Comparison of epidural lidocaine and fentanyl to intrathecal sufentanil for analgesia in early labour.
A randomized, double-blind study was undertaken comparing an epidural test dose of lidocaine followed by 100 microg fentanyl (E-LF, n = 19) to combined spinal epidural sufentanil 10 microg (CSE-S, n = 21) in low risk women in early labour. The primary outcome measured was the duration of analgesia; secondary outcomes included the quality of analgesia, incidence and severity of pruritus, lower limb motor blockade, and the ability to ambulate. A P < 0.05 was considered statistically significant. Baseline demographic characteristics, including parity, were similar between groups. CSE-S provided analgesia of longer duration than E-LF (126 +/- 61 min versus 83 +/- 37 min, P < 0.01). Visual analog scores (VAS) for pain were higher with E-LF throughout the study period (P < 0.05) although patients in both groups had clinically acceptable analgesia. The VAS for pruritus were higher in the CSE-S group (P < 0.05) but no patient requested treatment for pruritus. Mild motor weakness was more frequent in the E-LF group (5/19 versus 20/21, P < 0.05) and fewer patients in the E-LF group met criteria for ambulation (13/19 versus 20/21, P < 0.05). While both E-LF and CSE-S provide effective analgesia for women in early labour, the more rapid onset of analgesia, lower VAS pain scores, longer duration of action and lesser impact on ability to ambulate suggest advantages of CSE-S over E-LF.
Women's College Hospital, 76 Grenville Street, Toronto, Ontario, Canada M5S 1B2. breen003@mc.duke.edu
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Breen
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Giesinger
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Halpern