Intrathecal sufentanil dose response in nulliparous patients.
BACKGROUND
Intrathecal sufentanil provides effective analgesia during the first stage of labor. A range of doses has been reported to provide adequate pain relief. This study determined the dose of intrathecal sufentanil that produced acceptable pain relief in 50% of nulliparous patients (ED50) who requested labor analgesia.


METHODS
With institutional review board approval, 50 nulliparous patients requesting spinal opioid labor analgesia were enrolled into this prospective, randomized, double-blinded study. Each patient was in spontaneous labor at <5 cm cervical dilation. Patients received one of the following doses of intrathecal sufentanil: 1, 2, 3, 5, or 10 microg in 3 ml preservative-free saline (n = 10 for each dose). Pain, pain relief, hemodynamic, respiratory, and side effect data were collected at times 0, 2, 5, 10, 15, 20, 25, and 30 min. Probit analysis of the number of patients in each group who requested additional pain medicine at 30 min was used to determine the ED50.


RESULTS
The groups were demographically similar. The ED50 of intrathecal sufentanil was 1.8 microg (SE, 0.6 microg; 95% CI, 2.96 to 0.54 microg). The incidence of side effects was similar among the groups.


CONCLUSIONS
This is the first study to determine the ED50 of intrathecal sufentanil in spontaneously laboring nulliparous patients. As dose-response curves are determined for other labor analgesics, future studies can compare equianalgesic doses or dose combinations.
Thomas Jefferson University Hospital, Allegheny University of the Health Sciences, Philadelphia, Pennsylvania, USA. varkoosh@gte.net
V A
VA
Arkoosh
M
M
Cooper
M C
MC
Norris
L
L
Boxer
F
F
Ferouz
N S
NS
Silverman
H J
HJ
Huffnagle
S
S
Huffnagle
B L
BL
Leighton
D000328:Adult; D016362:Analgesia, Obstetrical; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D010147:Pain Measurement; D011247:Pregnancy; D011446:Prospective Studies; D011537:Pruritus / Q000139:chemically induced; D017409:Sufentanil / Q000008:administration & dosage / Q000009:adverse effects
D000701:Analgesics, Opioid; D017409:Sufentanil