{"id":632154,"date":"2025-05-06T12:36:23","date_gmt":"2025-05-06T16:36:23","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=632154"},"modified":"2026-03-17T15:14:08","modified_gmt":"2026-03-17T19:14:08","slug":"is-ther-fentanyl-in-an-epidural","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/is-ther-fentanyl-in-an-epidural\/","title":{"rendered":"Is there fentanyl in an epidural?"},"content":{"rendered":"<p><a href=\"https:\/\/www.singlecare.com\/prescription\/fentanyl\"><span style=\"font-weight: 400;\">Fentanyl<\/span><\/a><span style=\"font-weight: 400;\"> is an opioid medication used as an anesthetic in hospital settings as well as a pain reliever (analgesic) both in and out of the hospital. It plays a key role in various medical procedures, including epidurals. An epidural is a method of pain relief used commonly during childbirth that involves injecting medication into the lower back, in the space around your spinal nerves. Fentanyl can be one of the medications in epidural anesthesia, providing effective pain management when administered by trained healthcare professionals. Read on to learn more about the use of fentanyl in epidurals, including safety considerations and how it works for pain management.\u00a0<\/span><\/p>\n<h2 id=\"what-is-fentanyl-used-for\"><span style=\"font-weight: 400;\">What is fentanyl used for?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Fentanyl injections are <\/span><a href=\"https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2023\/019101s063lbl.pdf\"><span style=\"font-weight: 400;\">approved by the Food and Drug Administration (FDA)<\/span><\/a><span style=\"font-weight: 400;\"> as a pain reliever (analgesic) and an anesthetic in the following situations:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Pain management before a medical or surgical event or procedure, such as a vaginal birth or C-section<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">As an add-on to general or local anesthesia<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">As general anesthesia<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Pain management after a surgical procedure<\/span><\/li>\n<\/ul>\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK459275\/\"><span style=\"font-weight: 400;\">Fentanyl<\/span><\/a><span style=\"font-weight: 400;\"> is commonly used to sedate people who are intubated, to treat cancer pain, and to treat severe cases of pain in people who have kidney failure.\u00a0<\/span><\/p>\n<h3 id=\"pharmaceutical-fentanyl-vs-illegally-made-fentanyl\"><span style=\"font-weight: 400;\">Pharmaceutical fentanyl vs. illegally made fentanyl<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Pharmaceutical fentanyl and illegally made fentanyl (IMF) can both be <\/span><a href=\"https:\/\/www.cdc.gov\/overdose-prevention\/about\/fentanyl.html\"><span style=\"font-weight: 400;\">misused and dangerous<\/span><\/a><span style=\"font-weight: 400;\">. Pharmaceutical fentanyl, made by drug companies, comes in the form of skin patches or lozenges. \u201cFentanyl used in healthcare settings is overseen by the FDA. It is manufactured under strict regulations. It always comes in a known, <a href=\"https:\/\/www.singlecare.com\/prescription\/fentanyl\/dosage\">precise dose<\/a>. Doctors can control exactly how much a patient gets,\u201d explains <\/span><a href=\"https:\/\/www.rehab.com\/expert\/sylvie-stacy\"><span style=\"font-weight: 400;\">Sylvie Stacy<\/span><\/a><span style=\"font-weight: 400;\">, MD, chief medical officer at Rehab.com. Although it is effective when used as directed, it can be misused.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">On the other hand, IMF is made illegally and is found as a powder or pill. IMF may be combined with other illegal drugs, making them more dangerous and increasing the risk of a drug overdose. \u201cStreet fentanyl is made in illegal labs. It is often mixed with other drugs. It is completely unregulated. So you never really know what you\u2019re getting. That makes it incredibly dangerous,\u201d Dr. Stacy says. According to the Centers for Disease Control and Prevention (CDC), IMF was involved in more than 68% of overdose deaths in the U.S. in 2022.<\/span><\/p>\n<h2 id=\"how-do-epidurals-work\"><span style=\"font-weight: 400;\">How do epidurals work?<\/span><\/h2>\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK542219\/\"><span style=\"font-weight: 400;\">Epidural anesthesia<\/span><\/a><span style=\"font-weight: 400;\"> (another term for an epidural) is a type of anesthesia injected into the epidural space, near the spine. It\u2019s also called neuraxial analgesia. Anesthetic medications can be delivered to the epidural space via a tube to block pain and sensation in the lower back, lower abdomen, pelvis, and upper leg areas.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Epidurals are most commonly used for childbirth. A study published in 2018 found that about <\/span><a href=\"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2719581\"><span style=\"font-weight: 400;\">73% (almost 3 in 4) of people giving birth had an epidural<\/span><\/a><span style=\"font-weight: 400;\">. Epidurals can also be used for certain surgeries as well, including surgeries in the abdomen or around the lower spine.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Anesthesiologists, medical doctors with a specialization in administering anesthesia, typically choose a combination of medications for the epidurals. <\/span><a href=\"https:\/\/americanpregnancy.org\/healthy-pregnancy\/labor-and-birth\/what-is-an-epidural\"><span style=\"font-weight: 400;\">Epidurals contain<\/span><\/a><span style=\"font-weight: 400;\"> a combination of a local anesthetic that blocks pain in the lower body and an <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/opioids\"><span style=\"font-weight: 400;\">opioid<\/span><\/a><span style=\"font-weight: 400;\"> to manage pain. Medications commonly used in epidurals include Marcaine (bupivacaine), Naropin (ropivacaine), lidocaine, fentanyl, and sufentanil.<\/span><\/p>\n<h3 id=\"how-long-does-it-take-for-an-epidural-to-work\"><span style=\"font-weight: 400;\">How long does it take for an epidural to work?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">How long it takes an epidural to work and how long it lasts depends on the types and doses of the medications used. For example, bupivacaine reaches peak levels in the blood <\/span><a href=\"https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2018\/018053s060lbl.pdf\"><span style=\"font-weight: 400;\">30 to 45 minutes after injection<\/span><\/a><span style=\"font-weight: 400;\">, though the person may experience pain relief sooner. According to its drug label, bupivacaine reaches very low levels three to six hours after administration. If pain management is still needed, anesthesiologists may deliver <\/span><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC3417963\/\"><span style=\"font-weight: 400;\">maintenance doses<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h2 id=\"how-much-fentanyl-is-in-an-epidural\"><span style=\"font-weight: 400;\">How much fentanyl is in an epidural?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Epidurals contain a combination of a <\/span><a href=\"https:\/\/www.yalemedicine.org\/news\/epidural-anesthesia\"><span style=\"font-weight: 400;\">local anesthetic and an opioid<\/span><\/a><span style=\"font-weight: 400;\">, which may be fentanyl or hydromorphone, for example. Only weak concentrations of fentanyl are used, and it\u2019s typically measured in micrograms per milliliter (mcg\/mL). For example, an epidural may contain 0.0625% levobupivacaine, a local anesthetic, and <\/span><a href=\"https:\/\/bmcanesthesiol.biomedcentral.com\/articles\/10.1186\/s12871-023-02222-w\"><span style=\"font-weight: 400;\">2 mcg of fentanyl per milliliter of epidural solution<\/span><\/a><span style=\"font-weight: 400;\">. Only a small amount enters the mother\u2019s bloodstream, making it safe for the baby while ensuring the mother doesn\u2019t experience the side effects that oral or intravenous fentanyl would cause.\u00a0\u00a0\u00a0<\/span><\/p>\n<h2 id=\"fentanyl-during-labor-is-it-safe\"><span style=\"font-weight: 400;\">Fentanyl during labor: Is it safe?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">\u201cWhen administered by a trained medical professional, fentanyl is generally safe for labor pain relief. It is often included in epidurals and spinal blocks because it provides effective pain relief without causing excessive sedation,\u201d explains <\/span><a href=\"https:\/\/wellbridge.org\/contributors\/edmond-hakimi\/\"><span style=\"font-weight: 400;\">Edmond Hakimi<\/span><\/a><span style=\"font-weight: 400;\">, DO, a dual-board-certified internal medicine physician and the medical director at Wellbridge in Calverton, New York. He explains that, unlike opioid medications injected intravenously, \u201cepidural fentanyl works locally, reducing pain without significantly impacting the baby\u2019s breathing.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In a <\/span><a href=\"https:\/\/www.ajogmfm.org\/article\/S2589-9333(24)00036-3\/fulltext\"><span style=\"font-weight: 400;\">study of low-risk pregnancies in Thai hospitals<\/span><\/a><span style=\"font-weight: 400;\">, fentanyl given during childbirth through the veins or an injection under the skin did not have any negative effects on the mother or newborn. However, there are some <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/fentanyl-side-effects\/\"><span style=\"font-weight: 400;\">fentanyl side effects<\/span><\/a><span style=\"font-weight: 400;\"> and risks associated with epidurals in general. According to the American College of Obstetricians and Gynecologists (ACOG), common side effects of using opioids like fentanyl include <\/span><a href=\"https:\/\/www.acog.org\/womens-health\/faqs\/medications-for-pain-relief-during-labor-and-delivery\"><span style=\"font-weight: 400;\">itching, nausea, vomiting, and breathing problems<\/span><\/a><span style=\"font-weight: 400;\">. Other side effects of an epidural include lower blood pressure, fever, headache, soreness, shivering, difficulty urinating, and reactivation of cold sores.\u00a0<\/span><\/p>\n<h3 id=\"who-is-fentanyl-not-for\"><span style=\"font-weight: 400;\">Who is fentanyl not for?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Some people shouldn\u2019t use fentanyl, even in a safe hospital setting. According to its drug label, fentanyl is not for people who are allergic to fentanyl, who have a history of opioid addiction, or who are at risk of slowed heart or breathing activity (cardiovascular or respiratory depression). According to the American Pregnancy Association, an epidural is not an option for people who:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Use <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/anticoagulants\"><span style=\"font-weight: 400;\">blood thinners<\/span><\/a><span style=\"font-weight: 400;\"> or have low platelet counts<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Have an infection on the back, in the back, or in the blood<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are bleeding or are in shock\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are not at least 4 cm dilated, or labor is moving too fast<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Can\u2019t have their epidural space accessed by a healthcare provider<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">&#8220;Fentanyl may not be safe for all women, particularly those with severe respiratory disorders, opioid dependence, or certain heart conditions. In rare cases, high doses may cause temporary breathing issues for the baby, so its use is closely monitored,\u201d Dr. Hakimi shares.\u00a0<\/span><\/p>\n<p><strong>RELATED: <\/strong><a href=\"https:\/\/www.singlecare.com\/prescription\/fentanyl\/what-is\"><strong>Learn more about fentanyl uses &amp; warnings<\/strong><\/a><\/p>\n<h3 id=\"fentanyl-in-epidurals-and-breastfeeding\"><span style=\"font-weight: 400;\">Fentanyl in epidurals and breastfeeding<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">In general, fentanyl given during labor and short procedures is <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK501222\/\"><span style=\"font-weight: 400;\">not expected to harm newborns<\/span><\/a><span style=\"font-weight: 400;\">. Clinical trials have shown that epidurals, with or without fentanyl, <\/span><a href=\"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-2044.2009.06136.x\"><span style=\"font-weight: 400;\">don\u2019t have an effect on starting or continuing breastfeeding<\/span><\/a><span style=\"font-weight: 400;\"> after birth.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Newborns who are breastfed by people on oral opioids such as fentanyl can be at risk of side effects such as sleepiness and possible nervous system depression. If a baby shows signs of sleepiness, difficulty breastfeeding, difficulty breathing, or limpness, get emergency medical help immediately.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Fentanyl is an opioid medication used as an anesthetic in hospital settings as well as a pain reliever (analgesic) both in and out of the hospital. It plays a key role in various medical procedures, including epidurals. An epidural is a method of pain relief used commonly during childbirth that involves injecting medication into the [&hellip;]<\/p>\n","protected":false},"author":149,"featured_media":632155,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[808,8615],"coauthors":[21072],"class_list":["post-632154","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-pain-management","tag-pregnancy","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Is there fentanyl in an epidural?<\/title>\n<meta name=\"description\" content=\"There may be a weak concentration of fentanyl or another opioid in an epidural, but only a small amount enters the mother\u2019s bloodstream.\" \/>\n<meta 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