title: The addition of hydromorphone to epidural fentanyl does not affect analgesia in early labour.
abstract: OBJECTIVE
  Epidural fentanyl after a lidocaine and epinephrine test dose, provides adequate analgesia and allows for ambulation during early labour. The current study was designed to determine the influence of hydromorphone added to an epidural fentanyl bolus (e.g., whether there is an increase in duration of analgesia).
  
  
  METHODS
  Forty-four labouring primigravid women, at less than 5 cm cervical dilation, who requested epidural analgesia were enrolled in this randomized, double-blind study. After a 3 mL test dose of lidocaine with epinephrine, patients received fentanyl 100 microgram (in 10 mL volume). They randomly received the fentanyl with either saline or hydromorphone (300 microgram). After administration of the initial analgesic, pain scores and side effects were recorded for each patient at ten, 20, and 30 min, and every 30 min thereafter, by an observer blinded to the technique used.
  
  
  RESULTS
  The patients were taller in the hydromorphone group (P < 0.04). There were no other demographic differences between the two groups. The mean duration prior to re-dose was not significantly different in the group that received hydromorphone (135 +/- 52 min) compared to the control group (145 +/- 46 min). Side effects were similar between the two groups. No patient in either group experienced any detectable motor block.
  
  
  CONCLUSIONS
  In early labouring patients, the addition of hydromorphone (300 microgram) to epidural fentanyl (100 microgram after a lidocaine and epinephrine test dose) neither prolongs the duration of analgesia nor affects the ability to ambulate, and cannot be recommended according to the current study.
authors.affiliation: Department of Anesthesiology, Baystate Medical Center, Springfield, Massachusetts, USA.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Parker
authors.forename: Neil Roy
authors.initials: NR
authors.lastname: Connelly
authors.forename: Tanya
authors.initials: T
authors.lastname: Lucas
authors.forename: Uzma
authors.initials: U
authors.lastname: Faheem
authors.forename: Asad Syed
authors.initials: AS
authors.lastname: Rizvi
authors.forename: Mervat
authors.initials: M
authors.lastname: El-Mansouri
authors.forename: Nikhil
authors.initials: N
authors.lastname: Thakkar
authors.forename: Ramchander
authors.initials: R
authors.lastname: Kamasumadram
authors.forename: Kelly
authors.initials: K
authors.lastname: Dixon
authors.forename: Steven M
authors.initials: SM
authors.lastname: Dunn
authors.forename: Charles
authors.initials: C
authors.lastname: Gibson
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000701:Analgesics, Opioid; D001034:Apgar Score; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl; D006801:Humans; D004091:Hydromorphone; D009407:Nerve Block; D010147:Pain Measurement; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011247:Pregnancy
chemical_list: D000701:Analgesics, Opioid; D004091:Hydromorphone; D005283:Fentanyl