Book contents
- Frontmatter
- Contents
- Contributors
- Foreword
- Preface
- 1 Opioid Receptors: Gene Structure and Function
- 2 Endogenous Opioid Peptides and Analgesia
- 3 Supraspinal Mechanisms of Opioid Analgesia
- 4 Spinal Mechanisms of Opioid Analgesia
- 5 Peripheral Opioid Analgesia: Mechanisms and Clinical Implications
- 6 Mechanisms of Tolerance
- 7 Opioid–Nonopioid Interactions
- 8 Transplantation of Opioid-Producing Cells
- 9 Clinical Implications of Physicochemical Properties of Opioids
- 10 Clinical Pharmacology and Adverse Effects
- 11 Pre-emptive Analgesia by Opioids
- 12 Intraoperative Use of Opioids
- 13 Opioids in Acute Pain
- 14 Patient-Controlled Analgesia with Opioids
- 15 Opioids in Chronic Nonmalignant Pain
- 16 Opioids in Cancer Pain
- 17 Opioids in Visceral Pain
- 18 Opioids in Obstetrics
- Index
18 - Opioids in Obstetrics
Published online by Cambridge University Press: 06 July 2010
- Frontmatter
- Contents
- Contributors
- Foreword
- Preface
- 1 Opioid Receptors: Gene Structure and Function
- 2 Endogenous Opioid Peptides and Analgesia
- 3 Supraspinal Mechanisms of Opioid Analgesia
- 4 Spinal Mechanisms of Opioid Analgesia
- 5 Peripheral Opioid Analgesia: Mechanisms and Clinical Implications
- 6 Mechanisms of Tolerance
- 7 Opioid–Nonopioid Interactions
- 8 Transplantation of Opioid-Producing Cells
- 9 Clinical Implications of Physicochemical Properties of Opioids
- 10 Clinical Pharmacology and Adverse Effects
- 11 Pre-emptive Analgesia by Opioids
- 12 Intraoperative Use of Opioids
- 13 Opioids in Acute Pain
- 14 Patient-Controlled Analgesia with Opioids
- 15 Opioids in Chronic Nonmalignant Pain
- 16 Opioids in Cancer Pain
- 17 Opioids in Visceral Pain
- 18 Opioids in Obstetrics
- Index
Summary
Introduction
The use of pain-relieving drugs during labor is now common, but expectant mothers are still concerned about the effects of anesthetics on their unborn babies. However, mothers-to-be should be told that excessive pain or anxiety during labor may harm the fetus more than the judicious use of analgesic drugs. Psychological stress is difficult to quantify, but in the primate mother it can cause hypoxia and acidosis in the fetus, probably because of a reduction in uterine blood flow (Moore, 1993). The body reacts to stress by releasing endogenous opioids. The administration of exogenous opioids is another way to modulate the stress response. The modern use of synthetic opioid narcotics for analgesia during labor started with the use of meperidine in 1939. However, despite the widespread popularity of meperidine, the perinatal pharmacokinetics of meperidine remained long unknown and the pharmacodynamics of the drug not understood (Moore, 1993). Although a wide variety of narcotics are now available, only a few are used currently in obstetrics; these include morphine, meperidine, fentanyl, and sufentanil. These narcotics cause a variety of side effects in the mother, including respiratory depression, orthostatic hypotension, nausea, vomiting, and delay of gastric motility. All narcotics are rapidly transferred across the placenta and are capable of producing neonatal respiratory depression and changes in the neurobehavior of the child. To diminish the usual side effects observed with systematically and intramuscularly administered opioids, alternative ways of administration have been sought.
- Type
- Chapter
- Information
- Opioids in Pain ControlBasic and Clinical Aspects, pp. 335 - 348Publisher: Cambridge University PressPrint publication year: 1998