title: Epidural fentanyl produces labor analgesia by a spinal mechanism.
abstract: BACKGROUND
  The purpose of this study was to determine if epidural fentanyl produces analgesia in laboring patients by a primary spinal or supraspinal action.
  
  
  METHODS
  Fifty-four parturients were randomized to receive epidural 0.125% bupivacaine plus one of three treatments: epidural saline-intravenous saline, epidural fentanyl (20 microg/h)-intravenous saline, or epidural saline-intravenous fentanyl (20 microg/h). The study treatments were administered by continuous infusion, whereas epidural bupivacaine use was patient controlled.
  
  
  RESULTS
  Epidural bupivacaine use was significantly reduced by epidural (11.5+/-4.6 ml/h) but not by intravenous fentanyl (15.9+/-4.5 ml/h) compared with saline control (16+/-5.9 ml/ h). Analgesia characteristics and side effects were similar among groups.
  
  
  CONCLUSIONS
  Low-dose epidural infusions of fentanyl produce labor analgesia by a primary spinal action.
authors.affiliation: Department of Anesthesiology, The Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina, USA. rdangelo@bgsm.edu
authors.forename: R
authors.initials: R
authors.lastname: D'Angelo
authors.forename: J C
authors.initials: JC
authors.lastname: Gerancher
authors.forename: J C
authors.initials: JC
authors.lastname: Eisenach
authors.forename: B L
authors.initials: BL
authors.lastname: Raphael
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007743:Labor, Obstetric; D011247:Pregnancy
chemical_list: D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D005283:Fentanyl