title: Comparison of fentanyl and sufentanil in combination with bupivacaine for patient-controlled epidural analgesia during labor.
abstract: 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.
authors.affiliation: Department of Anesthesiology and Surgical Intensive Care 2, Université de Rennes I, Rennes, France.
authors.forename: H
authors.initials: H
authors.lastname: Le Guen
authors.forename: D
authors.initials: D
authors.lastname: Roy
authors.forename: B
authors.initials: B
authors.lastname: Branger
authors.forename: C
authors.initials: C
authors.lastname: Ecoffey
mesh_terms: 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
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D017409:Sufentanil; D005283:Fentanyl; D002045:Bupivacaine