Spinal Opioid Dosages for Labor and Delivery.

    

    Opioids may be given intrathecally as a single injection or intermittently via an epidural or intrathecal catheter. High doses may be associated with a high risk of side eff ects, most importantly respiratory depression. For that reason combinations of local anesthetics and opioids are most commonly used. 

    Pure opioid techniques are most useful for high-risk patients who may not tolerate the functional sympathectomy associated with spinal or epidural anesthesia. This group includes patients with hypovolemia or significant cardiovascular disease such as moderate to severe aortic stenosis, tetralogy of Fallot, Eisenmenger’s syndrome, or pulmonary hypertension.

Disadvantages include: less complete analgesia, lack of perineal relaxation, and side effects such as pruritus, nausea, vomiting, sedation, and respiratory depression. Side effects may be ameliorated with low doses of naloxone (0.1–0.2 mg/h intravenously).

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