Naloxone after Epidural Opiates

Epidural Opioid Analgesia and Neonatal Respiratory Depression. Kumar M, and Paes B, J Perinatol (Jul/Aug 2003) 23:425-427.

Epidural opioid analgesia is commonly employed as a therapeutic modality in the management of pain during labor. The general perception among health-care providers is that administered drugs remain in the maternal epidural space and do not compromise the respiratory status of newborns. We describe the clinical course of two newborns who developed respiratory depression following epidural fentanyl analgesia requiring administration of naloxone. The article further reviews possible mechanisms for the causation of neonatal respiratory depression.

Comment. I quote from the Discussion section of the paper: “Contrary to the widely held belief, fentanyl diffuses freely from the epidural space into the maternal blood because of its high lipid solubility… The drug is also freely transported across the placenta with a slightly higher concentration in the fetal compartment”. I guess we need to be asking what drugs the mother was given in her labor epidural. If fentanyl was included, then we should consider naloxone to reverse any neonatal respiratory depression. ABK.

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