Highlights
- •Neuraxial morphine is a cornerstone of post-cesarean analgesia.
- •Significant respiratory depression after low- and high-dose morphine is rare.
- •Monitoring for respiratory depression may interfere with maternal-baby bonding.
- •Consideration of relaxation of monitoring guidelines may be warranted.
Abstract
Background
Neuraxial administration of long-acting opioid is the “gold standard” for the management
of postoperative pain following cesarean delivery. Respiratory depression, however,
remains a concerning complication.
Methods
This retrospective single-center study of 4963 patients evaluated the frequency of
respiratory depression after neuraxial morphine administration in a post-cesarean
delivery population. The spinal dose of morphine varied from 100 to 450 µg intrathecally,
and from 3 to 5 mg epidurally. The primary outcome was the initiation of a Rapid Response
Team (RRT) event for respiratory failure due to neuraxial opioid in the 24 h following
morphine administration. Secondary outcomes studied included oxygen desaturation events
(SpO2 <90%), initiation of oxygen therapy and naloxone administration.
Results
There were no respiratory RRT events within the study period (95% confidence interval
[CI] 0 to 7 per 10 000). There were no desaturation events recorded and no patients
received supplemental oxygen therapy or naloxone (95% CI 0 to 7 per 10 000).
Conclusion
Clinically significant respiratory depression is rare among patients receiving neuraxial
morphine for post-cesarean delivery analgesia.
Keywords
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Article info
Publication history
Published online: August 24, 2022
Accepted:
August 18,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
