Volume 9, No. 4 • Winter 1994

No Need to Avoid Spinal Narcotics

Ezzzat 1. Abouleish, M.D.

To the Editor

I read with interest the article by Dr. C.D. Blitt and associates published recently in the APSF Newsletter. However, I disagree with No. 2 of their “New Guidelines’ which states: “Avoidance of subarachnoid opioids.’ My concern is that they gave no scientific evidence to support their statement while, historically, the safety of subarachnoid opioids has been established, provided the type is carefully chosen and the dose is properly administered. For example, we have been adding 0.2 mg morphine to spinal bupivacaine for cesarean section for many years’ and published the safety of the technique in a prospective study in 19911. In fact, no special monitoring equipment or place for postoperative stay is required if the dose of intrathecal morphine is limited to 0.2 mg. For vaginal delivery, intrathecal opioids, either alone or part of combined spinal-epidural technique, have been found useful and safe.” We have been routinely using intrathecal opioids for labor. Therefore, if ‘avoidance of subarachnoid opioids’ is chosen to be the guideline for a certain group of physicians, I hope this is not misinterpreted to be the standard of care for all. Otherwise, their statement could have serious medicolegal consequences.

Ezzzat 1. Abouleish, M.D. Department of Anesthesiology

The University of Texas Health Science Center Houston, TX


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