Combined spinal-epidural analgesia and epidural analgesia in labor: effect of intrathecal fentanyl vs. epidural bupivacaine as a bolus

Ngamprasertwong, P.; Kumwilaisakmd, K.; Indrambarya, T.; Supbornsug, K.; Ngarmukos, S.

Journal of the Medical Association of Thailand 90(7): 1368-1374

2007


ISSN/ISBN: 0125-2208
PMID: 17710979
Document Number: 2970
Objective: To compare the clinical effects of intrathecal fentanyl with conventional epidural bypivacaine bolus before the same continuous epidural infusion for labor analgesia.Material and Method: Fifty parturients in active labor were randomized to receive subarachnoid fentanyl 25 mcg as part of a combined spinal epidural analgesia (CSE) or bupivacaine 0. 25% 10 ml incrementally into the epidural space in the epidural group. After that, 0.0625% bupivacaine with fentanyl 2 mcg/ml was infused via epidural catheter in all women at a rate of 12 ml/h. Verbal numeric pain scores (VNPS), onset time to pain relief times of additional analgesia and other side effects were recorded.Results: Mean (SD) onset time to the first pain free contraction was not significantly different (7.8 +/- 4.3 min in the CSE group, 10. 2 +/- 5. 1 in in in epidural group, p = 0. 085). Most of the patients in the CSE group required additional epidural bolus dose (80% compared to 48% in the Epidural group, p = 0.038). There was no difference in motor blockage at time of delivery or mode of delivery. Significantly more women in the CSE group had pruritus (68% VS none in the epidural group, p < 0. 001), all had mild degree and did not require any treatment. There was no difference in other side effects.Conclusion: Intrathecal fentanyl as part of CSE did not produce statistically a significant faster onset compared to epidural bupivacaine bolus. Most of the patients in the CSE group required epidural bolus after intrathecal fentanyl with a higher incidence of pruritus.

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Combined spinal-epidural analgesia and epidural analgesia in labor: effect of intrathecal fentanyl vs. epidural bupivacaine as a bolus