Small dose bupivacaine-fentanyl spinal analgesia combined with morphine for labor.
We investigated the duration of labor analgesia produced by a small dose of spinal bupivacaine/fentanyl alone or in combination with a small dose of morphine. Sixty parturients were enrolled in this placebo-controlled, double-blinded, randomized trial. All women received a spinal injection of 12.5 micro g of fentanyl with 2 mg of bupivacaine. The morphine group (MBF) also received 125 micro g of morphine; the placebo group (BF) received saline. Pain scores were <3 of 10 within 10 min of injection. The median duration of analgesia was similar between groups (89 min versus 84 min; P = not significant), and only 20% of the MBF group experienced prolonged analgesia. During subsequent epidural analgesia, the MBF group had a significantly lesser rate of breakthrough pain (0.15 +/- 0.14 episodes per hour versus 0.26 +/- 0.18 episodes per hour; P = 0.02). Also, during the first 24 h postpartum, the MBF group required significantly fewer medications (3.3 +/- 3.7 doses versus 4.7 +/- 3.5 doses; P = 0.04). Intrathecal injection of this small dose of bupivacaine/fentanyl produced a rapid onset of labor analgesia; the addition of a small dose of morphine did not significantly prolong analgesia, but it improved subsequent pain relief, as measured by the rate of breakthrough pain and postpartum medication requirements. This may provide a clinically useful means of improving intra- and postpartum pain relief.


CONCLUSIONS
A small dose of intrathecal fentanyl 12.5 micro g and bupivacaine 2 mg produces effective labor analgesia lasting for approximately 85 min. The addition of a small 125- micro g dose of morphine improves pain control during subsequent epidural analgesia and reduces the requirements for postpartum pain medications.
Hess
Philip E
PE
Department of Anesthesiology and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. phess@caregroup.harvard.edu
Vasudevan
Anasuya
A
Snowman
Caroline
C
Pratt
Stephen D
SD
D000328:Adult; D016362:Analgesia, Obstetrical; D000701:Analgesics, Opioid; D000775:Anesthesia, Spinal; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D002584:Cervix Uteri / Q000033:anatomy & histology / Q000502:physiology; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D015993:Life Tables; D009020:Morphine; D010146:Pain / Q000517:prevention & control; D010147:Pain Measurement / Q000187:drug effects; D011247:Pregnancy; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D009020:Morphine; D005283:Fentanyl; D002045:Bupivacaine