ABSTRACT
BACKGROUND AND OBJECTIVES: Although dizziness and drowsiness may be produced with either intravenous or epidural fentanyl, their occurrence after an intravenous injection is more rapid and relatively more pronounced. The purpose of this study was to determine whether or not the difference between routes of administration would be a reliable method of detecting an accidental intravascular injection. METHODS: In part 1, using a double-blinded protocol, we prospectively assessed in laboring women the incidence of dizziness, drowsiness, or both associated with intravenous fentanyl (100 micrograms). In random order, subjects received two peripheral intravenous injections: 2 ml of fentanyl and 2 ml of saline, separated by a 3-minute observation period. RESULTS: In group 1 (18/18) and group 2 (22/22), all subjects reported a response to intravenous fentanyl within the one-minute assessment. In part 2, we evaluated in laboring patients the frequency of dizziness, drowsiness, or both to epidural fentanyl (100 micrograms). The study design was identical to part 1; however, the subjects received 2 ml of fentanyl and 2 ml of saline via a functional epidural catheter. In group 3 (1/18) and group 4 (1/22), one subject reported a response to epidural fentanyl within the 3-minute observation period. CONCLUSIONS: Overall, the responses to intravenous fentanyl (40/40) occurred in a remarkably more consistent fashion when compared to epidural fentanyl (2/40). Thus, the results suggest that in laboring patients, intravenous fentanyl produces predictable and easily detectable changes that may be useful in identifying an epidural catheter unintentionally placed intravascularly.
Subject(s)
Anesthesia, Epidural/methods , Anesthesia, Obstetrical/methods , Fentanyl/administration & dosage , Analgesia, Epidural/methods , Analgesia, Obstetrical/methods , Bupivacaine/administration & dosage , Double-Blind Method , False Positive Reactions , Female , Fentanyl/adverse effects , Humans , Injections, Epidural , Injections, Intravenous , Pregnancy , Prospective StudiesABSTRACT
Charts from 2929 consecutive parturients were reviewed. Twenty-four had platelet counts less than 100,000/microL in the peripartum period. Seventeen of the 24 had predisposing causes for thrombocytopenia, including preeclampsia (nine), immune thrombocytopenia purpura (two), infection (three), placenta accreta (one), abruption (one), and excessive surgical bleeding (one). Seven had asymptomatic thrombocytopenia of unknown origin. Fourteen of the 24 thrombocytopenic patients received regional anesthesia, and none had permanent sequelae. Based upon this retrospective review, peripartal thrombocytopenia (15,000-99,000/microL) did not increase the risk of neurologic complications after a regional anesthetic. There have been no reports in the literature of spinal or epidural hematomas in parturients after regional anesthesia, except for one patient with a spinal ependymoma.
