Questionim 23 years old and have chronic back pain, last year i have had cortisone shots in my lower spine and then had a nerve block, i recently re injured the area and can barely walk, i also just found out that i am 6 weeks pregnant, can they do another nerve block or cortisone shots while pregnant, i went to the ER and they gave me Percocet i have only taken 1 because im trying not to take anything that could potentually harm my fetus. and ideas on what i can do or should ask about when i have an apt with the dr?
AnswerHi Christy and thanks for writing,
Here an excerpt form an excellent article which should provide you with enough clear information to make an informed decision.
The most frequently used drug in labor is a narcotic-like analgesic called meperidine, Demerol (Pethidine in the UK). The use of meperidine has largely replaced the use of morphine during labor. This drug is frequently offered to the laboring woman by the obstetrician, nurse or midwife, accompanied by the standard remark, "This will help to take the edge off the contractions."
Meperidine does not eradicate pain, but for many women it makes the discomfort or pain of the contractions more tolerable. Other women find that meperidine causes them to lose control of their labor.
Meperidine is usually administered by injection either intramuscularly (IM) or intravenously (IV) in doses of 50 mg repeated every four hours, if the health care provider so desires and the mother agrees. As with most pain relieving drugs, meperidine can slow maternal respiration and circulation.When a narcotized mother breathes more slowly than normal and her blood flows more slowly than normal through her lung tissue there is always the likelihood that the fetus will receive less than a normal supply of oxygen.
In a well-controlled investigation by John Morrison, an obstetrician at the University of Mississippi, one of every 10 infants of mothers who received only 50 mg of meperidine during labor required resuscitation at birth. For this within 1 to 3 hours before delivery required resuscitation at birth.Unfortunately, it is difficult to insure that the baby will be born at a time when the effect of meperidine is minimal. For this reason midwives often administer the drug in smaller doses. such as 25 mg or 12 mg (or none at all) in order to insure that the mother will feel in control of her labor and the baby will be ready to breathe on his own immediately after birth. After repeated administrations of the drug, even in smaller doses, meperidine and its metabolite normeperidine tend to accumulate in the fetal circulation.
Meperidine is not without side effects, such as: sweating, dizziness, headache, nausea, vomiting, slowing of gastric function, agitation, tremor, uncoordinated muscle movement, transient hallucinations and disorientation, and visual disturbance.
The more serious hazards of meperidine for the mother are respiratory depression, respiratory arrest, circulatory depression, shock, cardiac arrest, coma and death. A less well known fact about meperidine is that the drug can cause an increase in cerebral spinal fluid pressure. The implications of this effect on mother, fetus and newborn infant, however, have not been investigated.
We have no way of knowing how frequently these adverse effects occur under normal clinical conditions because the law does not require physicians or midwives to report adverse drug reactions to the FDA, even if the patient dies.
The FDA has allowed the manufacturers of meperidine to provide in the drug's package insert only a minimum of information in regard to the drug's adverse effects on the fetus and newborn infant. The insert acknowledges that the drug crosses the placenta and can depress the respiratory and the psychophysiologic functions of the newborn infant and can increase the likelihood that the newborn infant may require resuscitation. The insert does not make clear that meperidine given to the mother during labor can slow the fetal heart and impede the normal transfer of oxygen from the mother's circulation to that of her fetus.
Severe or prolonged oxygen depletion has been shown to cause the fetal brain to swell. Whether an increase in cerebral spinal fluid pressure in the presense of fetal hypoxia, ruptured membranes and/or forceps extraction increases the likelihood of permanent brain dysfunction has yet to be investigated.
There is some concern that the severely narcotized newborn infant may be more prone to aspirate (inhale its gastric fluids) because the drug has blunted or paralyzed his protective gag reflex.
Other narcotic-like drugs approved by the FDA for use in labor are nalbuphine (Nubain), butorphanol (Stadol) and alphaprodine (Nisentil). Other drugs, namely hydromorphone (Dilaudid), fentanyl citrate (Sublimaze), and codeine, are also used in labor, but the FDA has not approved them for such use. Like meperidine, the delayed or long-term effects of drugs given during labor on the exposed fetus have not been adequately investigated. The little research that has been done on Nubain has shown the drug to concentrate more in the fetal circulation than in the mother's. Butorphanol is forty times more powerful than meperidine and must be administered with extreme care to avoid an overdose.
Hydroxyzine (Vistaril) is an antianxiety, antinausea drug sometimes administered to women during labor. The potentiating action of hydroxyzine must be considered when the drug is used in conjunction with other drugs which depress the central nervous system.
from http://www.aimsusa.org/rothdrug.htm
I hope this helps, all my best to you and your baby.
Margot
