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Patient-controlled analgesia (PCA) using fentanyl in a parturient with a platelet function abnormality
S J Kleiman1, S Wiesel, M J Tessler
1Department of Anaesthesia, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Summary
For laboring patients with bleeding disorders, intravenous fentanyl patient-controlled analgesia (PCA) offers effective pain relief when epidurals are contraindicated. This method provided safe analgesia for both mother and neonate in this case study.
Area of Science:
- Obstetrics and Gynecology
- Anesthesiology
- Pharmacology
Background:
- Platelet dysfunction in laboring patients contraindicates standard epidural analgesia.
- Alternative pain management strategies are crucial for safe labor and delivery.
Observation:
- A term parturient with documented platelet dysfunction required labor induction.
- Lumbar epidural analgesia (LEA) was contraindicated due to bleeding risk.
Findings:
- Intravenous (IV) fentanyl patient-controlled analgesia (PCA) was successfully implemented for labor pain.
- The patient received 400 mcg fentanyl over 3.5 hours with no adverse maternal or neonatal effects.
Implications:
- IV fentanyl PCA is a viable alternative analgesia for laboring patients with contraindications to LEA.
- Continuous monitoring is essential for maternal and neonatal safety when using this technique.