[quote TrenchArse]@Greybeardy isn’t Fentanyl just a stronger form of morphine? I looked into it after I had a ELCS for my last child as I was surprised at how out of it I was. I was expecting to find the experience terrifying and had done loads of breathing exercises beforehand as I was terrified of the thought of lying there awake and being sliced open. Within a couple of minutes after having it I was chilled as anything and felt just like I had when I’d been on opiates after an operation in the past. Or is the one done for ELCS different/ stronger than if the woman is expected to carry on labouring?[/quote]
@TrenchArse can obvs only make general rather than specific comments but…
Morphine, diamorphine and fentanyl are all opioids but have different pharmacological profiles. Epidurals and spinals are different techniques too and use completely different drug doses. It would be relatively unusual to use a de novo epidural anaesthetic for an elective c-section - more commonly spinal/combined spinal-epidural is used. If you had just an epidural for an ELCS there may be other things specific to your case that were different too.
Morphine is not routinely used in this country in either spinal or epidural anaesthetics because its pharmacology means it’s more likely to drift upwards and cause respiratory depression (however recent widespread diamorphine shortages mean that this is being debated again). Diamorphine and fentanyl are commonly added to spinal injections because they help prolong the duration of the block and help with post-op pain relief (diamorph more than fent) and their lipid solubility profiles mean they’re less likely to drift higher in the CSF. The doses of both used are tiny compared to the IV/IM doses and any systemic absorption from the csf is unlikely to give any sort of euphoria.
In epidurals for pain relief, low dose local anaesthetic with fentanyl are commonly used. The block for labour though is much lower and less ‘dense’ than the block needed for a section/forceps delivery and the opioid dose is very low. Unless the epidural catheter is passing into/through a vein getting a systemic dose of opioid big enough to cause euphoria is uncommon.
There are different techniques for topping up an epidural to give anaesthesia (as opposed to analgesia) and different people probably do different things with the opioids but it’s less common to put a big dose of opioid down the epidural at the start of the case because there is a higher chance of systemic absorption and the drug affecting the baby. Toward the end of the case with an epidural top-up though many anaesthetist would put a relatively big dose of diamorphine in to the catheter to help with post-op analgesia and the commoner side effects would be nausea and itching rather than euphoria.
Other things that might contribute to a sense of euphoria under spinal would be the relief at actually realising the anaesthetic is working (!)/ the effect that suddenly not having any sensory input from half the body has on the brain once the block is working. Also hyperventilating, which is quite common on labour ward and in theatre, can also cause a light-headed feeling.
Hope that makes sense/helps!