title: Ambulatory combined spinal-epidural analgesia for labor. Influence of epinephrine on bupivacaine-sufentanil combination.
abstract: OBJECTIVE
  Subarachnoid sufentanil 5 micrograms during labor is known to have variable results. However, subarachnoid sufentanil 5 micrograms plus bupivacaine 1 mg provides good quality labor analgesia of 100 minutes' average duration. The objective of this study was to examine the effects of adding epinephrine 25 micrograms to this mixture.
  
  
  METHODS
  Forty-two parturients with less than 5 cm cervical dilation participated in this double-blind, randomized study. A combined spinal-epidural technique was used for subarachnoid administration of sufentanil 5 micrograms and bupivacaine 1 mg with or without epinephrine 25 micrograms. Analgesia was assessed by visual analog scores. Time elapsed until first request for additional analgesia, blood pressure, heart rate, sensory levels, motor block, and incidence of pruritus, nausea, and sedation were noted.
  
  
  RESULTS
  Addition of epinephrine prolonged the duration of analgesia from 103.8 +/- 28.2 minutes to 142 +/- 54.3 minutes and lowered the median cephalad level of sensory block from T3 to T6. The incidence of side effects was similar in both groups, as was the motor performance; 19 patients were able to ambulate in each group.
  
  
  CONCLUSIONS
  This minimal bupivacaine-sufentanil-epinephrine mixture allows high-quality analgesia of 142 +/- 54.3 minutes' duration, with a low sensory block level and no motor block. However, hypotension can occur as a late side effect.
authors.affiliation: Department of Anesthesiology, Clinique Ste. Anne-St. Remi, Brussels, Belgium.
authors.forename: P E
authors.initials: PE
authors.lastname: Gautier
authors.forename: F
authors.initials: F
authors.lastname: Debry
authors.forename: L
authors.initials: L
authors.lastname: Fanard
authors.forename: A
authors.initials: A
authors.lastname: Van Steenberge
authors.forename: J L
authors.initials: JL
authors.lastname: Hody
mesh_terms: D000316:Adrenergic alpha-Agonists; D000328:Adult; D000553:Ambulatory Care; D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D002045:Bupivacaine; D004311:Double-Blind Method; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D004837:Epinephrine; D005260:Female; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D017409:Sufentanil
chemical_list: D000316:Adrenergic alpha-Agonists; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D017409:Sufentanil; D002045:Bupivacaine; D004837:Epinephrine