Intrathecal opioids and respiratory depression: Is it myth in obstetrics?
The addition of opioids to bupivacaine for spinal anesthesia has been shown to improve quality of anesthesia by the action of fentanyl, and extend postoperative analgesia by the effect of morphine. Side effects, particularly respiratory depression, have prevented their widespread use. Studies are not consistent regarding the incidence of respiratory depression due to the variety of definitions of this complication and the doses of opioids used. Low dose regimens currently used do not produce further respiratory depression than parenteral opioids. The high levels of progesterone, a potent respiratory stimulant, makes safe the use of neuroaxial opioids in scenarios such as obstetrical anesthesia or analgesia, hence their use should not be overlooked.
2. Dahl JB, Jeppesen IS, Jorgensen H, Wetterslev J, Moiniche S. Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal anesthesia: a qualitative and quantitative systematic review of randomized controlled trials. Anesthesiology. 1999;91:1919-27. Epub 1999/12/22.
3. Bardsley PA. Chronic respiratory failure in COPD: is there a place for a respiratory stimulant? Thorax. 1993;48:781-4. Epub 1993/08/01.
4. Pena F, Garcia O. Breathing generation and potential pharmacotherapeutic approaches to central respiratory disorders. CurrMed Chem. 2006;13:2681-93. Epub 2006/10/05.
5. Smyth A, Riley M. Chronic respiratory failure: an unusual cause and treatment. Thorax. 2002;57:835-6. Epub 2002/08/30.
6. Sultan P, Gutierrez MC, Carvalho B. Neuraxial morphine and respiratory depression: finding the right balance. Drugs. 2011;71:1807-19. Epub 2011/09/29.
7. Bujedo BM. Spinal opioid bioavailability in postoperative pain. Pain Pract. 2014;14:350-64. Epub 2013/07/10.
8. Elkus R, Popovich J Jr. Respiratory physiology in pregnancy. Clin Chest Med. 1992;13:555-65. Epub 1992/12/11.
9. Hendrick V, Altshuler LL, Suri R. Hormonal changes in the postpartum and implications for postpartum depression. Psychosomatics. 1998;39:93-101. Epub 1998/05/19.
10. Saaresranta T, Polo O. Long-term progestin therapy for female chronic respiratory insufficiency? Respir Med. 2004;98:194-5. Epub 2004/02/20.
11. Horlocker TT, Burton AW, Connis RT, Hughes SC, Nickinovich DG, Palmer CM, et al. Practice guidelines for the prevention, detection, and management of respiratory depression associated with neuraxial opioid administration. Anesthesiology. 2009;110: 218-30. Epub 2009/02/06.
12. Dalchow S, Lubeigt O, Peters G, Harvey A, Duggan T, Binning A. Transcutaneous carbon dioxide levels and oxygen saturation following caesarean section performed under spinal anaesthesia with intrathecal opioids. Int J Obstet Anest. 2013;22:217-22. Epub 2013/05/28.
13. Meylan N, Elia N, Lysakowski C, Tramer MR. Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery: meta-analysis of randomized trials. Br J Anaest. 2009;102:156-67. Epub 2009/01/20.
14. Popping DM, Elia N, Marret E, Wenk M, Tramer MR. Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: a meta-analysis of randomized trials. Pain. 2012;153:784-93. Epub 2012/01/11.
15. Gehling M, Tryba M. Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: a meta-analysis. Anaesthesia. 2009;64:643-51. Epub 2009/05/23.
16. Shapiro A, Zohar E, Zaslansky R, Hoppenstein D, Shabat S, Fredman B. The frequency and timing of respiratory depression in 1524 postoperative patients treated with systemic or neuraxial morphine. J Clin Anest. 2005;17:537-42. Epub 2005/11/22.
17. Carvalho B. Respiratory depression after neuraxial opioids in the obstetric setting. Anest Analg. 2008;107:956-61. Epub 2008/08/21.
18. DANE. Nacimientos por tipo de parto año 2012; 2012. Available from: http://www.dane.gov.co/danewebV09/index.php?option=comcontent&view=article&id=1806&Itemid=119.
19. Duarte G, Navarro R, Eslava J. Inequity in healthcare-The outlook for obstetric analgesia. Rev Colomb Anestesiol. 2013;41:215-7, http://dx.doi.org/10.1016Zj.rcae.2013.01.003.
20. Caldwell LE, Rosen MA, Shnider SM. Subarachnoid morphine and fentanyl for labor analgesia. Efficacy and adverse effects. Reg Anest. 1994;19:2-8. Epub 1994/01/01.
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