title: The dermatomal spread of epidural bupivacaine with and without prior intrathecal sufentanil.
abstract: Clinicians often use a technique combining intrathecal sufentanil and epidural bupivacaine to provide labor analgesia. This study determines the effect of 27- or 24-gauge dural puncture and intrathecal sufentanil 10 micrograms on the dermatomal spread of epidural bupivacaine. Healthy laboring women received no dural puncture (n = 77) (no puncture group [NPG]) or dural puncture with a 27-gauge Whitacre needle (n = 33) or a 24-gauge Sprotte needle (n = 37) and intrathecal sufentanil 10 micrograms (dural puncture group [DPG]) before epidural injection of 13 mL bupivacaine 0.25%. More dermatomes were anesthetized in the DPG, 16.6 +/- 7.5 vs 13.6 +/- 6.6 in the NPG (P < 0.02). More patients in the DPG had sensory blockade T-4 or higher (17 of 70 DPG patients vs 8 of 77 NPG patients; P < 0.05). No patient in either group showed clinical evidence of respiratory compromise. In conclusion, epidural bupivacaine anesthetized more dermatomes when administered 104 +/- 42 min after dural puncture and intrathecal sufentanil 10 micrograms than when given without prior dural puncture and intrathecal injection.
authors.affiliation: Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
authors.forename: B L
authors.initials: BL
authors.lastname: Leighton
authors.forename: V A
authors.initials: VA
authors.lastname: Arkoosh
authors.forename: S
authors.initials: S
authors.lastname: Huffnagle
authors.forename: H J
authors.initials: HJ
authors.lastname: Huffnagle
authors.forename: S M
authors.initials: SM
authors.lastname: Kinsella
authors.forename: M C
authors.initials: MC
authors.lastname: Norris
mesh_terms: D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D011247:Pregnancy; D011446:Prospective Studies; D012677:Sensation; D012867:Skin / Q000294:innervation; D013129:Spinal Puncture; D017409:Sufentanil / Q000008:administration & dosage*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D017409:Sufentanil; D002045:Bupivacaine