To the Editor:—

We read with interest the recent review article by Dahl et al.  1regarding intrathecal opioids in patients undergoing cesarean section. Although our previous work substantiates the claim that intrathecal fentanyl (10 μg) does not allow for adequate postoperative analgesia, 2we take exception with the comment that the use of intrathecal opioids are “… hardly justified … if the only purpose is to improve intraoperative analgesia.” When patients undergoing cesarean section are not administered intrathecal fentanyl, both intraoperative pain and the need for intraoperative opioid supplementation are higher. 2When fentanyl (10 μg) was added to spinal anesthetic, the need for intraoperative opioids decreased from approximately 20% to 0%, without any increase in side effects. Therefore, we believe that not only is the use of intrathecal fentanyl justified, but that omitting it is unjustified.

Dahl JB, Jeppesen IS, Jorgensen H, Wetterslev J, Moiniche S: Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal anesthesia. A nesthesiology 1999; 91: 1919–27
Connelly NR, Dunn SM, Ingold V, Villa EA: The use of fentanyl added to morphine-lidocaine-epinephrine spinal solution in patients undergoing cesarean section. Anesth Analg 1994; 78: 912–20