Gross Michael, Saint-Hilaire Quincy, Kohler Garrison, Thornton Imani
Anesthesiology, HCA Florida Westside Hospital, Plantation, USA.
Medical School, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA.
Cureus. 2025 Feb 18;17(2):e79247. doi: 10.7759/cureus.79247. eCollection 2025 Feb.
Delayed onset of spinal anesthesia can pose challenges during cesarean section (CS) in patients with a history of chronic opioid use. We present a case of delayed onset of spinal anesthesia in a patient with chronic opioid use undergoing CS, highlighting the clinical implications and management strategies. Delayed onset of spinal anesthesia in chronic opioid users can result from neurophysiological adaptations and pharmacokinetic interactions in the central nervous system. Previous studies have suggested chronic opioid users display a delayed onset and shorter duration of action of neuraxial blockade. This can have great implications in pregnant women who require anesthesia for CS. Delayed onset can lead to misconception of a failed spinal block and conversion to general anesthesia. In reality, additional time may be needed for the block to rise to an adequate level. Additionally, delayed time to incision can lead to poor outcomes for the mother and baby in urgent scenarios. When providing anesthesia for chronic opioid users undergoing CS, it is important to understand the possibility of delayed onset of neuraxial blockade which can impact patient care.
对于有慢性阿片类药物使用史的患者，剖宫产（CS）期间脊髓麻醉起效延迟可能带来挑战。我们报告一例有慢性阿片类药物使用史的患者在剖宫产时脊髓麻醉起效延迟的病例，强调其临床意义及管理策略。慢性阿片类药物使用者脊髓麻醉起效延迟可能是由于中枢神经系统的神经生理适应性变化和药代动力学相互作用所致。既往研究表明，慢性阿片类药物使用者神经轴阻滞起效延迟且作用持续时间缩短。这对于需要剖宫产麻醉的孕妇可能有重大影响。起效延迟可能导致对脊髓阻滞失败的误解并转为全身麻醉。实际上，可能需要额外的时间使阻滞达到足够水平。此外，在紧急情况下，延迟切开时间可能对母婴产生不良后果。为有慢性阿片类药物使用史的患者进行剖宫产麻醉时，了解神经轴阻滞起效延迟的可能性对患者护理很重要，这可能会影响患者护理。
