Fetal heart rate abnormalities after regional analgesia for labor pain: the effect of intrathecal opioids.
OBJECTIVE
Intrathecal opioids used to relieve labor pain have been associated with uterine hyperactivity and nonreassuring fetal heart rate abnormalities. We retrospectively evaluated all charts of singleton, term, vertex-presenting parturients in active labor requesting neuraxial pain relief during a 1-year period for the occurrence of nonreassuring fetal heart rate tracings.


METHODS
Three different strategies to relieve labor pain were routinely used in our department: conventional epidural using 10 mL bupivacaine 0.125% and sufentanil 0.75 microg/mL; combined spinal and epidural (CSE) using intrathecal sufentanil (7.5 microg); and CSE using intrathecal bupivacaine (2.5 mg) and sufentanil (1.5 microg). Charts (n = 1,293) were evaluated for nonreassuring fetal heart tracings and uterine hyperactivity as well as for neonatal and labor outcome.


RESULTS
Intrathecal sufentanil (7.5 microg) produced significantly more nonreassuring tracings and uterine hyperactivity. However, this did not result in more cesarean deliveries or detrimental neonatal outcome.


CONCLUSIONS
Based on this retrospective analysis, we conclude that intrathecal sufentanil in a dose of 7.5 microg has the potential to result in more nonreassuring fetal heart rate tracings compared with both intrathecal analgesia using a bupivacaine (2.5 mg)/sufentanil (1.5 microg) mixture and epidural analgesia using bupivacaine, sufentanil, and epinephrine. Reg Anesth Pain Med 2001;26:257-262.
Van de Velde
M
M
Department of Anesthesiology, Katholieke Universiteit Leuven and University Hospitals Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium. marc.vandevelde@uz.kuleuven.ac.be
Vercauteren
M
M
Vandermeersch
E
E
D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D019162:Anesthetics, Combined / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage; D001034:Apgar Score; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D002045:Bupivacaine / Q000008:administration & dosage; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005315:Fetal Diseases / Q000139:chemically induced; D006340:Heart Rate, Fetal / Q000187:drug effects*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D011247:Pregnancy; D012189:Retrospective Studies; D017409:Sufentanil / Q000008:administration & dosage / Q000009:adverse effects*; D014590:Uterine Contraction / Q000187:drug effects
D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D017409:Sufentanil; D002045:Bupivacaine