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Society for Obstetric Anesthesia and Perinatology Consensus Statement

Monitoring Recommendations for Prevention and Detection of Respiratory Depression Associated With Administration of Neuraxial Morphine for Cesarean Delivery Analgesia

Bauchat, Jeanette R. MD, MS*; Weiniger, Carolyn F. MBChB; Sultan, Pervez MBChB, FRCA, MD; Habib, Ashraf S. MBBCh, MSc, MHSc, FRCA§; Ando, Kazuo MD, PhD; Kowalczyk, John J. MD; Kato, Rie MD, DPhil#; George, Ronald B. MD, FRCPC**; Palmer, Craig M. MD††; Carvalho, Brendan MBBCh, FRCA‡‡

doi: 10.1213/ANE.0000000000004195
Obstetric Anesthesiology: PDF Only

The majority of women undergoing cesarean delivery in the United States receive neuraxial morphine, the most effective form of postoperative analgesia for this surgery. Current American Society of Anesthesiologists (ASA) and American Society of Regional Anesthesia and Pain Medicine (ASRA) recommend respiratory monitoring standards following neuraxial morphine administration in the general surgical population that may be too frequent and intensive when applied to the healthy obstetric population receiving a single dose of neuraxial morphine at the time of surgery. There is limited evidence to support or guide the optimal modality, frequency, and duration of respiratory monitoring in the postoperative cesarean delivery patient receiving a single dose of neuraxial morphine. Consistent with the mission of the Society for Obstetric Anesthesia and Perinatology (SOAP) to improve outcomes in pregnancy for women and neonates, the purpose of this consensus statement is to encourage the use of this highly effective analgesic technique while promoting safe practice and patient-centered care. The document aims to reduce unnecessary interruptions from respiratory monitoring in healthy mothers while focusing vigilance on monitoring in those women at highest risk for respiratory depression following neuraxial morphine administration. This consensus statement promotes the use of low-dose neuraxial morphine and multimodal analgesia after cesarean delivery, gives perspective on the safety of this analgesic technique in healthy women, and promotes patient risk stratification and perioperative risk assessment to determine and adjust the intensity, frequency, and duration of respiratory monitoring.

From the *Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee

Division of Anesthesiology & Critical Care & Pain, Sourasky Medical Center, Tel Aviv, Israel

Department of Anaesthesia and Perioperative Medicine, University College London Hospital, London, United Kingdom

§Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina

Department of Anesthesiology, Aichi Medical University, Aichi, Japan

Department of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

#Division of Anesthesiology, Kitasato University School of Medicine, Kanagawa, Japan

**Department of Anaesthesia, Pain Management and Perioperative Medicine, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada

††Department of Anesthesiology, University of Arizona College of Medicine, Tucson, Arizona

‡‡Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.

Accepted for publication March 21, 2019.

Funding: None.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Reprints will not be available from the authors.

Address correspondence to Jeanette R. Bauchat, MD, MS, Obstetric Anesthesiology Division, Vanderbilt University Medical Center, Room 4202 VUH (7580), 1211 Medical Center Dr, Nashville, TN 37232. Address e-mail to

© 2019 International Anesthesia Research Society