title: A randomised double-blind comparison of epidural fentanyl versus fentanyl and bupivicaine for pain relief in the second stage of labour.
abstract: OBJECTIVE
  To compare the effectiveness of two different methods for epidural analgesia in the second stage of labour-fentanyl alone versus the usual mixture of bupivicaine and fentanyl.
  
  
  METHODS
  A double-blind, randomised, controlled trial.
  
  
  METHODS
  An English maternity hospital.
  
  
  METHODS
  Eighty nulliparous women in the second stage of labour.
  
  
  METHODS
  After successful institution of epidural analgesia with a continuous infusion of bupivicaine/fentanyl mixture in the first stage of labour, the patients were randomised at full dilatation to receive either continuation of the same solution or a change to a fentanyl-only solution given at the same rate.
  
  
  METHODS
  Mode of delivery, duration of the second stage and quality of analgesia.
  
  
  RESULTS
  There was no difference in the number of instrumental deliveries (30%vs 27.5%) or the duration of the second stage (141 vs 147 minutes) between the bupivicaine/fentanyl and fentanyl groups, respectively. The bupivicaine/fentanyl group demonstrated a lower need for rescue epidural analgesia (1 vs 6, RR 0.2, 95% CI 0.02-1.3) and significantly fewer high pain scores (11 vs 20, RR 0.6, 95% CI 0.3-1.0).
  
  
  CONCLUSIONS
  Second stage epidural analgesia with fentanyl did not alter delivery outcomes or labour duration but resulted in poorer analgesia.
authors.affiliation: Department of Obstetrics and Gynaecology, Women and Children's Hospital, Hull Royal Infirmary, The University of Hull, Kingston upon Hull, UK.
authors.forename: S W
authors.initials: SW
authors.lastname: Lindow
authors.forename: A R
authors.initials: AR
authors.lastname: Dhillon
authors.forename: S W
authors.initials: SW
authors.lastname: Husaini
authors.forename: I F
authors.initials: IF
authors.lastname: Russell
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods; D016362:Analgesia, Obstetrical / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007748:Labor Stage, Second; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D010146:Pain / Q000517:prevention & control*; D011247:Pregnancy
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine