Comparison of fentanyl and sufentanil in combination with bupivacaine for patient-controlled epidural analgesia during labor.
OBJECTIVE
To compare the efficacy of fentanyl plus bupivacaine with sufentanil plus bupivacaine for treatment of pain during labor and delivery using patient-controlled epidural analgesia (PCEA).


METHODS
Prospective, double-blind, clinical investigation.


METHODS
University-affiliated hospital.


METHODS
226 ASA physical status I and II laboring patients.


METHODS
Patients were randomized to receive 0.125% bupivacaine with fentanyl (2 micro g.ml(-1)) or 0.125% bupivacaine with sufentanil (0.25 micro g.ml(-1)) through PCEA.


METHODS
Maternal analgesia assessed by visual analog scale was recorded before epidural block, 1 and 3 hours after epidural block, at full cervical dilation, and at delivery. Motor blockade assessed by Bromage scale was recorded at delivery.


RESULTS
Nine patients in group fentanyl, and 11 in group sufentanil were excluded from the study. Overall analgesia was good and no difference was observed between the two groups. Total boluses of 4 mL bupivacaine-opioid administered and the number of supplementary top-up injections of 5 mL 0.25% bupivacaine were similar in both groups. In group sufentanil, motor blockade and pruritus were significantly lower than in group fentanyl. Nausea was not recorded in any patients. Mode of delivery was similar in both groups, i.e., cesarean section, vacuum or forceps, or spontaneous vaginal delivery. No difference was observed in Apgar scores.


CONCLUSIONS
Sufentanil is preferable to fentanyl during bupivacaine PCEA as there is less incidence of motor blockade and pruritus.
Le Guen
H
H
Department of Anesthesiology and Surgical Intensive Care 2, Université de Rennes I, Rennes, France.
Roy
D
D
Branger
B
B
Ecoffey
C
C
D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects; D016362:Analgesia, Obstetrical / Q000009:adverse effects; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000009:adverse effects; D000779:Anesthetics, Local / Q000009:adverse effects; D002045:Bupivacaine / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000009:adverse effects; D006801:Humans; D010147:Pain Measurement; D011247:Pregnancy; D011446:Prospective Studies; D017409:Sufentanil / Q000009:adverse effects
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D017409:Sufentanil; D005283:Fentanyl; D002045:Bupivacaine