title: Diluent volume for epidural fentanyl and its effect on analgesia in early labor.
abstract: Epidural fentanyl after a lidocaine and epinephrine test dose provides adequate analgesia and allows for ambulation during early labor. We designed the current study to determine the influence of the diluent volume of the epidural fentanyl bolus (e.g., whether it has an effect on the onset and duration of analgesia). Sixty laboring primigravid women received a 3-mL epidural test dose of lidocaine with epinephrine and then received a fentanyl 100- micro g bolus in either a 2-mL, 10-mL, or 20-mL volume. Pain scores and side effects were recorded for each patient. The onset of analgesia was similar in all three groups. The mean duration before re-dose was not significantly different in the 2-mL group (108 +/- 40 min), the 10-mL group (126 +/- 57 min), or the 20-mL group (126 +/- 41 min). No patient in any group experienced any detectable motor block; one patient (2-mL group) complained of mild knee weakness and was not allowed to ambulate. In early laboring patients, the volume in which 100 micro g of epidural fentanyl (after a lidocaine-epinephrine test dose) is administered does not affect the onset or duration of analgesia, nor does it affect the ability to ambulate.
  
  
  CONCLUSIONS
  In early laboring patients, the volume in which 100 micro g of epidural fentanyl (after a lidocaine-epinephrine test dose) is administered does not affect the onset or duration of ambulatory analgesia.
authors.affiliation: Department of Anesthesiology, Baystate Medical Center, Springfield, Massachusetts.
authors.forename: Neil Roy
authors.initials: NR
authors.lastname: Connelly
authors.forename: Robert K
authors.initials: RK
authors.lastname: Parker
authors.forename: Thomas
authors.initials: T
authors.lastname: Pedersen
authors.forename: Thenu
authors.initials: T
authors.lastname: Manikantan
authors.forename: Tanya
authors.initials: T
authors.lastname: Lucas
authors.forename: Stelian
authors.initials: S
authors.lastname: Serban
authors.forename: Mervat
authors.initials: M
authors.lastname: El-Mansouri
authors.forename: Scott
authors.initials: S
authors.lastname: DuBois
authors.forename: Edgar Delos
authors.initials: ED
authors.lastname: Santos
authors.forename: Asad
authors.initials: A
authors.lastname: Rizvi
authors.forename: Charles
authors.initials: C
authors.lastname: Gibson
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects; D016362:Analgesia, Obstetrical / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D000779:Anesthetics, Local; D002585:Cesarean Section; D036861:Delivery, Obstetric; D004837:Epinephrine; D005260:Female; D005283:Fentanyl / Q000009:adverse effects; D006801:Humans; D007747:Labor Stage, First; D008012:Lidocaine; D009407:Nerve Block; D010147:Pain Measurement; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011247:Pregnancy; D013997:Time Factors; D014662:Vasoconstrictor Agents
chemical_list: D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D005283:Fentanyl; D004837:Epinephrine