Non-invasive hemodynamic changes of intrathecal fentanyl, morphine and epIdural bupivacaine for pain relief in labor

J. Van Hook, C. Jayasinghe, V. Blass, E. Uçkan, Gary Hankins, G. Anderson

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To examine the non-invasive central hemodynamic effects of combined spinal epidural anesthesia (CSE) for intrapartum pain relief. STUDY DESIGN: Nine term laboring subjects were entered into this prospec live IRB approved study following informed consent. Alter standardized intravenous hydration, each participant initially received intrathecal (IT) fentanyl and morphine. Epidnral catheters were placed and upon patient request for pain relief they received continuous epidural anesthesia with bupivacaine and fentanyl. Hemodynamic measurements of cardiac output (CO), stroke volume (SV) and total peripheral resistance (TPR) were obtained using non-iuvasive Doppler technique (UltraCom, Lawrence Medical Systems, Redmond, Washington) at four stages during the study, baseline, after IT opioids, before epidural dosing and after steady state epidural blockade. Maternal and fetal outcome parameters were obtained during labor and following delivery. RESULTS: Statistically significant hemodynamic findings were noted in the mean arterial pressures (MAP ±SD) of the following groups: baseline (79.9 ± 6.7), after IT opioids (72.5 ±6.5), before epidural (67.7 ±7.4) and post epidural (70.6 ±6.1) (see graph). No significant differences in demographic characteristics were noted. All infants had normal fetal heart rate tracings and had uncomplicated deliveries. No significant differences were noted in maternal HR, CO or TPR. CONCLUSION: Our results indicate when using CSE in uncomplicated laboring patients with normal fetoplacental function, maternal hemodynamics are not appreciably altered. The limited changes in MAP did not appear to be clinically significant following IT opioids or epidural bupivacaiiie. The combination of IT opoids and epidural bupivicaine appears hemodynamically benign in normal healthy pregnant patienis.

Original languageEnglish (US)
JournalActa Diabetologica Latina
Volume176
Issue number1 PART II
StatePublished - 1997

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Bupivacaine
Fentanyl
Morphine
Epidural Anesthesia
Hemodynamics
Opioid Analgesics
Pain
Spinal Anesthesia
Mothers
Cardiac Output
Vascular Resistance
Spectinomycin
Fetal Heart Rate
Research Ethics Committees
Informed Consent
Stroke Volume
Arterial Pressure
Catheters
Demography

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Van Hook, J., Jayasinghe, C., Blass, V., Uçkan, E., Hankins, G., & Anderson, G. (1997). Non-invasive hemodynamic changes of intrathecal fentanyl, morphine and epIdural bupivacaine for pain relief in labor. Acta Diabetologica Latina, 176(1 PART II).

Non-invasive hemodynamic changes of intrathecal fentanyl, morphine and epIdural bupivacaine for pain relief in labor. / Van Hook, J.; Jayasinghe, C.; Blass, V.; Uçkan, E.; Hankins, Gary; Anderson, G.

In: Acta Diabetologica Latina, Vol. 176, No. 1 PART II, 1997.

Research output: Contribution to journalArticle

Van Hook, J, Jayasinghe, C, Blass, V, Uçkan, E, Hankins, G & Anderson, G 1997, 'Non-invasive hemodynamic changes of intrathecal fentanyl, morphine and epIdural bupivacaine for pain relief in labor', Acta Diabetologica Latina, vol. 176, no. 1 PART II.
Van Hook, J. ; Jayasinghe, C. ; Blass, V. ; Uçkan, E. ; Hankins, Gary ; Anderson, G. / Non-invasive hemodynamic changes of intrathecal fentanyl, morphine and epIdural bupivacaine for pain relief in labor. In: Acta Diabetologica Latina. 1997 ; Vol. 176, No. 1 PART II.
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AU - Hankins, Gary

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AB - OBJECTIVE: To examine the non-invasive central hemodynamic effects of combined spinal epidural anesthesia (CSE) for intrapartum pain relief. STUDY DESIGN: Nine term laboring subjects were entered into this prospec live IRB approved study following informed consent. Alter standardized intravenous hydration, each participant initially received intrathecal (IT) fentanyl and morphine. Epidnral catheters were placed and upon patient request for pain relief they received continuous epidural anesthesia with bupivacaine and fentanyl. Hemodynamic measurements of cardiac output (CO), stroke volume (SV) and total peripheral resistance (TPR) were obtained using non-iuvasive Doppler technique (UltraCom, Lawrence Medical Systems, Redmond, Washington) at four stages during the study, baseline, after IT opioids, before epidural dosing and after steady state epidural blockade. Maternal and fetal outcome parameters were obtained during labor and following delivery. RESULTS: Statistically significant hemodynamic findings were noted in the mean arterial pressures (MAP ±SD) of the following groups: baseline (79.9 ± 6.7), after IT opioids (72.5 ±6.5), before epidural (67.7 ±7.4) and post epidural (70.6 ±6.1) (see graph). No significant differences in demographic characteristics were noted. All infants had normal fetal heart rate tracings and had uncomplicated deliveries. No significant differences were noted in maternal HR, CO or TPR. CONCLUSION: Our results indicate when using CSE in uncomplicated laboring patients with normal fetoplacental function, maternal hemodynamics are not appreciably altered. The limited changes in MAP did not appear to be clinically significant following IT opioids or epidural bupivacaiiie. The combination of IT opoids and epidural bupivicaine appears hemodynamically benign in normal healthy pregnant patienis.

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