Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuraxial Opioid Administration: An Updated Report by the American Society of Anesthesiologists Task Force on Neuraxial Opioids and the American Society of Regional Anesthesia and Pain Medicin

RACTICE guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care. These recommendations may be adopted, modified, or rejected according to the clinical needs and constraints and are not intended to replace local institutional policies. In addition, practice guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome. Practice guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. They provide basic recommendations that are supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open-forum commentary, and clinical feasibility data. This document updates the “Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuraxial Opioid Administration: An Updated Report by the ASA Task Force on Neuraxial Opioids,” adopted by ASA in 2008 and published in 2009.†

[1]  E. Riley,et al.  Single-dose, extended-release epidural morphine (DepoDur) compared to conventional epidural morphine for post-cesarean pain. , 2008, Anesthesia and analgesia.

[2]  E. Riley,et al.  Single-Dose, Extended-Release Epidural Morphine (DepoDur™) Compared to Conventional Epidural Morphine for Post-Cesarean Pain , 2007 .

[3]  A. Boezaart Evaluation of a single-dose, extended-release epidural morphine formulation for pain after knee arthroplasty. , 2006, The Journal of bone and joint surgery. American volume.

[4]  M. Uyar,et al.  The effects of sufentanil or morphine added to hyperbaric bupivacaine in spinal anaesthesia for Caesarean section , 2006, European journal of anaesthesiology.

[5]  Judith E. Hall,et al.  A comparison of 0.2 and 0.5 mg intrathecal morphine for postoperative analgesia after total knee replacement , 2005, Anaesthesia.

[6]  S. Segal,et al.  Single-Dose, Sustained-Release Epidural Morphine in the Management of Postoperative Pain After Elective Cesarean Delivery: Results of a Multicenter Randomized Controlled Study , 2005, Anesthesia and analgesia.

[7]  D. Gambling,et al.  A Comparison of Depodur™, a Novel, Single-Dose Extended-Release Epidural Morphine, with Standard Epidural Morphine for Pain Relief After Lower Abdominal Surgery , 2005, Anesthesia and analgesia.

[8]  R. Fournier,et al.  Intrathecal Sufentanil Is More Potent Than Intravenous for Postoperative Analgesia After Total-Hip Replacement , 2005, Regional Anesthesia & Pain Medicine.

[9]  R. Liston,et al.  A Multicenter Randomized Controlled Trial Comparing Patient-Controlled Epidural with Intravenous Analgesia for Pain Relief in Labor , 2004, Anesthesia and analgesia.

[10]  A. Reber,et al.  Impact of spinal anaesthesia and obesity on maternal respiratory function during elective Caesarean section * , 2004, Anaesthesia.

[11]  J. Laffey,et al.  Optimizing the Dose of Intrathecal Morphine in Older Patients Undergoing Hip Arthroplasty , 2003, Anesthesia and analgesia.

[12]  Richard Taylor,et al.  Intrathecal Morphine for Postoperative Analgesia: A Randomized, Controlled, Dose-Ranging Study After Hip and Knee Arthroplasty , 2003, Anesthesia and analgesia.

[13]  P. Myles,et al.  Perioperative Epidural Analgesia and Outcome After Major Abdominal Surgery in High-Risk Patients , 2003, Anesthesia and analgesia.

[14]  C. M. Cowan,et al.  Comparison of intrathecal fentanyl and diamorphine in addition to bupivacaine for caesarean section under spinal anaesthesia. , 2002, British journal of anaesthesia.

[15]  D. Sessler,et al.  More Epidural than Intravenous Sufentanil is Required to Provide Comparable Postoperative Pain Relief , 2001, Anesthesia and analgesia.

[16]  M. Goodarzi Comparison of epidural morphine, hydromorphone and fentanyl for postoperative pain control in children undergoing orthopaedic surgery , 1999, Paediatric anaesthesia.

[17]  X. Capdevila,et al.  Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. , 1999, Anesthesiology.

[18]  E. Liu,et al.  Side‐effects of epidural infusions of opioid bupivacaine mixtures , 1998, Anaesthesia.

[19]  S. Sjöström,et al.  Postoperative analgesia with epidural bupivacaine and low‐dose fentanyl ‐ a comparison of two concentrations , 1998, Acta anaesthesiologica Scandinavica.

[20]  G. Fanelli,et al.  Comparison between epidural infusion of fentanyl/bupivacaine and morphine/bupivacaine after orthopaedic surgery , 1998, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[21]  B. Holtmann,et al.  Intrathecal Sufentanil (5 vs. 10 μg) for Labor Analgesia:: Efficacy and Side Effects , 1998, Regional Anesthesia & Pain Medicine.

[22]  M. Norris,et al.  Intrathecal sufentanil (5 vs. 10 microg) for labor analgesia: efficacy and side effects. , 1998, Regional anesthesia and pain medicine.

[23]  M. Roizen,et al.  Three Sudden Postoperative Respiratory Arrests Associated with Epidural Opioids in Patients with Sleep Apnea , 1997, Anesthesia and analgesia.

[24]  L. Lindgren,et al.  Comparison of epidural morphine and oxycodone for pain after abdominal surgery. , 1997, Journal of clinical anesthesia.

[25]  C. Greenhalgh,et al.  Respiratory arrest in a parturient following intrathecal injection of sufentanil and bupivacaine , 1996, Anaesthesia.

[26]  Jennifer A. Ferguson,et al.  Analgesia After Thoracotomy: Effects of Epidural Fentanyl Concentration/Infusion Rate , 1995, Anesthesia and analgesia.

[27]  M. C. Sarna,et al.  Respiratory arrest after second dose of intrathecal sufentanil. , 1995, Anesthesiology.

[28]  J. Eisenach Opioid antagonist adjuncts to epidural morphine for postcesarean analgesia: maternal outcomes. , 1994, Anesthesia and analgesia.

[29]  E. De Keersmaecker,et al.  Continuous administration of fentanyl for postoperative pain: a comparison of the epidural, intravenous, and transdermal routes. , 1994, Journal of clinical anesthesia.

[30]  Y. Kosaka,et al.  Comparison of continuous epidural infusion of morphine/bupivacaine with fentanyl/ bupivacaine for postoperative pain relief , 1994, Acta anaesthesiologica Scandinavica.

[31]  S. Laganière,et al.  A comparison of lumbar epidural and intravenous fentanyl infusions for post-thoracotomy analgesia , 1994, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[32]  Y. Hatano,et al.  Severe respiratory depression after epidural morphine in a patient with myotonic dystrophy , 1993, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[33]  J. Cooper,et al.  Perioperative monitoring with pulse oximetry and late postoperative cognitive dysfunction. , 1993, British journal of anaesthesia.

[34]  E. Geller,et al.  A randomized double-blind comparison of epidural sufentanil versus intravenous sufentanil or epidural fentanyl analgesia after major abdominal surgery. , 1993, Anesthesia and analgesia.

[35]  C. Lebrault,et al.  Equivalence of postoperative analgesia with patient-controlled intravenous or epidural alfentanil. , 1993, Anesthesia and analgesia.

[36]  M. L. Noll Spotlight article: pulse oximetry in the postoperative care of cardiac surgical patients: a randomized clinical trial. (Bierman MI, Stein KL, Snyder JV. Chest 1992; 102: 1367-70.). , 1993, Heart & lung : the journal of critical care.

[37]  Joachim S. Gravenstein,et al.  Randomized Evaluation of Pulse Oximetry in 20,802 Patients; II: Perioperative Events and Postoperative Complications , 1993, Anesthesiology.

[38]  V. Sarma,et al.  Intrathecal morphine for the relief of post‐hysterectomy pain ‐ a double‐blind, dose‐response study , 1993, Acta anaesthesiologica Scandinavica.

[39]  J. Snyder,et al.  Pulse oximetry in the postoperative care of cardiac surgical patients. A randomized controlled trail. , 1993, Chest.

[40]  R. Chioléro,et al.  A randomized comparison of intravenous versus lumbar and thoracic epidural fentanyl for analgesia after thoracotomy. , 1992, Anesthesiology.

[41]  J. Snyder,et al.  Pulse Oximetry in the Postoperative Care of Cardiac Surgical Patients: A Randomized Controlled Trial , 1992 .

[42]  P. White,et al.  Epidural patient-controlled analgesia: an alternative to intravenous patient-controlled analgesia for pain relief after cesarean delivery. , 1992, Anesthesia and analgesia.

[43]  M. White,et al.  Side effects during continuous epidural infusion of morphine and fentanyl , 1992, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[44]  J. Møller,et al.  Hypoxaemia is reduced by pulse oximetry monitoring in the operating theatre and in the recovery room. , 1992, British journal of anaesthesia.

[45]  S. Datta,et al.  Does epidural administration of butorphanol offer any clinical advantage over the intravenous route? A double-blind, placebo-controlled trial. , 1992, Anesthesiology.

[46]  J. Willaert,et al.  Postoperative analgesia for major abdominal surgery with continuous thoracic epidural infusion of bupivacaine with sufentanil, versus bupivacaine with morphine. A randomized double blind study. , 1992, Acta anaesthesiologica Belgica.

[47]  L. Nuutinen,et al.  A randomized double-blind comparison of epidural versus intravenous fentanyl infusion for analgesia after thoracotomy. , 1991, Anesthesiology.

[48]  N. Valentin,et al.  Respiratory depression during epidural morphine treatment , 1991, Acta anaesthesiologica Scandinavica.

[49]  F. Camu,et al.  Alfentanil infusion for postoperative pain: a comparison of epidural and intravenous routes. , 1991, Anesthesiology.

[50]  C. Palmer,et al.  Early respiratory depression following intrathecal fentanyl-morphine combination. , 1991, Anesthesiology.

[51]  D. Hoyt,et al.  Prospective evaluation of epidural and intravenous administration of fentanyl for pain control and restoration of ventilatory function following multiple rib fractures. , 1991, The Journal of trauma.

[52]  D. Silverman,et al.  Comparison of Epidurally Administered Sufentanil, Morphine, and Sufentanil‐Morphine Combination for Postoperative Analgesia , 1991, Anesthesia and analgesia.

[53]  Y. Hamaya,et al.  Effective Doses of Epidural Morphine for Relief of Postcholecystectomy Pain , 1991, Anesthesia and analgesia.

[54]  G. Sharwood-Smith,et al.  Profound respiratory depression after extradural fentanyl. , 1990, British journal of anaesthesia.

[55]  I. Wilson,et al.  Analgesia following extradural and i.m. pethidine in post-caesarean section patients. , 1990, British journal of anaesthesia.

[56]  B. Anderson,et al.  Postoperative Pain Control With a Continuous Infusion of Epidural Sufentanil in the Intensive Care Unit: A Comparison With Epidural Morphine , 1990, Anesthesia and analgesia.

[57]  L. S. Reisner,et al.  A randomized double-blind comparison of epidural versus intravenous fentanyl infusion for analgesia after cesarean section. , 1990, Anesthesiology.

[58]  I. Wilson,et al.  ANALGESIA FOLLOWING EXTRADURAL AND I.M. PETHIDINE IN POST-CAESAREAN SECTION PATIENTS , 1990 .

[59]  G. Sharwood-Smith,et al.  PROFOUND RESPIRATORY DEPRESSION AFTER EXTRADURAL FENTANYL , 1990 .

[60]  T. Abboud,et al.  Prophylactic oral naltrexone with epidural morphine: effect on adverse reactions and ventilatory responses to carbon dioxide. , 1990, Anesthesiology.

[61]  A. Sandler,et al.  A comparison of epidural and intramuscular morphine in patients following cesarean section. , 1990, Anesthesiology.

[62]  T. Abboud,et al.  Prophylactic Oral Naltrexone With Intrathecal Morphine for Cesarean Section: Effects on Adverse Reactions and Analgesia , 1989, Anesthesia and Analgesia.

[63]  H. Van Aken,et al.  Surgical analgesia for knee arthroscopy with epidural lignocaine and sufentanil--effect of varying sufentanil doses. , 1990, Acta anaesthesiologica Belgica.

[64]  E. Krane,et al.  The dose response of caudal morphine in children. , 1989, Anesthesiology.

[65]  C. Chabal,et al.  A Dose‐Response Study of Intrathecal Morphine: Efficacy, Duration, Optimal Dose, and Side Effects , 1988, Anesthesia and analgesia.

[66]  A. Sandler,et al.  Analgesic and Respiratory Effects of Epidural Sufentanil in Patients Following Thoracotomy , 1988, Anesthesiology.

[67]  P. Rosseel,et al.  Epidural sufentanil for intra– and postoperative analgesia in thoracic surgery: a comparative study with intravenous sufentanil , 1988, Acta anaesthesiologica Scandinavica.

[68]  B. Gorsky ALTERATION OF BLOOD COMPONENTS WITH HEMODILUTION AND ADMINISTRATION OF WASHED SHED RED CELLS , 1988 .

[69]  D. Benhamou,et al.  Effect of Naloxone Infusion on Analgesia and Respiratory Depression after Epidural Fentanyl , 1988, Anesthesia and analgesia.

[70]  E. Krane Delayed respiratory depression in a child after caudal epidural morphine. , 1988, Anesthesia and analgesia.

[71]  D. Hoaglin,et al.  A single-blind study of pulse oximetry in children. , 1988, Anesthesiology.

[72]  G. Rolly,et al.  Epidural sufentanil versus intramuscular buprenorphine for postoperative analgesia , 1987, Anaesthesia.

[73]  J. Egmond,et al.  Post‐operative analgesia by high thoracic epidural versus intramuscular nicomorphine after thoracotomy. Part III , 1987, Acta anaesthesiologica Scandinavica.

[74]  F. Camu,et al.  Analgesic and Cardiorespiratory Effects of Epidural Sufentanil and Morphine in Humans , 1987, Anesthesia and analgesia.

[75]  M. Avram,et al.  Epidural hydromorphone: a double-blind comparison with intramuscular hydromorphone for postcesarean section analgesia. , 1987, Anesthesiology.

[76]  C. Blackburn Respiratory arrest after epidural sufentanil , 1987, Anaesthesia.

[77]  D. Hoaglin,et al.  A single-blind study of pulse oximetry in children , 1986 .

[78]  A. Sandier,et al.  Respiratory depression following epidural morphine: A clinical study , 1986, Canadian Anaesthetists' Society journal.

[79]  J. Reiher,et al.  The sleep apnoea syndrome and epidural morphine , 1986, Canadian Anaesthetists' Society journal.

[80]  N. Rawal,et al.  Influence of Naloxone Infusion on Analgesia and Respiratory Depression Following Epidural Morphine , 1986, Anesthesiology.

[81]  J. Egmond,et al.  Post‐operative Analgesia by Epidural Versus Intramuscular Nicomorphine after Thoracotomy. Part II , 1985, Acta anaesthesiologica Scandinavica.

[82]  J. Egmond,et al.  Post‐operative Analgesia by Epidural Versus Intramuscular Nicomorphine after Thoracotomy. Part I , 1985, Acta anaesthesiologica Scandinavica.

[83]  H. Breivik,et al.  Epidural Morphine for Postoperative Pain: Experience with 1085 Patients , 1985, Acta anaesthesiologica Scandinavica.

[84]  A. Sandler,et al.  Postthoracotomy Pain and Pulmonary Function Following Epidural and Systemic Morphine , 1984, Anesthesiology.

[85]  N. Rawal,et al.  Comparison of Intramuscular and Epidural Morphine for Postoperative Analgesia in the Grossly Obese: Influence on Postoperative Ambulation and Pulmonary Function , 1984, Anesthesia and analgesia.

[86]  P. D. Phillips,et al.  Extradural versus intramuscular diamorphine , 1983, Anaesthesia.

[87]  J. Klinck,et al.  Epidural Morphine in the elderly , 1982, Regional Anesthesia & Pain Medicine.

[88]  J. Klinck,et al.  Epidural morphine in the elderly. A controlled trial after upper abdominal surgery. , 1982, Anaesthesia.

[89]  M. Chauvin,et al.  Postoperative spinal analgesia with morphine. , 1981, British journal of anaesthesia.

[90]  T. L. James,et al.  Respiratory depression after intrathecal narcotics , 1980, Anaesthesia.

[91]  V. Christensen Respiratory depression after extradural morphine. , 1980, British journal of anaesthesia.

[92]  L. Mather,et al.  SPINAL NARCOTICS AND RESPIRATORY DEPRESSION , 1979, The Lancet.