title: Combined spinal epidural for labour analgesia--duration, efficacy and side effects of adding sufentanil or fentanyl to bupivacaine intrathecally vs plain bupivacaine.
abstract: OBJECTIVE
  The aim of the study was to evaluate the efficacy and side effects of adding sufentanil 10 micrograms, fentanyl 10 micrograms or a control of 1 mL saline to 2.5 mg bupivacaine given intrathecally via combined spinal epidural (CSE) for labour pain relief in the first stage.
  
  
  METHODS
  Sixty ASA I or II patients who requested for epidural analgesia were randomised to three groups. CSE was performed with a 16G Touhy needle and 27G Whitacre needle.
  
  
  RESULTS
  Patients in the sufentanil/bupivacaine group had a significantly longer duration of analgesia (162.9 min +/- 63.4) compared with fentanyl/bupivacaine (110.0 min +/- 44.6) compared with plain bupivacaine (70.0 min +/- 32.1). Pruritus was significant in patients with sufentanil (80%) and fentanyl (47.4%) but did not occur with plain bupivacaine. There was no significant difference in the incidence of nausea or vomiting, hypotension and motor blockade although blood pressures in the sufentanil group were consistently lower than the other two groups. Pain scores were lowest in the sufentanil group. Fetal heart rate changes and Apgar scores were not significantly different between the groups.
  
  
  CONCLUSIONS
  In combined spinal epidural for labour analgesia, adding sufentanil 10 micrograms to intrathecal bupivacaine 2.5 mg provided fast onset and good analgesia for a longer duration compared with adding fentanyl 10 micrograms and with plain bupivacaine. The main side effect was pruritus. Neonatal outcome was similar.
authors.affiliation: Department of Anaesthesia, KK Women's and Children's Hospital, Singapore.
authors.forename: W K
authors.initials: WK
authors.lastname: Lo
authors.forename: J L
authors.initials: JL
authors.lastname: Chong
authors.forename: L H
authors.initials: LH
authors.lastname: Chen
mesh_terms: D000759:Adjuvants, Anesthesia / Q000009:adverse effects; D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects; D000779:Anesthetics, Local / Q000009:adverse effects; D002045:Bupivacaine / Q000009:adverse effects; D005260:Female; D005283:Fentanyl; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007278:Injections, Spinal; D007743:Labor, Obstetric; D009325:Nausea / Q000139:chemically induced; D010146:Pain / Q000188:drug therapy; D011247:Pregnancy; D011256:Pregnancy Outcome; D017409:Sufentanil / Q000009:adverse effects; D014839:Vomiting / Q000139:chemically induced
chemical_list: D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D017409:Sufentanil; D005283:Fentanyl; D002045:Bupivacaine