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Opioids have been administered intrathecally with subarachnoid block for postoperative pain relief in parturients undergoing elective cesarean deliveries. This case report presents the uncommon occurrence of intrathecal opioid-induced hypothermia in the latent phase of recovery following elective cesarean delivery. There are few case reports on the occurrence of latentphase postanesthesia care hypothermia in patients receiving subarachnoid block with morphine sulfate injection (Duramorph). Hypothermia can occur postoperatively for many reasons and can be life-threatening. In this case, hypothermia developed and progressed throughout the postoperative period. The causes of hypothermia were evaluated and treated without success initially. Thyroid dysfunction and alternative differential diagnoses were ruled out. Further assessment determined that the morphine injection might have been a contributing factor. Naloxone at 40-μg increments was administered intravenously and corrected the hypothermia. Awareness of hypothermia postoperatively with associated morphine administration through subarachnoid block must be ruled out in cases of progressing hypothermia.
Keywords: Cesarean delivery, hypothermia, morphine injection (Duramorph), postanesthesia care, subarachnoid block.
Intrathecally administered opioids have been used as an adjunct for postoperative pain relief after cesarean delivery.1 Although many benefits exist, there may be some unwanted side effects of the opioids. Anesthesia providers should be aware of the causes of hypothermia, which may be life-threatening. Prevention and recognition of contributing factors must be identified to help reduce morbidity and mortality in these rare cases. This case report describes the diagnosis and successful treatment of a young woman who experienced mild hypothermia (34.4°C [93.8°F]) in a 4-hour period after cesarean delivery.
Case Summary
A 29-year-old woman, gravida 4, para 1, ASA physical status 2, was scheduled for a primary cesarean delivery because of the diagnosis of breech presentation at gestation of 39 weeks and 1 day. The patient had a history of 2 previous miscarriages and a surgical history for minimal dental work. A previous spontaneous vaginal delivery occurred in 2011 without the aid of any narcotics, epidural analgesia, or pain relief. Preanesthetic evaluation showed no family history of anesthesia complications or any remarkable medical history. Thyroid function screening showed no abnormal values. The patient had no known drug allergies and was taking prenatal vitamins. She was 157.5 cm (5 ft 2 in) tall, weighed 67.5 kg (150 lb), and was neurologically intact. All bloodwork results...