Reactions 923 - 12 Oct 2002

SFentanyl/bupivacaine

Respiratory arrest following intrathecaladministration during labour: case report

A 26-year-old woman, who was 39 weeks pregnant,experienced respiratory arrest following the intrathecaladministration of fentanyl and bupivacaine for pain reliefduring labour.

The woman had initially received epidural analgesiaconsisting of a bolus dose of 10ml bupivacaine 0.125% withfentanyl 50µg, followed by a continuous infusion ofbupivacaine 0.1% with fentanyl 2 µg/ml at 10 ml/hour via acatheter inserted at the L3–4 vertebral interspace. Over thefollowing 2 hours she received 2 10 ml rescue bolus doses ofbupivacaine (total dose 45mg) and fentanyl (total 100µg)without relief of labour pain. The catheter was removed andshe subsequently received an intrathecal injection of fentanyl10µg with bupivacaine 2.5mg at the L2–3 interspace.Approximately 4 minutes later, she became increasinglysomnolent, lost consciousness and stopped breathing. Her BPdecreased to 75/40mm Hg, her oxygen saturationprogressively decreased to 85%, and the fetal heart ratedecreased from 140 to 60 beats/min.

The woman was intubated and ventilated, and her oxygensaturation returned to 100% within 2–3 minutes; her BPincreased to 104/60mm Hg and the fetal heart rate returned tobaseline. Spontaneous respiration returned within 5–6minutes and, 4 minutes later, she regained consciousness. Sherequired no further treatment and was extubatedapproximately 30 minutes after respiratory arrest. For the restof her labour, she received epidural analgesia with bupivacaine0.1% and fentanyl 2 µg/ml at the rate of 10 ml/hour. Due to alack of progression, her infant was delivered by Caesareansection 3 hours after the induction of epidural analgesia.

Author comment: ‘The time of onset of respiratory arrest . . .is consistent with a reaction to intrathecal fentanyladministration. Extensive cephalad spread of fentanyl mighthave been facilitated by the volume of the epidural rescueboluses of bupivacaine with fentanyl.’Kuczkowski KM. Respiratory arrest in a parturient following intrathecaladministration of fentanyl and bupivacaine as part of a combined spinal-epiduralanalgesia for labour. Anaesthesia 57: 939-940, Sep 2002 - USA 800909760

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Reactions 12 Oct 2002 No. 9230114-9954/10/0923-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved