[The efficacy and safety of continuous epidural analgesia versus intradural-epidural analgesia during labor].
OBJECTIVE
To determine the efficacy and safety of intradural-epidural analgesia in comparison with continuous epidural analgesia during labor and childbirth.


METHODS
Forty-two women whose labor began spontaneously were enrolled and distributed randomly in two groups. The intradural-epidural analgesia group (IEA, n = 21) received 25 microgram of intradural fentanyl with 2.5 mg of isobaric bupivacaine with adrenalin, after which analgesia was maintained with epidural administration of one 8 mL bolus of 0.125% bupivacaine, followed by perfusion of a balanced concentration at a rate of 8 ml/h. Patients in the continuous epidural analgesia group (CEA, n = 21) were given 8 ml of 0.25% bupivacaine with adrenalin; the epidural perfusion of 0.125% bupivacaine and 1 microgram/ml of fentanyl was started at the same rate as in the IEA group. We recorded pain as assessed on a visual analog scale, extension of sensory and motor block, maternal hemodynamic constants, number of boluses of bupivacaine used, total doses of bupivacaine and oxytocin, instruments needed for childbirth, and side effects (pruritus, nausea and vomiting).


RESULTS
Analgesic efficacy during the first 30 minutes was greater in the IEA group. The total dose of bupivacaine, required top-up boluses, and the extension of sensory block at 30 minutes, one hour and two hours were also significantly less in the IEA group. The incidence of pruritus was higher in the IEA group. No significant differences were observed for other variables.


CONCLUSIONS
Intradural-epidural analgesia provides effective analgesia for labor, with rapid onset, reduced extension of sensory block, lower total doses of local anesthetics and few side effects.
Gómez
P
P
Servicio de Anestesiología y Reanimación. Hospital Universitario de Valme. Sevilla.
Echevarría
M
M
Calderón
J
J
Caba
F
F
Martínez
A
A
Rodríguez
R
R
D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D000762:Anesthesia Recovery Period; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D002585:Cesarean Section / Q000706:statistics & numerical data; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007231:Infant, Newborn; D007743:Labor, Obstetric / Q000187:drug effects; D009325:Nausea / Q000139:chemically induced; D010121:Oxytocin / Q000627:therapeutic use; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011446:Prospective Studies; D011537:Pruritus / Q000139:chemically induced; D012449:Safety; D016037:Single-Blind Method; D014839:Vomiting / Q000139:chemically induced
D010121:Oxytocin; D005283:Fentanyl; D002045:Bupivacaine; D004837:Epinephrine