Fooling Ourselves: Intravenous Fentanyl Creates the Illusion of a Successful Epidural

Abstract

In his first few days on the OB Anesthesia rotation, the anesthesia resident is urgently called to do an epidural for a healthy patient with severe labor pain, and the anesthesia attending accompanies him to the patient’s room, where she is screaming in pain. It is her first baby; she is at four centimeters of cervical dilation and says she has to push. The nurses are afraid she will push and that the baby’s head will tear her cervix, and they have been encouraging her to get an epidural for several hours, but she has refused until now. Now the patient’s husband is very upset and impatient for his wife to get pain relief. The mood in the room is almost desperate.