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Epidural and intrathecal opioid administration - An OAA approved survey of current practice in the UK
Abstract Number: 42
Abstract Type: Original Research
Introduction: The choice of neuraxial opioid used during caesarean section remains controversial1,2, however it has been shown that their use leads to reduced intraoperative discomfort.3
Methods: After OAA approval (Survey number 100) an email questionnaire was sent to 218 lead obstetric anaesthetists in September 2010. Questions were posed on intrathecal and epidural opioid usage and use of oral and intramuscular opioid usage post neuraxial opioid usage.
Results: Of the 218 invited participants 169 responded (77.5%) with 6 responses rejected. The standard intrathecal opioid used for caesarean section is shown in table 1.
Epidural opioids in labour were used in all departments. Low dose mix was used with 2mcg/ml Fentanyl in 98.1% of cases, with 2 respondents using 4mcg/ml and 1 using 1mcg/ml. Other respondents used alfentanil 0.0015% with bupivacaine 0.1% or using diamorphine 2.5mg in 10mls normal saline. At caesarean section, elective and emergency, 95.0% of respondents used either diamorphine (dose range 1mg-5mg mean dose 2.93mg) or fentanyl, (dose range 40-100mcg mean dose used 85.3mcg) the remaining using morphine.
Following neuraxial opioids oral or intramuscular opioids were used by 136 (82.9%) responders, with 8.8% of these having limitations on the usage of opioids. The commonest route of administration was oral (70%), with the most commonly administered drug being oramorph or codeine.
Discussion: There is differing clinical practice in neuraxial opioid usage at caesarean section, with the dose used being the most variable. Also following neuraxial opioid usage there is wide variations in practice of administering further opioids, however most departments do give opioids with no limitation on timing if the patient is in pain.
1. Wrench IJ, Sanghera S, Pinder A, et al. Dose response to intrathecal diamorphine for elective caesarean section and compliance with a national audit standard. Int J Obstet Anaesth 2007;16:17-21
2. Paech MJ, Pavy TJG, Orlikowski CEP, et al. Post operative intraspinal opioid analgesia after caesarean section; a randomised comparison of subarachnoid morphine and epidural pethedine. Int J Obstet Anaesth. 2009;9:238-245
3. Cowan CM, Kendall JB, Barclay PM, et al. Comparison of intrathecal fentanyl and diamorphine in addition to bupivacaine for caesarean section under spinal anaesthesia. Br J Anaesth 2002;89(3):452-8