The effect of epidural fentanyl on the minimum local analgesic concentration of epidural chloroprocaine in labor.
The minimum local analgesic concentration (MLAC) has been defined as the median effective local analgesic concentration (EC50) in a 20-mL volume in the first stage of labor. The aim of this study was to determine the local anesthetic sparing efficacy of epidural fentanyl by its effect on the MLAC of chloroprocaine. Fifty-six parturients, not exceeding 7 cm cervical dilation, who requested epidural analgesia were allocated to one of two groups in this double-blind, randomized, prospective study. After placing a lumbar epidural catheter, 20 mL of the solution being tested was given: chloroprocaine (n = 28) or chloroprocaine with fentanyl 3 micrograms/mL (60 micrograms) (n = 28). The concentration of chloroprocaine was determined by the response of the previous patient to a higher or lower concentration using up-down sequential allocation. Analgesic efficacy was assessed using 100-mm visual analog pain scores with 10 mm or less within 30 min defined as effective. The MLAC of chloroprocaine was reduced from 0.43% wt/vol to 0.26% wt/vol by fentanyl (P = 0.023). Thus, the addition of epidural fentanyl 3 micrograms/mL (60 micrograms resulted in a significant 40% reduction in the MLAC of chloroprocaine in the first stage of labor.
Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor 48109-0048, USA.
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Polley
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Columb
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Lyons
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Nair
D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007747:Labor Stage, First; D007743:Labor, Obstetric; D010147:Pain Measurement; D011247:Pregnancy; D011343:Procaine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011446:Prospective Studies; D012044:Regression Analysis
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D004338:Drug Combinations; D011343:Procaine; C004616:chloroprocaine; D005283:Fentanyl