The use of combined spinal-epidural analgesia utilizing intrathecal morphine for labor pain in a community hospital

Abstract

Purpose: To assess the incidence of adverse outcomes in pre-selected laboring patients who received low dose intrathecal morphine as part of the regional technique for labor analgesia. Methods: Retrospective observational study of 205 laboring patients who delivered at a large community hospital between January 2007 and December 2010. All patients received Duramorph, 250 μg, and fentanyl, 25 μg intrathecally. The primary adverse outcome was delayed maternal respiratory depression. Secondary adverse outcomes included high pain scores, low Apgar scores, and postpartum hemorrhage. Results: No cases of respiratory depression requiring naloxone administration were reported during the study. No infants had Apgar scores <7 at five minutes for reasons related to anesthesia, 25% of patients (N=53) underwent cesarean section, and <1% of deliveries (N=2) were complicated by postpartum hemorrhage. Among all study participants, only 4% (N=9) had pain scores >4. Conclusion: This study demonstrates that regional analgesia utilizing low doses of intrathecal morphine and fentanyl in selected laboring patients is safe and effective. © 2013 Shilkrut AG, et al.