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Risk for Neuraxial Morphine-Associated Adverse Events and Neonatal Falls: A Retrospective Observational Study
Abstract Number: T1I-483
Abstract Type: Original Research
Risk estimations of clinically significant respiratory depression (CSRD) associated with neuraxial morphine are limited by lack of comparison to morphine non-exposed groups. Such comparisons are necessary to inform comprehensive approaches to preventing postpartum maternal sedation, as sedation from any cause can lead to harm. For example, postpartum neonatal falls (NF) have been reported, but NF risk associated with neuraxial morphine is unknown. We aimed to calculate the risk of CSRD associated with neuraxial morphine use. Secondarily, we assessed the risk for NF associated with neuraxial morphine.
A single-institution retrospective cohort included vaginal or cesarean deliveries from 2014-2018. CSRD was defined as rapid response activation for sedation/respiratory depression and/or naloxone to reverse suspected opioid-related sedation/respiratory depression. NF cases were identified by event reporting system (report rate ~100%) and reviewed by hand for temporal proximity to reports of maternal sleep/sedation. The primary outcome was incidence of CSRD associated with neuraxial morphine exposure. Secondary outcome was NF risk from maternal sleep/sedation associated with neuraxial morphine. Multivariable logistic regression was used; where event rates were low, proportion rate estimates with 95% confidence intervals were reported.
Of 33,419 unique encounters, 23,162 (69.3%) were vaginal and 10,257 (30.7%) cesarean. There were no cases of rapid response for sedation/respiratory depression. 1 case of postpartum naloxone for “sedation” was a cesarean under general anesthesia without neuraxial morphine. Due to low numbers, risk estimation could not be calculated. However, estimated CSRD prevalence (rate) was 0.3:10,000 (95%CI, 0.000004-0.0002). Of 14 NF cases, 9 (64.3%) were temporally related to maternal sleep/sedation, 5 (35.7%) were mechanical/car seat issues. Postpartum NF rate from maternal sleep/sedation was 1:3,717 (95%CI, 0.00014-0.00051). NF from maternal sleep/sedation was not associated with neuraxial morphine after adjusting for covariates (medications with sedative effects, body mass index, age, delivery time, delivery mode) (adjusted OR 0.50, 95%CI 0.03-8.08, P=0.63).
Postpartum CSRD and NF are rare. These events occur independent of neuraxial morphine exposure. Anesthesiologists should be concerned with preventing postpartum sedation/respiratory depression beyond mitigating risks from neuraxial morphine exposure.