title: Bupivacaine augments intrathecal fentanyl for labor analgesia.
abstract: BACKGROUND
  fentanyl has been shown to be an effective analgesic for labor; this study investigated the analgesic effect of low-dose bpivacaine added to intrathecal fentanyl for labor analgesia
  
  
  METHODS
  Ninety parturients in active labor who requested regional analgesia were randomized to receive an intrathecal injection of either fentanyl, 25 microg; bupivacaine, 1.25 mg, with fentanyl, 25 microg; or bupivacaine, 2.5 mg, with fentanyl, 25 microg, as part of a combined spinal-epidural technique. Visual analog pain scores were recorded before and at intervals after injection until the patient requested further analgesia. Maternal blood pressure and fetal heart rate were recorded before and at intervals after injection. Lower-extremity muscle strength was tested before and 30 min after injection; anesthetic level to cold sensation and the presence and severity of pruritus were recorded.
  
  
  RESULTS
  Duration of analgesia was longer in the group receiving bupivacaine, 2.5 mg, and fentanyl, 25 microg, than the group receiving plain fentanyl (108 vs. 92 min; P < 0.05). Onset of analgesia was faster in both groups receiving bupivacaine compared with plain fentanyl (P < 0.05). No differences in muscle strength after injection were found in any group, although anesthetic levels to cold were documented in all patients in the bupivacaine groups, and 21 of 30 in the plain fentanyl group. Baseline fetal heart rates did not change after injection in any group, and maternal blood pressure was unchanged.
  
  
  CONCLUSIONS
  The addition of 2.5 mg isobaric bupivacaine to 25 microg fentanyl for intrathecal labor analgesia modestly increases duration and speeds onset of analgesia compared with plain intrathecal fentanyl.
authors.affiliation: Department of Anesthesiology, Arizona Health Sciences Center, Tucson, USA. cpalmer@u.arizona.edu
authors.forename: C M
authors.initials: CM
authors.lastname: Palmer
authors.forename: G
authors.initials: G
authors.lastname: Van Maren
authors.forename: W M
authors.initials: WM
authors.lastname: Nogami
authors.forename: D
authors.initials: D
authors.lastname: Alves
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D004357:Drug Synergism; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006340:Heart Rate, Fetal / Q000187:drug effects; D006801:Humans; D007278:Injections, Spinal; D011247:Pregnancy
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine