Society for Obstetric Anesthesia and Perinatology Consensus Statement: Monitoring Recommendations for Prevention and Detection of Respiratory Depression Associated With Administration of Neuraxial Morphine for Cesarean Delivery Analgesia

• Published in: Anesthesia and analgesia Vol. 129; no. 2; pp. 458 - 474
• Main Authors: Bauchat, Jeanette R, Weiniger, Carolyn F, Sultan, Pervez, Habib, Ashraf S, Ando, Kazuo, Kowalczyk, John J, Kato, Rie, George, Ronald B, Palmer, Craig M, Carvalho, Brendan
• Format: Journal Article
• Language: English
• Published: United States International Anesthesia Research Society 01.08.2019
• Subjects: Analgesia, Obstetrical - adverse effects; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Cesarean Section - adverse effects; Consensus; Drug Administration Schedule; Female; Humans; Lung - drug effects; Lung - physiopathology; Morphine - administration & dosage; Morphine - adverse effects; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Pregnancy; Respiration - drug effects; Respiratory Insufficiency - chemically induced; Respiratory Insufficiency - diagnosis; Respiratory Insufficiency - physiopathology; Respiratory Insufficiency - prevention & control; Risk Assessment; Risk Factors; Treatment Outcome
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/ANE.0000000000004195

The majority of women undergoing cesarean delivery in the United States receive neuraxial morphine, the most effective form of postoperative analgesia for this surgery. Current American Society of Anesthesiologists (ASA) and American Society of Regional Anesthesia and Pain Medicine (ASRA) recommend respiratory monitoring standards following neuraxial morphine administration in the general surgical population that may be too frequent and intensive when applied to the healthy obstetric population receiving a single dose of neuraxial morphine at the time of surgery. There is limited evidence to support or guide the optimal modality, frequency, and duration of respiratory monitoring in the postoperative cesarean delivery patient receiving a single dose of neuraxial morphine. Consistent with the mission of the Society for Obstetric Anesthesia and Perinatology (SOAP) to improve outcomes in pregnancy for women and neonates, the purpose of this consensus statement is to encourage the use of this highly effective analgesic technique while promoting safe practice and patient-centered care. The document aims to reduce unnecessary interruptions from respiratory monitoring in healthy mothers while focusing vigilance on monitoring in those women at highest risk for respiratory depression following neuraxial morphine administration. This consensus statement promotes the use of low-dose neuraxial morphine and multimodal analgesia after cesarean delivery, gives perspective on the safety of this analgesic technique in healthy women, and promotes patient risk stratification and perioperative risk assessment to determine and adjust the intensity, frequency, and duration of respiratory monitoring.