Continuous epidural infusion of 0.0625% bupivacaine-0.0002% fentanyl during the second stage of labor.
A randomized, double-blind, placebo-controlled study was performed to evaluate the analgesic efficacy and influence of continuing an epidural infusion of 0.0625% bupivacaine-0.0002% fentanyl during the second stage of labor in nulliparous women. When the cervix was fully dilated, coded study solution was substituted for the known bupivacaine-fentanyl solution. The study solution for 29 patients was 0.0625% bupivacaine-0.0002% fentanyl; 34 patients received saline placebo. The two groups had similar pain scores during the first stage of labor. During the second stage, pain scores were significantly higher in the saline-placebo group at each 30-min interval between 60 and 150 min after the diagnosis of full cervical dilation. Similarly, there was a significant difference between the two groups in global assessment of analgesia quality during the second stage, but the difference occurred in those patients with a second-stage duration of greater than or equal to 60 min. Among the women who delivered vaginally, eleven of 28 (39%) women in the bupivacaine-fentanyl group, versus five of 34 (15%) in the saline-placebo group, had surgical perineal anesthesia for vaginal delivery (P less than .05). Six of 28 (21%) women in the bupivacaine-fentanyl group, and five of 34 (15%) in the saline-placebo group, underwent instrumental vaginal delivery (P = NS). The median duration of the second stage of labor was 53 min (range = 5-283) in the bupivacaine-fentanyl group, and 63 min (range = 16-181) in the saline-placebo group (P = NS).(ABSTRACT TRUNCATED AT 250 WORDS)
Chestnut
D H
DH
Department of Anesthesia, University of Iowa College of Medicine, Iowa City 52242.
Laszewski
L J
LJ
Pollack
K L
KL
Bates
J N
JN
Manago
N K
NK
Choi
W W
WW
D000767:Anesthesia, Epidural / Q000379:methods; D000773:Anesthesia, Obstetrical; D002045:Bupivacaine; D002585:Cesarean Section; D036861:Delivery, Obstetric; D005260:Female; D005283:Fentanyl; D006801:Humans; D007748:Labor Stage, Second; D007743:Labor, Obstetric; D010146:Pain; D011247:Pregnancy; D011256:Pregnancy Outcome
D005283:Fentanyl; D002045:Bupivacaine