Epidural Opioid Analgesia and Neonatal Respiratory Depression

Abstract

, FRCP(C), FRCP(I) MDEpidural 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.

The Role of Fentanyl in Cancer-Related Pain

“…Withdrawal symptoms (e.g., irritability, hyperreflexia, hyperactivity, tremors, diaphoresis, tachypnea) and respiratory depression have been observed in neonates whose mothers were receiving fentanyl during pregnancy or labor (epidural route). 41 There are insufficient data to establish safety during breastfeeding; thus, caution is advised.…”

Behavioral effects of perinatal opioid exposure

“…Despite this fact, later consequences of opioid use during labor were present. Babies delivered after their mothers received N300 μg fentanyl during the last 4 h of labor may be at greater risk of respiratory depression (Kumar and Paes, 2003). Moreover, infants whose mothers received 80 μg sufentanil show mild neurobehavioral depression (Capogna et al, 1989).…”

An account of significant events influencing Australian breastfeeding practice over the last 40 years

“…15,30 Kumar (2003), identified newborn respiratory depression following maternal epidural analgesia combined with opioids and concluded that these neonates were more prone to respiratory sequelae in-utero and after birth. 31,32 The same author reported that epidural opioids diffused freely from the epidural space into the maternal blood, crossed the placental barrier and impacted on the fetal and newborn immature central nervous system (CNS), resulting in slightly higher opioid concentrations deposited in fetal peripheral tissue. 31 Increasing incidence of birth trauma Birth trauma experienced by the mother or the baby significantly influences the first and early breastfeeds.…”

“…31,32 The same author reported that epidural opioids diffused freely from the epidural space into the maternal blood, crossed the placental barrier and impacted on the fetal and newborn immature central nervous system (CNS), resulting in slightly higher opioid concentrations deposited in fetal peripheral tissue. 31 Increasing incidence of birth trauma Birth trauma experienced by the mother or the baby significantly influences the first and early breastfeeds. Birth trauma is defined as a physical or psychological event involving ''actual or threatened serious injury or death to the mother or her baby'' during the maternity phase.…”