Analgesic efficacy and side effects of subarachnoid sufentanil-bupivacaine administered to women in advanced labor.
OBJECTIVE
Previous studies of labor analgesia using subarachnoid sufentanil (alone or with adjuvants) have focused on women in the early first stage of labor. This study prospectively evaluated analgesia and side effects of subarachnoid sufentanil (10 micrograms) plus bupivacaine (2.5 mg) in parturients with cervical dilation of 7 cm or more.


METHODS
In an open-label, nonrandomized trial, 32 parturients in the late first stage of labor, who had requested regional anesthesia, consented to subarachnoid injection of sufentanil (10 micrograms) and bupivacaine (2.5 mg). Patients rated their pain by a verbal pain score (0-10 scale) prior to regional anesthesia, 5 minutes after subarachnoid injection, and every 20 minutes thereafter until delivery or request for additional analgesia. Blood pressure, pruritus, Bromage motor block score (0-3), mode of delivery, and need for supplemental analgesics were recorded.


RESULTS
Lumbar puncture was successful in 30 women. Pain scores (mean +/- SD) were 8.7 +/- 1.0 prespinal and 0.7 +/- 1.5 5 minutes postinjection, and remained less than 5 for 130 minutes after the spinal injection. Of these 30 patients, 24 had unassisted vaginal delivery, 4 had instrumental vaginal delivery (3 vacuum, 1 low forceps), and 2 had cesarean delivery. Of the 28 patients who delivered vaginally, 19 did not require supplemental analgesics and had a delivery pain score of 5 or lower. Blood pressure decreased after spinal analgesia (P < .05), and necessitated treatment in three patients. The Bromage motor block score was 0 in 26 patients and 1 in 4 patients. Pruritus was noted by 22 patients.


CONCLUSIONS
In parturients with cervical dilation of 7 cm or more, subarachnoid sufentanil-bupivacaine produces rapid analgesia with an effective duration of approximately 130 minutes.
Viscomi
C M
CM
Department of Anesthesiology, University of Vermont College of Medicine, Burlington, USA.
Rathmell
J P
JP
Mason
S B
SB
Livermore
M
M
Schapiro
H
H
D000328:Adult; D016362:Analgesia, Obstetrical / Q000379:methods*; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000009:adverse effects; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D007747:Labor Stage, First; D011247:Pregnancy; D011446:Prospective Studies; D011537:Pruritus / Q000139:chemically induced; D013346:Subarachnoid Space; D017409:Sufentanil / Q000009:adverse effects
D017409:Sufentanil; D002045:Bupivacaine