention than low-dose or traditional EA alone [2]. The optimal drug combinations and dosages for CSE are not established. Fentanyl is a well-accepted analgesic for use in SA, it has short-lasting effects

Objectives

Methods

Results

Conclusion