Abstract
Epidural opioid analgesia is commonly employed as a therapeutic modality in the management of pain during labor. The general perception among health-care providers is that administered drugs remain in the maternal epidural space and do not compromise the respiratory status of newborns. We describe the clinical course of two newborns who developed respiratory depression following epidural fentanyl analgesia requiring administration of naloxone. The article further reviews the maternal–fetal–placental pharmacokinetics of epidural fentanyl and the possible mechanisms for the causation of neonatal respiratory depression.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Carrie LE, O'Sullivan GM, Seegobin R . Epidural fentanyl in labour. Anaesthesia 1981;36:965–969.
Noble DW, Morrison LM, Brockway MS, McClure JH . Adrenaline, fentanyl or adrenaline and fentanyl as adjuncts to bupivacaine for extradural anaesthesia in elective caesarean section. Br J Anaesth 1991;66:645–650.
Porter J, Bonello E, Reynolds F . Effect of epidural fentanyl on neonatal respiration. Anesthesiology 1998;89:79–85.
Desprats R, Dumas JC, Giroux M, Campistron G, Faure F, Teixeira MG, Grandjean H, Houin G, Pontonnier G . Maternal and umbilical cord concentrations of fentanyl after epidural analgesia for cesarean section. Eur J Obstet Gynecol Reprod Biol 1991;42:89–94.
Fernando R, Bonello E, Gill P, Urquhart J, Reynolds F, Morgan B . Neonatal welfare and placental transfer of fentanyl and bupivacaine during ambulatory combined spinal epidural analgesia for labour. Anaesthesia 1997;52:517–524.
Cartwright P, Prys-Roberts C, Gill K, Dye A, Stafford M, Gray A . Ventilatory depression related to plasma fentanyl concentrations during and after anesthesia in humans. Anesth Analg 1983;62:966–974.
Hertzka RE, Gauntlett IS, Fisher DM, Spellman MJ . Fentanyl-induced ventilatory depression: effects of age. Anesthesiology 1989;70:213–218.
Koehntop DE, Rodman JH, Brundage DM, Hegland MG, Buckley JJ . Pharmacokinetics of fentanyl in neonates. Anesth Analg 1986;65:227–232.
McClain DA, Hug CC Jr . Intravenous fentanyl kinetics. Clin Pharmacol Ther 1980;28:106–114.
Mather LE . Clinical pharmacokinetics of fentanyl and its newer derivatives. Clin Pharmacokinet 1983;8:422–446.
Katz R, Kelly HW . Pharmacokinetics of continuous infusions of fentanyl in critically ill children. Crit Care Med 1993;21:995–1000.
Becker LD, Paulson BA, Miller RD, Severinghaus JW, Eger EI II . Biphasic respiratory depression after fentanyldroperidol or fentanyl alone used to supplement nitrous oxide anesthesia. Anesthesiology 1976;44:291–296.
Vettermann J, Thomas H, Lischke V, Asskali F . Repeated addition of fentanyl to bupivacaine peridural analgesia in labor. Clinical action and fentanyl plasma level. Anaesthesist 1996;45:428–436.
Lieberman E, Lang J, Richardson DK, Frigoletto FD, Heffner LJ, Cohen A . Intrapartum maternal fever and neonatal outcome. Pediatrics 2000;105:8–13.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kumar, M., Paes, B. Epidural Opioid Analgesia and Neonatal Respiratory Depression. J Perinatol 23, 425–427 (2003). https://doi.org/10.1038/sj.jp.7210905
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.jp.7210905
