title: Epidural anesthesia for labor in an ambulatory patient.
abstract: The effectiveness of two epidural analgesic regimens on the ability to ambulate was compared in women in labor by a prospective, randomized, double-blind design. One group of patients received epidural fentanyl, a 75-micrograms bolus and an infusion of fentanyl 2.5 micrograms/mL at 15 mL/h (FENT, n = 53). A second group received ultra low-dose bupivacaine (0.04%), epinephrine (1.7 micrograms/mL), and fentanyl (1.7 micrograms/mL) (BEF, n = 77), a 15-mL bolus followed by an infusion at 15 mL/h. Adequate analgesia was rapidly obtained in 90.6% of patients in the FENT group and 92.2% of patients in the BEF group (P = 0.89). Seventy percent of patients in the FENT group ambulated versus 68% in the other group. The BEF mixture provided analgesia of longer duration (287 +/- 171 min versus 156 +/- 72 min, P = 0.0001). The number of patients delivering during administration of only their study drug (without needing higher doses of local anesthetics) was 52% for BEF and 21% for FENT (P = 0.0005). Hip flexion weakness precluding ambulation occurred in 17% (P = 0.002) of BEF patients and orthostatic hypotension in 9% (P = 0.08). Neither problem occurred in FENT patients. Neonatal outcome was similar in both groups. Approximately 70% of women receiving epidural analgesia with fentanyl or ultra low-dose bupivacaine, epinephrine, and fentanyl may ambulate safely during labor.
authors.affiliation: Department of Anesthesia, Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: T W
authors.initials: TW
authors.lastname: Breen
authors.forename: T
authors.initials: T
authors.lastname: Shapiro
authors.forename: B
authors.initials: B
authors.lastname: Glass
authors.forename: D
authors.initials: D
authors.lastname: Foster-Payne
authors.forename: N E
authors.initials: NE
authors.lastname: Oriol
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D002045:Bupivacaine / Q000008:administration & dosage; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007743:Labor, Obstetric; D011247:Pregnancy; D011446:Prospective Studies
chemical_list: D005283:Fentanyl; D002045:Bupivacaine; D004837:Epinephrine