Caesarean Delivery: A Narrative Review on the Choice of Neuraxially Administered Opioid and Its Implications for the Multimodal Peripartum Pain Concept
Nowadays, obstetrical anesthesia-related mortality is a very rare complication in industrialized countries. The recommended choice of intrathecal opioid for spinal anesthesia in the context of a multimodal peripartum pain management concept is discussed in this narrative review. Nowadays, there is a...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-02-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/60/3/358 |
| _version_ | 1797240136281358336 |
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| author | Mark Ulrich Gerbershagen Hanaa Baagil |
| author_facet | Mark Ulrich Gerbershagen Hanaa Baagil |
| author_sort | Mark Ulrich Gerbershagen |
| collection | DOAJ |
| description | Nowadays, obstetrical anesthesia-related mortality is a very rare complication in industrialized countries. The recommended choice of intrathecal opioid for spinal anesthesia in the context of a multimodal peripartum pain management concept is discussed in this narrative review. Nowadays, there is a consensus that a perioperative multimodal pain concept should be used for caesarean delivery. This pain concept should include neuraxial opioids for spinal anesthesia, acetaminophen, NSAIDs, intravenous dexamethasone, and postoperative local or regional anesthetic procedures. Long-acting lipophobic opioids (diamorphine and morphine) have a significant analgesic advantage over short-acting lipophilic opioids (sufentanil and fentanyl). The risk of clinically relevant respiratory depression after neuraxial long-acting opioids is nowadays considered negligible, even if the data situation is weak in this regard. The question remains as to whether a pain concept that is ideally adapted to a neuraxial short-acting opioid shows benefit to a pain concept that is optimally adapted to neuraxial morphine. If long-acting opioids are used, the timing of each additional component of the multimodal analgesia strategy could ideally be adjusted to this longer duration of action. |
| first_indexed | 2024-04-24T18:02:38Z |
| format | Article |
| id | doaj.art-7300f8cbf38e49d18d75ec28ceb45002 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-04-24T18:02:38Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-7300f8cbf38e49d18d75ec28ceb450022024-03-27T13:53:23ZengMDPI AGMedicina1010-660X1648-91442024-02-0160335810.3390/medicina60030358Caesarean Delivery: A Narrative Review on the Choice of Neuraxially Administered Opioid and Its Implications for the Multimodal Peripartum Pain ConceptMark Ulrich Gerbershagen0Hanaa Baagil1Department of Anaesthesiology, Teaching Hospital of the University Cologne, Hospital Cologne Holweide, University of Witten-Herdecke, Neufelder Str. 32, 51067 Cologne, GermanyDepartment of Anaesthesiology, Teaching Hospital of the University Cologne, Hospital Cologne Holweide, University of Witten-Herdecke, Neufelder Str. 32, 51067 Cologne, GermanyNowadays, obstetrical anesthesia-related mortality is a very rare complication in industrialized countries. The recommended choice of intrathecal opioid for spinal anesthesia in the context of a multimodal peripartum pain management concept is discussed in this narrative review. Nowadays, there is a consensus that a perioperative multimodal pain concept should be used for caesarean delivery. This pain concept should include neuraxial opioids for spinal anesthesia, acetaminophen, NSAIDs, intravenous dexamethasone, and postoperative local or regional anesthetic procedures. Long-acting lipophobic opioids (diamorphine and morphine) have a significant analgesic advantage over short-acting lipophilic opioids (sufentanil and fentanyl). The risk of clinically relevant respiratory depression after neuraxial long-acting opioids is nowadays considered negligible, even if the data situation is weak in this regard. The question remains as to whether a pain concept that is ideally adapted to a neuraxial short-acting opioid shows benefit to a pain concept that is optimally adapted to neuraxial morphine. If long-acting opioids are used, the timing of each additional component of the multimodal analgesia strategy could ideally be adjusted to this longer duration of action.https://www.mdpi.com/1648-9144/60/3/358caesarean deliveryintrathecal opioidneuraxial opioidpain managementmultimodal pain managementperipartum |
| spellingShingle | Mark Ulrich Gerbershagen Hanaa Baagil Caesarean Delivery: A Narrative Review on the Choice of Neuraxially Administered Opioid and Its Implications for the Multimodal Peripartum Pain Concept Medicina caesarean delivery intrathecal opioid neuraxial opioid pain management multimodal pain management peripartum |
| title | Caesarean Delivery: A Narrative Review on the Choice of Neuraxially Administered Opioid and Its Implications for the Multimodal Peripartum Pain Concept |
| title_full | Caesarean Delivery: A Narrative Review on the Choice of Neuraxially Administered Opioid and Its Implications for the Multimodal Peripartum Pain Concept |
| title_fullStr | Caesarean Delivery: A Narrative Review on the Choice of Neuraxially Administered Opioid and Its Implications for the Multimodal Peripartum Pain Concept |
| title_full_unstemmed | Caesarean Delivery: A Narrative Review on the Choice of Neuraxially Administered Opioid and Its Implications for the Multimodal Peripartum Pain Concept |
| title_short | Caesarean Delivery: A Narrative Review on the Choice of Neuraxially Administered Opioid and Its Implications for the Multimodal Peripartum Pain Concept |
| title_sort | caesarean delivery a narrative review on the choice of neuraxially administered opioid and its implications for the multimodal peripartum pain concept |
| topic | caesarean delivery intrathecal opioid neuraxial opioid pain management multimodal pain management peripartum |
| url | https://www.mdpi.com/1648-9144/60/3/358 |
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