Accidental intrathecal sufentanil overdose during combined spinal-epidural analgesia for labor

Coleman, Lewis S.; Carvalho, Brendan; Lipman, Steven; Schmiesing, Clifford A.; Riley, Edward T.

doi:10.1016/j.ijoa.2008.10.001

Cited by 9 publications

(8 citation statements)

References 29 publications

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“…Ropivacaine (1-propyl-2′, 6′-pipecoloxylidide, chemical structure) is an amino acid local anesthetic and was recently introduced for labor analgesia, since it has less cardiac toxicity and provide more differential block between sensory and motor [7, 16]. For opioids, the analgesic effect of sufentanil is 3 to 5 times more potent than fentanyl due to the strong affinity for opioid receptors [17, 18].…”

Section: Discussionmentioning

confidence: 99%

“…Besides, the overall incidence of adverse drug reactions in CSEA group was lower than CEA group, including the lower nausea and vomiting rates and pruritus rates. The reduced dose of sufentanil were responsible for this result since complications of anesthetics were dose-dependent [18, 23]. Additionally, delaying sufentanil injection may exert the maximum effect of ropivacaine, which has long analgesic duration, less adverse drug reactions and differential block between sensory and motor [24].…”

Section: Discussionmentioning

confidence: 99%

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Comparison of ropivacaine combined with sufentanil for epidural anesthesia and spinal-epidural anesthesia in labor analgesia

Wang

2020

BMC Anesthesiol

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BackgroundTo compare the application and efficacy of ropivacaine combined with sufentanil for continuous epidural anesthesia (CEA) and combined spinal-epidural anesthesia (CSEA) in labor analgesia.MethodsThree hundred sixty pregnant women requesting labor analgesia from October 2017 to August 2018 were selected retrospectively. According to the anesthetic method, subjects were divided into CSEA group and CEA group. Ropivacaine combined with sufentanil were used in all subjects. The labor time, visual analogue scale (VAS), Apgar score of newborn, adverse pregnancy outcomes and adverse drug reactions were observed.ResultsThere was no significant difference in pre-analgesia (T0) VAS scores between the two groups (P > 0.05). VAS scores of first stage of labor (T1), second stage of labor (T2) and third stage of labor (T3) in CSEA group were significantly lower than CEA group (P < 0.01). The onset time, T1 and total labor time in CSEA group were significantly shorter than CEA group (P < 0.01). There were no significant differences between T2 and T3 (P > 0.05). There were no significant differences in adverse pregnancy outcomes and Apgar scores at 1, 5 and 10 min after birth between the two groups (P > 0.05). The incidence of adverse drug outcomes in CSEA group was significantly lower than CEA group (P < 0.01). Maternal satisfaction in CSEA group was significantly higher than CEA group (P < 0.01).ConclusionConsidering ropivacaine combined with sufentanil for CSEA achieved a shorter onset time and labor period, significant analgesic effect, lower adverse drug reactions rates and higher subject satisfaction than CEA, it may be worthy of clinical promotion and application.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of ropivacaine combined with sufentanil for epidural anesthesia and spinal-epidural anesthesia in labor analgesia

Wang

2020

BMC Anesthesiol

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“…Swallowing is a complex process consisting of three stages (oral, pharyngeal, and esophageal) and employing several dozen paired muscle groups and a neural control mechanism extending from the spinal cord to the cortex. Case reports about dysphagia after intrathecal opioid administration suggest that centrally located opioid receptors are involved in swallowing . In the current study, most of the volunteers went from experiencing no difficulty to severe swallowing difficulty when receiving remifentanil, and this effect emerged immediately after the remifentanil target concentration was achieved.…”

Section: Discussionmentioning

confidence: 59%

“…In previous studies, our group found that the majority of volunteers spontaneously reported swallowing difficulties during remifentanil infusion Swallowing discomfort is a poorly recognised side effect of opioids and a contributory cause of aspiration. A PubMed search using the key phrases ‘swallowing/swallowing disorders/deglutition/deglutition disorders AND opioids/fentanyl/alfentanil/remifentanil’ resulted in one retrospective study showing dysphagia in chronic opioid users and five case reports about dysphagia after intrathecal administration of fentanyl, fentanyl and morphine, and sufentanil …”

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confidence: 99%

Effects of remifentanil on the esophagogastric junction and swallowing

Savilampi

Ahlstrand

Magnuson

et al. 2013

Acta Anaesthesiol Scand

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“…A recent report of a dramatic overdose of intrathecal opioid for labor (45 mcg sufentanil as part of a CSE) demonstrated intense pruritus as well as difficulty swallowing, but incomplete pain relief for the second stage of labor. 43…”

Section: Cse Technique Appears Cumbersome and Time Consumingmentioning

confidence: 99%

Progress in analgesia for labor: focus on neuraxial blocks

Ranasinghe

Birnbach

2009

IJWH

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Neuraxial analgesia is widely accepted as the most effective and the least depressant method of providing pain relief in labor. Over the last several decades neuraxial labor analgesia techniques and medications have progressed to the point now where they provide high quality pain relief with minimal side effects to both the mother and the fetus while maximizing the maternal autonomy possible for the parturient receiving neuraxial analgesia. The introduction of the combined spinal epidural technique for labor has allowed for the rapid onset of analgesia with minimal motor blockade, therefore allowing the comfortable parturient to ambulate. Patient-controlled epidural analgesia techniques have evolved to allow for more flexible analgesia that is tailored to the individual needs of the parturient and effective throughout the different phases of labor. Computer integrated systems have been studied to provide seamless analgesia from induction of neuraxial block to delivery. New adjuvant drugs that improve the effectiveness of neuraxial labor analgesia while decreasing the side effects that may occur due to high dose of a single drug are likely to be added to future labor analgesia practice. Bupivacaine still remains a popular choice of local anesthetic for labor analgesia. New local anesthetics with less cardiotoxicity have been introduced, but their cost effectiveness in the current labor analgesia practice has been questioned.

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Accidental intrathecal sufentanil overdose during combined spinal-epidural analgesia for labor

Cited by 9 publications

References 29 publications

Comparison of ropivacaine combined with sufentanil for epidural anesthesia and spinal-epidural anesthesia in labor analgesia

Comparison of ropivacaine combined with sufentanil for epidural anesthesia and spinal-epidural anesthesia in labor analgesia

Effects of remifentanil on the esophagogastric junction and swallowing

Progress in analgesia for labor: focus on neuraxial blocks

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