Epidural infusion of alfentanil or diamorphine with bupivacaine in labour--a dose finding study.
Following induction of epidural analgesia with 0.375% bupivacaine, 120 healthy parturients were randomly assigned in a double blind fashion to one of eight infusion groups. All received 8 ml.h-1 of 0.125% bupivacaine either alone (control group), or with alfentanil at 133, 266 or 400 micrograms.h-1 (groups A1-A3) or with diamorphine at 133, 266, 400 or 533 micrograms.h-1 (groups D1-D4). Significantly longer top-up intervals were achieved with the two highest doses of both alfentanil and diamorphine when compared with bupivacaine alone (p < 0.01), making the minimum effective doses 266 micrograms.h-1 of alfentanil and 400 micrograms.h-1 of diamorphine. Perineal analgesia was better in all the opioid groups compared with the control group (p < 0.05). The intensity of motor block was greater in the control group (p < 0.05). The incidence of pruritus did not differ between groups. The highest dose of diamorphine caused significantly more nausea. No significant neonatal side-effects were demonstrated.
Hill
D A
DA
Department of Anaesthetics, Waveney Hospital, Ballymena, N. Ireland.
McCarthy
G
G
Bali
I M
IM
D000293:Adolescent; D000328:Adult; D015760:Alfentanil / Q000008:administration & dosage* / Q000009:adverse effects; D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D001034:Apgar Score; D002045:Bupivacaine / Q000009:adverse effects; D036861:Delivery, Obstetric / Q000379:methods; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D003932:Heroin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007743:Labor, Obstetric; D011247:Pregnancy
D015760:Alfentanil; D003932:Heroin; D002045:Bupivacaine