0.0625% bupivacaine with 0.0002% fentanyl via patient-controlled epidural analgesia for pain of labor and delivery.
OBJECTIVE
To compare the utility of 0.0625% bupivacaine with fentanyl administered via patient-controlled epidural analgesia (PCEA) to a traditional continuous epidural infusion for pain of labor and delivery.


METHODS
Forty-one women in established labor were randomized to receive either (a) 0.0625% bupivacaine with 2 micrograms/ml fentanyl via PCEA (demand dose = 3 ml, lockout interval = 6 min, background infusion = 6 ml/h, no 1 or 4 h limits) or (b) 0.125% bupivacaine with 2 micrograms/ml fentanyl via continuous epidural infusion (CEI) at 12 ml/h. Supplemental 0.25% bupivacaine (3 ml every 5 min, p.r.n., x 3) was administered for treatment of breakthrough pain upon patient request. The study protocol was double-blind and placebo-controlled.


METHODS
Visual analogue pain scores, motor strength, pinprick level of sensory analgesia and bupivacaine use were assessed by an anesthesiologist unaware of the individual patient's randomization to a particular study group.


RESULTS
The cephalad extent of pinprick sensory analgesia was significantly lower during both the first (p < 0.03) and second (p < 0.03) stages of labor in patients receiving PCEA. However, visual analogue pain scores, intensity of motor blockade, and need for physician-administered supplemental bupivacaine were comparable in both groups. Patients receiving PCEA used 40% less bupivacaine per hour while achieving analgesia comparable to patients receiving CEI.


CONCLUSIONS
The results of this study show that 0.0625% bupivacaine with 2 micrograms/ml of fentanyl is an effective analgesic combination when used via PCEA.
Ferrante
F M
FM
Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Barber
M J
MJ
Segal
M
M
Hughes
N J
NJ
Datta
S
S
D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D001034:Apgar Score; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage; D036861:Delivery, Obstetric; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D010147:Pain Measurement; D011247:Pregnancy
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D004338:Drug Combinations; D005283:Fentanyl; D002045:Bupivacaine