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Anesth Analg 1988; 67:318-323
© 1988 International Anesthesia Research Society
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Recurrent Herpes Simplex Virus Labialis and the Use of Epidural Morphine in Obstetric Patients

Lesley-Ann L. Crone, MD, John M. Conly, MD, Keith M. Clark, Allison C. Crichlow, Gaylord C. Wardell, MD, Audrey Zbitnew, MS, Lottie M. Rea, RN, Sharon L. Cronk, RN, Catherine M. Anderson, RN, Leonard K. Tan, MB, PhD, and William L. Albritton, MD, PhD

Received from the Departments of Anesthesia, Microbiology, and Social and Preventive Medicine, University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

Abstract

A retrospective study of sequential obstetric patients delivering at University Hospital and receiving epidural anesthesia was conducted to determine if a suggested association exists between the recurrence of oral herpes simplex lesions and the use of epidural morphine. In a retrospective study of 291 patients, 13 of 134 (9.7%) receiving epidural morphine developed recurrentoral herpes lesions in contrast to 1 of 157 (0.6%) not receiving the drug (P < 0.001). In a prospective hospital-based study of 729 consecutive obstetric patients, 146 patients received epidural opioids (morphine, fentanyl, or both) and 583 did not. Recurrent HSVL lesions occurred in 13 of 140 (9.3%) patients given epidural morphine but in only 6 of 583 (1.0%) not given epidural opioids (P < 0.001). Three of the 13 patients with HSVL received both epidural morphine and fentanyl and 10 received only epidural morphine. Because of the small numbers of patients receiving only fentanyl, no relation between HSVL reactivation and epidural fentanyl could be established. In patients having cesarean sections, the association of recurrent HSVL and the use of epidural morphine was significant (P = 0.04), suggesting cesarean delivery was not a confounder. A hitherto undescribed triggering agent, epidural morphine, appears to be associated with reactivation ofHSVL in obstetric patients in the postpartum period.

Key Words: ANESTHESIA, obstetric • ANESTHETIC TECHNIQUES, EPIDURAL—morphine • INFECTION—herpes simplex




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 Anesth. Analg.Home page
P. W. Davies, M. C. Vallejo, K. T. Shannon, A. J. Amortegui, and S. Ramanathan
Oral Herpes Simplex Reactivation After Intrathecal Morphine: A Prospective Randomized Trial in an Obstetric Population
Anesth. Analg., May 1, 2005; 100(5): 1472 - 1476.
[Abstract] [Full Text] [PDF]


Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1988 by the International Anesthesia Research Society.