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Respiratory depression after administration of single-dose neuraxial morphine for post-cesarean delivery analgesia: a retrospective cohort study

Published:August 24, 2022DOI:https://doi.org/10.1016/j.ijoa.2022.103592

      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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