[The use of opioids by the regional route in obstetrics]

Epidural and spinal administration of opioids in obstetrics can be used during labour and for cesarean section. Although these routes of administration are of limited use when opiates are employed as sole agents, the association with local anesthetics may improve the characteristics of analgesia. The administration of a local anesthetic-opiate mixture allows a reduction of the total amount of local anesthetics, thus reducing the incidence of maternal hypotension and the percentage of instrumental extraction. In the particular setting of cesarean section, opioids could shorten the onset and improve the quality of the duration of analgesia. Opioids may also be used for postoperative analgesia after cesarean section. Since they could be responsible for an opioid-related respiratory depression in the mother and the neonate, a strict supervision is absolutely necessary following this particular mode of administration of opiates. If human and technical means of supervision failed to bring into operation, it would be better not to use opioids by the spinal route in such a context.