Chapter 14 - Epidural and intrathecal opiates and outcome

Summary

Neuraxial opioids are an essential component of the pharmacologic options available for use in present-day obstetrical anesthesia practice. By producing an analgesic action in the absence of associated motor block or reduction in sympathetic tone, neuraxial opiates are an ideal component of the list of analgesic medications available for use by the obstetrical anesthesiologist. Morphine is a hydrophilic opioid, among the first to be used for postsurgical analgesia when administered by epidural or intrathecal route. The lipid solubility of hydromorphone is between that of lipid soluble fentanyl and hydrophilic morphine. Fentanyl is a highly lipid soluble opioid with a resulting rapid onset and short duration of action. The beneficial effects of neuraxial opioid administration are associated with potential complications or side effects, both in the mother and in the fetus. Hydrophilic drugs are primarily used as part of a multimodal analgesia plan for postoperative pain management following cesarean section.