Monitoring, prevention and treatment of side effects of long-acting neuraxial opioids for post-cesarean analgesia

• Published in: International journal of obstetric anesthesia 2019-08, Vol.39, p.117-128
• Main Authors: Yurashevich, M., Habib, A.S.
• Format: Article
• Language: English
• Subjects: Analgesics, Opioid - adverse effects; Cesarean; Cesarean Section; Female; Humans; Hypothermia; Hypothermia - chemically induced; Morphine - administration & dosage; Naloxone - therapeutic use; Nausea; Opioids, neuraxial; Pain, Postoperative - drug therapy; Postoperative Nausea and Vomiting - drug therapy; Pregnancy; Pruritus; Pruritus - chemically induced; Pruritus - prevention & control; Respiratory depression; Respiratory Insufficiency - chemically induced; Serotonin Antagonists - therapeutic use; Vomiting
• ISSN: 0959-289X; 1532-3374
• DOI: 10.1016/j.ijoa.2019.03.010

•Neuraxial morphine is the “gold standard” for post cesarean delivery analgesia.•The most serious complication is respiratory depression, but is very rare.•Pruritus, nausea and vomiting are the most common side effects.•Intrathecal morphine can contribute to hypothermia, but the mechanism is not clear. Long-acting neuraxial opioids such as morphine and diamorphine, administered via spinal or epidural routes, are staple components of a multimodal approach to postoperative analgesia following cesarean delivery. The widespread use of neuraxial opioids is due largely to their significant analgesic efficacy and favorable safety profile. The most common side effects of neuraxial opioids are pruritus, nausea and vomiting. These symptoms appear to be dose-related. The most serious complication of neuraxial opioids is respiratory depression, which occurs in 0–0.9% of cases. Hypothermia has also been reported in association with neuraxial morphine use at cesarean delivery. This article will review recent advances in prophylaxis, treatment and monitoring of the side effects of long-acting neuraxial opioids.