title: Use of fetal analgesia during prenatal surgery.
abstract: OBJECTIVE
  Recent progresses in fetal surgery have raised concern on fetal pain, its long-term consequences and the risks of sudden fetal movements induced by pain. In several studies, surgeons have directly administered opioids to the fetus, while others have considered sufficient the maternally administered analgesics. We performed a review of the literature to assess the state of the art.
  
  
  METHODS
  We performed a PubMed search to retrieve the papers that in the last 10 years reported studies of human fetal surgery and that described whether any fetal analgesia was administered.
  
  
  RESULTS
  We retrieved 34 papers. In three papers, the procedure did not hurt the fetus, being performed on fetal annexes, in two papers, it was performed in the first half of pregnancy, when pain perception is unlikely. In 10 of the 29 remaining papers, fetal surgery was performed using direct fetal analgesia, while in 19, analgesia was administered only to the mother. In most cases, fetal direct analgesia was obtained using i.m. opioids, and muscle relaxant. Rare drawbacks on either fetuses or mothers due to fetal analgesia were reported.
  
  
  CONCLUSIONS
  Fetal direct analgesia is performed only in a minority of cases and no study gives details about fetal reactions to pain. More research is needed to assess or exclude its possible long-term drawbacks, as well as the actual consequences of pain during surgery.
authors.affiliation: Department of Pediatrics, University of Siena, Italy. cvbellieni@gmail.com
authors.forename: Carlo V
authors.initials: CV
authors.lastname: Bellieni
authors.forename: M
authors.initials: M
authors.lastname: Tei
authors.forename: G
authors.initials: G
authors.lastname: Stazzoni
authors.forename: S
authors.initials: S
authors.lastname: Bertrando
authors.forename: S
authors.initials: S
authors.lastname: Cornacchione
authors.forename: G
authors.initials: G
authors.lastname: Buonocore
mesh_terms: D000698:Analgesia; D005260:Female; D046128:Fetal Therapies / Q000009:adverse effects*; D005333:Fetus / Q000601:surgery*; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D011247:Pregnancy