The incidence of herpes simplex virus labialis after cesarean delivery

Epidural and subarachnoid opioids have been associated with the development of oral herpes simplex lesions. Because of this risk, some anesthesiologists avoid neuraxial morphine in parturients with a history of herpes simplex virus labialis. When we began using neuraxial opioids for analgesia after cesarean delivery, we did not see any increased incidence of facial lesions. To confirm this impression, we studied 357 consecutive parturients presenting for elective or emergent cesarean delivery between 1 December 1989 and 27 June 1990. The women received spinal, epidural, or general anesthesia. Two hundred and one women received either spinal or epidural morphine, the remaining 156 parturients received only systemic opioids for postoperative analgesia. An investigator saw each patient daily until discharge. Only 11 patients (3%) developed oral lesions while hospitalized. None of these women had severe lesions. Neuraxial morphine did not increase the risk of labial lesions significantly (3.5% vs. 2.6%). Despite published data to the contrary, we found no correlation between neuraxial morphine and the risk of facial herpes virus lesions in women after cesarean delivery. We offer patients the option of neuraxial morphine for analgesia after cesarean delivery despite any history of oral herpes lesions.