| Intraspinal Narcotics in Obstetrics . |
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Brett B Gutsche |
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University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, U.S.A. |
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| Abstract |
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The use of intraspinal narcotics has attracted great interest, particularly in the discipline of obstetric anesthesia. As the advent of spinal and epidural local anesthetics dramatically effected the anesthetic management of labor, delivery and obstetric surgery, likewise intraspinal narcotics are emerging as safe and very effective methods of relieving post cesarean section pain, improving labor and cesarean section analgesia in combination with local anesthetics, and injected alone in the subarachnoid space for the management of labor itself.
Though intraspinal narcotic analgesia is associated with a number of specific side effects, with proper management these adverse reactions are either avoidable or can be greatly minimized. Compared to the benefits of nearly complete pain relief in the intrapartum and postpartum periods, the price paid in terms of these side effects is minimal. Few mothers, who have undergone cesarean section both with and without postpartum epidural narcotics, would give up the excellent analgesia afforded to avoid the side effects associated with their use. Excellent reviews of the development and clinical application of intraspinal narcotics have been made by Yaksh, Cousins, Elkins-Sinn and Hughes. |
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