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Epidural and intrathecal opiates in obstetrics
International Journal of Clinical Pharmacology, Therapy, and Toxicology
|June 1, 1984
Summary
Epidural and intrathecal opiates offer limited pain relief in obstetrics due to unpredictable responses and short durations. Side effects like delayed respiratory depression restrict their routine use in labor and delivery.
Area of Science:
- Anesthesiology
- Obstetrics
- Pharmacology
Background:
- Epidural and intrathecal opiates are used for pain management in obstetrics.
- Their primary site of action is spinal cord opiate receptors, but systemic effects are possible.
Purpose of the Study:
- To review the efficacy and limitations of epidural and intrathecal opiates in obstetric pain management.
- To explore reasons for unpredictable responses and side effects in pregnant patients.
Main Methods:
- Review of existing literature on epidural and intrathecal opiate use in obstetrics.
- Analysis of pharmacological action and anatomical considerations.
Main Results:
- Responses to epidural opiates in term pregnancy are unpredictable and short-acting.
- Reasons include increased epidural venous flow, deeper visceral pain fibers, and bypassed opiate receptors.
- Intrathecal opiates provide analgesia but have unacceptable side effects.
- Epidural opiates are effective post-cesarean but carry a risk of delayed respiratory depression.
Conclusions:
- Epidural and intrathecal opiates have a limited role in routine obstetric practice.
- Unpredictable efficacy and significant side effects necessitate caution.