Analgesia for Labour and Delivery Using Incremental Diamorphine and Bupivacaine via a 32–gauge Intrathecal Catheter

Abstract

Twenty mothers who had requested regional analgesia during labour had a 32-gauge catheter inserted into the lumbar subarachnoid space. The mean time to place the catheters was 116 s (range 55-270 s) and there were no technical difficulties. Incremental diamorphine was given, up to a maximum initial dose of 0.5 mg. Analgesia was excellent in 11 mothers, good in seven and unsatisfactory in two. The duration of initial analgesia from diamorphine was 101 min (range 30-170 min). Eight mothers were able to move about during the first stage, with effective analgesia. Side effects were common: 15 mothers had pruritus, 15 had nausea or vomiting, and eight had mild sedation. No mother had a ventilatory frequency of less than 12 b.p.m. in the 12 h after the last dose of intrathecal diamorphine. Intrathecal 0.5% bupivacaine was given to 16 mothers in the first stage because the analgesia after a top-up with diamorphine became insufficient later in the labour. Fifteen mothers were pain free after bupivacaine; there was one failure. The initial effective dose of bupivacaine was between 0.25 ml and 2 ml. The maximum height of the block after bupivacaine was T9, and there was no hypotension. Nine mothers were given hyperbaric 0.5% bupivacaine 1-2 ml during the second stage; all were pain free for the procedure. The maximum force needed to withdraw the catheters was 700 g; and all catheters were removed intact. There were no post-spinal headaches.

Intrathecal diamorphine for analgesia after Caesarean sectionA dose finding study and assessment of side‐effects

“…There was no evidence of neonatal depression in the present study and similar findings have been reported previously using intrathecal diamorphine [19, 20]. This is probably due to the fact that relatively smaller doses of the drug are given by the intrathecal route compared with systemic routes of administration, thereby reducing the dose available for transfer to the fetus.…”

“…Although occasional cases have been reported, respiratory depression following intrathecal diamorphine in nonobstetric cases appears to be rare even with higher doses [3, 4, 17, 18]. This appears to be true in obstetrics also [19, 20] and was confirmed in the present study. S p O 2 values below 95% were frequently observed in all groups following surgery in the present study although the differences between the groups were not significant.…”

“…The present study showed a dose‐related increase in both the incidence and the severity of this symptom. Previous studies have also shown high incidences of pruritus following intrathecal diamorphine in parturients [2, 19]. Bromage has suggested that the parturient may be particularly susceptible to such side‐effects of intrathecal opioids [26].…”

Sectio caesarea in Katheter-Spinalanästhesie bei einer kardiopulmonalen Hochrisikopatientin

“…Das "Titrieren" der Höhe des Anästhesieniveaus mit geringen Einzeldosen des Lokalanästhetikums ermöglicht die weitgehende Vermeidung hypotensiver Zustände: Mehrere Autoren betonen das völlige Fehlen dieser Komplikation bei Anwendung der CSA in der Geburtshilfe in größeren Kollektiven [13,16,19]. Die exzellente kardiovaskuläre Stabilität bei Anwendung der CSA wurde erst kürzlich erneut demonstriert [12].…”

“…Diese werden im Zusammenhang mit der CSA extrem selten berichtet, in Veröffentlichungen über die Anwendung der Methode in der Geburtshilfe ist diese Komplikation bisher nicht aufgetreten -strengste Beachtung der Hygiene vorausgesetzt [16].…”