Reduced duration of intrathecal sufentanil analgesia in laboring cocaine users.
On the basis of our previous clinical experience, we hypothesized in this study that the duration and/or quality of labor analgesia produced by intrathecal sufentanil was less in cocaine-abusing parturients compared with nonabusing parturients. Ten micro g of sufentanil was given intrathecally as part of a combined spinal-epidural (CSE) technique to two groups of laboring parturients: 1). those whose urine tested positive for cocaine (cocaine group), and 2). those whose urine tested negative for cocaine (control group). The epidural catheter was not injected with local anesthetic until the patient requested additional pain relief. The time from injection of intrathecal sufentanil until patient request for additional pain relief was defined as duration of analgesia. Baseline visual analog pain score (VAPS) and cervical dilation were measured before the CSE was performed. After injection of intrathecal sufentanil, VAPS was recorded at specific intervals. Cervical dilation was again documented when the patient requested additional analgesia. We found that both groups reported high baseline VAPS and a marked decrease in VAPS after injection of sufentanil that did not differ between groups. Geometric mean duration of pain relief with adjustment for cervical dilation was 87 min in the cocaine group compared with 139 min in the control group (P = 0.019). All patients experienced itching. We conclude that intrathecal sufentanil produces a similar quality but shorter duration of analgesia in cocaine-abusing parturients compared with nonabusing parturients.


CONCLUSIONS
Intrathecal sufentanil administered as part of a combined spinal-epidural technique produces similar quality but reduced duration of labor analgesia in cocaine-abusing parturients compared with nonabusing parturients.
*Department of Anesthesiology, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia; the †Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; the ‡University of Kentucky College of Medicine, Lexington, Kentucky.
Vernon H
VH
Ross
Charles H
CH
Moore
Peter H
PH
Pan
Regina Y
RY
Fragneto
Robert L
RL
James
Gina B
GB
Justis
D000328:Adult; D016362:Analgesia, Obstetrical; D000701:Analgesics, Opioid; D001034:Apgar Score; D001724:Birth Weight; D002585:Cesarean Section; D019970:Cocaine-Related Disorders; D036861:Delivery, Obstetric; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D007231:Infant, Newborn; D007278:Injections, Spinal; D007743:Labor, Obstetric / Q000187:drug effects / Q000502:physiology; D010147:Pain Measurement / Q000187:drug effects; D011247:Pregnancy; D017409:Sufentanil; D014590:Uterine Contraction / Q000187:drug effects
D000701:Analgesics, Opioid; D017409:Sufentanil