Epidural Opioid Analgesia and Neonatal Respiratory Depression

Epidural opioid analgesia is commonly employed as a therapeutic modality in the management of pain during labor. The general perception among health-care providers is that administered drugs remain in the maternal epidural space and do not compromise the respiratory status of newborns. We describe the clinical course of two newborns who developed respiratory depression following epidural fentanyl analgesia requiring administration of naloxone. The article further reviews the maternal–fetal–placental pharmacokinetics of epidural fentanyl and the possible mechanisms for the causation of neonatal respiratory depression.