title: Speed of onset of regional analgesia in labour: a comparison of the epidural and spinal routes.
abstract: This study compares the speed of onset of effective analgesia in two randomly assigned groups of patients requesting analgesia in labour. Patients in the combined spinal-epidural group (n = 69) were given a subarachnoid injection of 1.5 ml containing bupivacaine 2.5 mg and fentanyl 25 microg for initiation of analgesia. Patients in the epidural group (n = 73) were given an epidural injection of 10 ml containing bupivacaine 12.5 mg and fentanyl 50 microg. Mean (SD) onset times to the first pain-free contraction were 10.0 (5.7) min in the combined spinal-epidural group and 12.1 (6.5) min in the epidural group (p = 0.054). Patients in the combined spinal-epidural group suffered a higher incidence of motor weakness and proprioceptive deficit than those in the epidural group (p = 0.01). The incidence of technique failure and side-effects was similar in the two groups. It is our contention that the statistically nonsignificant difference in onset times does not justify the additional potential for side-effects and the extra cost of the equipment involved in the combined spinal-epidural technique.
authors.affiliation: Department of Anaesthesia, Northwick Park and St Mark's Hospitals, Harrow, Middlesex, UK.
authors.forename: J S
authors.initials: JS
authors.lastname: Nickells
authors.forename: D J
authors.initials: DJ
authors.lastname: Vaughan
authors.forename: N K
authors.initials: NK
authors.lastname: Lillywhite
authors.forename: B
authors.initials: B
authors.lastname: Loughnan
authors.forename: M
authors.initials: M
authors.lastname: Hasan
authors.forename: P N
authors.initials: PN
authors.lastname: Robinson
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local; D002045:Bupivacaine; D005260:Female; D005283:Fentanyl; D006801:Humans; D007743:Labor, Obstetric; D011247:Pregnancy; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine