The reason naloxone, along with antiemetics, is given post epidural
with Duramorph is because there is such a high incidence of nausea
and itching after this type of epidural.  It has nothing to do with plasma
levels of narcotic causing sedation, or apnea, or anything like that.
It's for itching--not that it works all that great  (about 50/50  in my
patients).   Watch out what you say about plasma levels of fentanyl
with continuous epidural--they might actually be rather low, unless there
was a complication with the epidural.  I'm hoping someone on Lactnet
has a reference on cord-blood levels of fentanyl  correlated with
poorer neonatal latch-on, etc., because I've seen little sedation or
latch-on problems with my OB patients' babies that ever seemed to
be related to the type of analgesia.  Any such study should correct
for the length of the labor, because an injudiciously -timed epidural
can prolong the labor  and give you a pooped-out mom or baby, whether
it  involved narcotic or local anesthetic.
(Guess  you can figure out my bias here.)   Lisa G. Matthews, M.D. FACOG



                                                                    Stamford,
CT