title: Comparison of intrathecal levobupivacaine with and without fentanyl in combined spinal epidural for labor analgesia.
abstract: BACKGROUND
  The initiation of epidural infusion immediately after intrathecal (IT) injection to prolong labor analgesia has gained increasing popularity. The effect of additional intrathecal fentanyl on levobupivacaine for labor analgesia has not been fully investigated. We wished to determine if addition of IT fentanyl to IT levobupivacaine in combined spinal epidural (CSE) could prolong obstetric analgesia when epidural infusion is initiated promptly.
  
  
  METHODS
  In this randomized controlled trial, 40 nulliparous parturients in labor were recruited to receive either IT 2.5 mg levobupivacaine (L) or IT 2.5 mg levobupivacaine + 25 microg fentanyl (LF). A 10 ml/h epidural infusion of 0.125% levobupivacaine and 2 microg/ml fentanyl was immediately started. The proportion of parturients who delivered without breakthrough pain and the duration of analgesia were analyzed with the x2 test and Kaplan-Meier technique (using a log-rank test), respectively. Sensory block, motor block, pain scores, and post-block side effects were also evaluated.
  
  
  RESULTS
  The percentage of parturients with "successful" blocks, i.e. parturients not requiring further analgesic supplementation, was significantly higher in LF (87.5% vs. 44%, p<0.05). The duration of analgesia was also significantly longer in group LF (mean 530 min +/- SE65 vs. 361 +/- 66, p<0.05).
  
  
  CONCLUSIONS
  The addition of 25 microg intrathecal fentanyl to 2.5 mg levobupivacaine as part of CSE for labor analgesia decreased the incidence of labor breakthrough pain and resulted in a longer duration of labor pain relief. This may decrease the need for supplemental labor pain relief and the anesthetists' workload in the delivery suite.
authors.affiliation: Department of Anesthesia (O&G), KK Women's and Children's Hospital, Singapore, Singapore. yvel6@hotmail.com
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Lim
authors.forename: Alex T
authors.initials: AT
authors.lastname: Sia
authors.forename: Cecilia E
authors.initials: CE
authors.lastname: Ocampo
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007278:Injections, Spinal; D007747:Labor Stage, First; D000077554:Levobupivacaine; D010121:Oxytocin / Q000008:administration & dosage; D010147:Pain Measurement / Q000187:drug effects; D036801:Parturition; D017060:Patient Satisfaction; D011247:Pregnancy
chemical_list: D010121:Oxytocin; D000077554:Levobupivacaine; D005283:Fentanyl; D002045:Bupivacaine