Placental Passage and Uterine Effects of Fentanyl

Craft, John B.; Coaldrake, Lee A.; Bolan, Jean C.; Mondino, M.; Mazel, Paul; Gilman, Robin; Shokes, Leslie; Woolf, W. A.

doi:10.1213/00000539-198310000-00007

Cited by 55 publications

(8 citation statements)

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“…It has no adverse effects on uterine tone or blood flow. 19 When given by hourly iv injections of 50-100 pg for labour analgesia there was no increase in the incidence of respiratory depression or low APGAR scores. Furthermore, neonatal neurological and adaptive capacities at 2 and 24 hr after delivery were normal.…”

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confidence: 89%

Intravenous fentanyl PCA during labour

et al. 1997

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To evaluate the usefulness of intravenous patient-controlled analgesia (PCA) fentanyl for labour analgesia, its effectiveness for maternal pain and safety for the fetus and newbom.Methods: Twenty primigravidas were randomised to receive intravenous PCA fentanyl or epidural analgesia for labour pain. Maternal pain, heart rate and arterial oxyhaemoglobin saturation (Sp02) were monitored. Fetal and neonatal monitoring induded cardiotocogram (CTG), APG/~ neurological scoring and static-charge-sensitive bed (SCSB) recording for 12 hr postnatally with ECG and SpOr Fentanyt concentrations and pH of umbilical artery and vein were analysed. l~sull~: Ini~ally, epidural analgesia was more effective (P = 0.0 I), and three patients in the fentanyl group were given epidural due to unsatisfactory pain relief. Overall satisfaction for analgesia did not differ between the groups. Maternal side-effects were more frequent in the fentanyl group (dizziness and tiredness most often, P = 0.0001 ). Severe sideeffects were not reported. In CTG there were no differences between groups. All the newboms were healthy, APGAR and pH were normal. Naloxone was not used. Neurological scoring was similar in both groups. In 12 hr monitoring heart rate, breathing frequency and movement time were similar in both groups, but SpO~ was lower in the fentanyt group (P < 0.00 I). Umbilical cord fentanyt concentrations were low or beyond the detection limit. Cx)nd~ion: Intravenous fentanyl can be used for labour analgesia with the doses reported here as an altemative to epidural analgesia. However, the fetus and neonate must be appropriately monitored. Naloxone and oxygen should be available if neonatal distress occurs.Obj~cis : ~aluer rimportance de I'analg&ie intraveineuse auto-contr61& (PCA) au fentanyl en analg~sie obst~tri-cale en tenant compte de son efl~cacitE et de la s&uritE foeto-matemelle. M~J~xlm : Vingt primipares ont Et6 assign&s al6atoirernent ~ recevoir soit du fentanyl intraveineux en PCA soit une analgEsie Epidurale dans le but de soulager la douleur de I'accouchement. La douleur maternelle, la fr~luence cardiaque et la saturation art&ielle (SpO2) ont EtE not&~s. Le monitorage foetal et n~natal inclualt la cardiotocographie (CTG), le score d'APGAFL r~valuation neurologique et I'enregistrement au lit sensible ~ la statique (SCSB) pendant 12 h apr~s la nalssance avec I'I~CG ET la SpO 2. La concentration de fentanyt et le pH de rart&e et de la veine ombilicales Kent mesur~s, ]L~ultats : Initialement, I'analg~sie Epidurale s'est av&& plus ef~ce (P = 0,0 I) et trois pa~entes clu groupe fentanyl ont dO accepter une analg&ie Epidurale ~ cause du manque de soulagement. La satisfaction globale en rapport avec t'analg~'ie n'a pas diffEr~ entre les groupes. Des effets maternels secondaires sans gravit~ sont survenus plus souvent dans le groupe fentanyt (surtout des &ourdissements et de la fatigue, P = 0,0001). Le CTG n'a pas r~vEIE de differences intergroupes. Tousles enfants sont n8 en 10on ~at avec des scores d'APGAR et des pH normaux. On n'a pas ...

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confidence: 89%

Intravenous fentanyl PCA during labour

et al. 1997

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“…Fentanyl has no active metabolites to cause respiratory depression in the neonate. 24,25 The published reports of PCA fentanyl for labour analgesia have used bolus doses varying from 20 to 60 µg, with and without continuous infusion, higher doses being associated with maternal respiratory depression. With our study population, the choice of narcotic was not limited by consideration of fetal effects.…”

Section: Discussionmentioning

confidence: 99%

Patient-controlled analgesia with fentanyl provides effective analgesia for second trimester labour: a randomized controlled study

Castro

Tharmaratnam

Brockhurst

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To examine dose and lockout intervals for effective fentanyl patient-controlled analgesia (PCA) in second trimester genetic termination of pregnancy, and compare three different fentanyl PCA regimes with morphine PCA. M Me et th ho od ds s: :In a double-blind randomized study, 60 ASA physical status I-II patients received one of three fentanyl PCAs or morphine PCA. Labour was induced with prostaglandins and PCA use continued until delivery. Within two hours following delivery, four visual analogue scales (VAS) were administered measuring anticipated pain, pain relief in labour and delivery, and overall satisfaction. The drug delivery/demand ratio for two hours preceding delivery was obtained from the PCA pump. The outcome variables were analyzed using the Chi square test and analysis of variance as appropriate.R Re es su ul lt ts s: : The delivery/demand ratio was 0.71 ± 0.27 (mean ± standard deviation) for morphine; 0.67 ± 0.21 for fentanyl 50 µg, lockout six-minute; 0.63 ± 0.21 for fentanyl 25 µg, lockout threeminute; and 0.81 ± 0.17 for fentanyl 50 µg, lockout three-minute groups. We found no significant differences among the four groups with respect to using delivery/demand ratio as a measure of pain relief. Morphine had the highest rate of side effects compared to fentanyl. There was strong evidence of differences among groups with regard to patient satisfaction and expected pain, and moderate evidence of differences in the delivery and labour pain scores.C Co on nc cl lu us si io on n: : This study found PCA fentanyl 50 µg with a lockout period of six minutes provided satisfactory analgesia for second trimester labour. Objectif : Déterminer la dose et les périodes réfractaires d'une analgésie auto-contrôlée (AAC) efficace utilisée en cas d'interruption de grossesse génétique, et comparer trois régimes d'AAC avec fentanyl à la morphine en AAC. Méthode : Pendant l'étude randomisée et à double insu, 60 patientes d'état physique ASA I-II ont reçu l'un des trois régimes de fentanyl en AAC ou de la morphine en AAC. Le travail a été induit avec des prostaglandines et l'AAC continue a été utilisée jusqu'à l'accouchement. Pendant les deux premières heures après l'accouchement, la douleur attendue, le soulagement de la douleur du travail et de l'accouchement et la satisfaction générale ont été évalués grâce à quatre échelles visuelles analogiques (EVA). Pendant les deux heures précé-

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“…In pregnant ewes, it has no effect on uterine blood flow. 38 Intrathecal opioids, especially meperidine, which has a local anesthetic-like effect, but also sufentanil, because of pain relief and possibly sympathetic blockade, can lower maternal blood pressure and thus potentially reduce uterine blood flow.…”

Section: Opioidsmentioning

confidence: 99%