Is an Epidural a Fentanyl mixture?
An epidural is a common medical procedure that provides pain relief or lack of feeling during labor and childbirth. The epidural medication is usually distributed through an IV injected at the back of the spine. Epidurals can also be used for certain types of surgeries as well as treatment for specific causes of chronic pain. For labor and childbirth, the most commonly used epidural is a combination of an anesthesia medication and a narcotic medication. The most common narcotic used in epidurals is fentanyl.
Epidural medications fall into their own class of drugs called anesthetics. Common epidural medications include bupivacaine, chloropropane or lidocaine. They are also known as epidural anesthesia, epidural block, epidural steroid injection or regional anesthesia. Epidurals are often mixed with opioid medications such as fentanyl or morphine. This is done to decrease the dosage of anesthetic to help reduce some of the adverse side effects of anesthesia and allow for more movement while still being able to provide pain relief.
What is an Epidural?
Epidurals are generally a very safe procedure. It is also a very common procedure used mostly during childbirth. It involves injecting the epidural medication into the space around your spinal nerve called the epidural space. This stops the pain signals from traveling from your spine to your brain. Since the spinal cord is the main highway the connects nerves located throughout the body, epidurals are usually injected in this area. The epidural will temporarily numb the nerves, which block pain signals. The goal of an epidural is to provide pain relief in specific regions of your body depending on where it is injected.
Is an Epidural a Fentanyl mixed medication?
For the most part, an epidural consists of a local anesthetic and an opioid such as fentanyl. It is commonly found in epidural solutions used for labor analgesia. Fentanyl and other narcotic medications added to the epidural allow the anesthesiologist to balance out the numbing agents in the solution. This allows for pain relief during contractions while still being able to feel pressure and move their legs and shift during active labor.
Is an epidural with fentanyl dangerous? This medication solution has been used in the medical setting since the late 1970s. The amount of fentanyl mixed into the epidural solution is very limited and very little is able to pass down into the bloodstream, according to anesthesiologists. Doctors and medical professionals say the epidural will have no significant effects on the fetus or baby and most women opt to maintain the fentanyl solution in the epidural. However, if a patient does not want an opioid or narcotic mixture, there are options to mix a solution without fentanyl. When this occurs the doctors will use a substitute medication or increase the concentration of the local anesthetic agent.
Like any other medication, fentanyl epidurals can produce adverse side effects. However, these side effects tend to be mild and very temporary.
Potential Side Effects of Fentanyl Epidural
- Nausea and vomiting
- Respiratory depression
- Itching – this is a common side effect of opioid medications
- Low blood pressure – can cause lightheadedness and dizziness
- Headache
What type of Opioid or Narcotic medication is typically used in Epidurals?
Both morphine and fentanyl are popular narcotics used in epidural solutions. Though both opioid medications, they each contain different properties that produce different outcomes. Morphine is a longer-lasting medication that can help provide sustained pain relief. However, this medication also has a slower onset of action compared to fentanyl. Fentanyl has a quicker duration of action and begins to work right away for the patient. However, because it is metabolized so quickly, it can require an additional dose in order to help manage pain relief. Both opioid medications are commonly used for labor epidurals.
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Potential dangers of using a Fentanyl Epidural
There have been ongoing studies and research on the safety of fentanyl epidurals and the potential dangers they could pose to the mother and child during labor and post-labor. Research from the AACC’s The Journal of Applied Laboratory Medicine found that fentanyl solutions in epidurals can actually be passed onto the baby during labor. However, research found the infants in the study did not experience any adverse side effects from the fentanyl transfer. Despite not finding any dangerous or life-threatening effects, researchers say it is important information to have because it can prevent new mothers from being accused of fentanyl abuse when they test positive for maternal or neonatal fentanyl. In other cases where there is fentanyl abuse, the consequences include incarceration, involvement of child protective services, stigma and anxiety.
Because fentanyl and other opioids such as morphine are commonly used in epidural for labor, researchers set out to determine whether or not it could negatively impact the health and well-being of newborns. A team of researchers from Brigham and Women’s Hospital in Boston performed drug testing on 96 urine samples from newborns whose mothers had no history of fentanyl drug use and 82 urine samples from newborns whose mothers received fentanyl epidurals during labor. The outcome was one out of three babies whose mothers received a fentanyl epidural tested positive for the opioid drug, while 14 newborns whose mothers did not receive a fentanyl epidural tested negative. Ultimately, researchers concluded the likelihood of fentanyl passing on to the newborn correlated with the duration and dose of fentanyl epidural that was given to the mother.
The use of Fentanyl after Child labor
Childbirth can be a physically and emotionally exhausting event. It is not uncommon for women to be prescribed medication to help them with pain management after birth. For many years, women who had routine vaginal births would be sent home with at least a 30-day supply of opioid pain medication for pain management. Medications such as Norco and Percocet were considered normal. Even as recently as 2017, postpartum women were routinely prescribed a 3-5 day supply of opioid medications even after an uncomplicated birth delivery. Oftentimes, many of these women did not have any clear need for painkillers.
According to a report published by the CDC, when a person is prescribed short-term pain medication, the risk of chronic use can start as early as the third day of use. Now most women who receive prescription opioids postpartum do not develop a dependence or addiction to opioids. But, there are a few that will. Today, there are newer guidelines for limiting the amounts of opioids prescribed post-birth and only to post-surgical women such as women who have had c-sections.
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Treatment for Opioid Use Disorder
Fentanyl is a powerful opioid drug. It is commonly used in epidural solutions for women during child labor to help with pain relief and management. In some cases, it can also be prescribed postpartum to patients who have had intensive procedures such as a C-section. Though these medications are carefully utilized and prescribed by a medical professional, there is a small risk of the patient developing a tolerance, dependence and addiction to the opioid. Professional behavioral treatment programs such as Hotel California by the Sea provide options for those in need of substance use disorder treatment.
We provide treatment at all levels of care including detox, residential and outpatient programs. Treatment methods such as CBT, DBT and EMDR therapy have proven highly effective in helping our clients in rehab. Hotel California by the Sea is dedicated to helping our clients reach their goals in recovery and overcome their addictions.
References:
https://my.clevelandclinic.org/health/treatments/21896-epidural
https://advances.massgeneral.org/obgyn/journal.aspx?id=2409
https://www.guardianrecovery.com/addiction-treatment/fentanyl-abuse-addiction/what-is-a-fentanyl-epidural
https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/what-is-an-epidural/