Intrathecal Narcotics for Labor Revisited: The Combination of Fentanyl and Morphine Intrathecally Provides Rapid Onset of Profound, Prolonged Analgesia

Many anesthesiologists are frustrated by the limitations of currently available techniques for labor analgesia (1). Parenteral medications, commonly used for labor analgesia, can depress both mother and baby without providing adequate pain relief (1,2). Lumbar epidural analgesia, although very effective at relieving the pain of labor, is actually received by only 16% of laboring patients in the United States (1). Reasons cited for the underutilization of this technique include the amount of time required and the poor reimbursement offered (1). Intrathecal morphine (1-2 mg) can be rapidly administered and provides good analgesia for the first stage of labor; however, the associated long latency, high incidence of side effects, and lack of perineal anesthesia severely limit its usefulness (3-6). We hypothesized that the intrathecal administration of a combination of fentanyl, a narcotic with a short latency and a brief duration of action, and a lower dose of morphine might provide satisfactory labor analgesia with a shorter latency and a lower incidence of side effects. Here, we report the results of administering intrathecal fentanyl 25 pg and morphine 0.25 mg to 15 laboring patients.